Expert: Terry B - 12/2/2008

Question
QUESTION: I am HIV + and my wife is not. My question is this, is there any risk involved with my performing oral sex on her? My reading indicates that there is not a risk unless there is blood present in my mouth at the time, does that mean blood like I just had oral surgery (tooth pulled etc.) or simply if I just flossed and noticed a bit of blood on the floss?

ANSWER: Dear Jim:

Peace.  

I seem to have done the same reading you have; the risk seems minimal except in the presence of blood, semen, or vaginal secretions.  I would be attentive to your oral health, however, and of course you can always use a latex barrier (I've also heard 'non microwave-able' wrap) to protect both of you.  Any blood is of some risk, of course, so save the flossing for afterwards?

Best to you and yours,

Terry
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To clarify, Jim, any blood presents some risk.  I think that's clear in the "Any blood is of some risk" part of my answer.  The more blood, the greater the risk.  There is risk to you as well any time there is a break in your skin or mucous membrane from other infections.  "Minimal" is because there are no absolutes if you are in direct contact with someone who is infected.  I hope that clarifies.  Best to you and yours,

Terry

---------- FOLLOW-UP ----------

QUESTION: I hope Im not dragging this out too long, I really appreciate the input. To be as clear as possible "no blood = no risk" yes or no. saliva poses no risk yes or no. when you say "minimal" are you referring to what is described as "negligible"...for instance the ONE case the CDC investigated in all these years of tracking HIV, where there was no other contact made aside from receiving oral sex from an HIV positive partner, and that partner also had bleeding gums. So in the 20+ years of investigating HIV transmission the CDC has found only 1 case where they determined receiving oral sex from an HIV positive partner was the LIKELY route of infection, and that case involved a HIV positive partner with bleeding gums.

Answer
Dear Jim:

Peace.  As a scientist, I struggle with any absolutes - and asking me for them time and time again just creates tension between us.  IF you could determine no blood cells in your mouth fluids, I could say no risk; saliva itself is no risk.  Blood in the presence of saliva is smaller risk than blood itself (saliva breaks down proteins, virii are essentially genetic material inside a protein coat).  Of the millions of HIV transmissions that occur, the CDC investigates only a small fraction - one 'proven' case could represent a much larger number of unproven cases.  In short, I can't provide for you what you seem to desire, a guarantee of safety in unprotected oral sex.

What might be more helpful is to talk in terms of probability.  The probability of passing HIV to your uninfected partner is remote but exists, perhaps a similar risk as being struck by lightning.  The difference is that you can reduce that risk further by using barrier protection - as would going inside during a storm.  Using your antiretroviral medications and maintaining an undetectable viral load would provide further protection.  

You need to make decisions about what risk is acceptable to you and your partner - I would suggest a discussion with her and review of the degree of risk.  That way it's a shared decision and you can make the decisions together instead of in the heat of passion.

The best to you and yours,

Terry