Expert: Terry B - 5/23/2008

Question
I am confused and I assume the medical community is a bit confused about this type of transmission because of the so many different answers.  It has always been assumed by the medical community that HIV transmission orally is possible. However, they cant seem to come up with a clear answer and that is scary.  My concern is being HIV positive and sucking a guy who is negative.  Can I transmit the virus?  Used to be that the answere was most porbably not, never a confirmed case even though it is thereotically possible. Now the CDC says YES it is via the pee slit.  But other sites currently say no it is highly highly unlikely....still no documented cases.  Is the CDC taking the high road and just flatly saying it will transmit from an HIV person by that person giving a bj to someone negative?  I hope they are just covering their bases and trying to take all risk away or have the suddenly seen many documented and proven cases?  Very concerned.  I hope I didnt give anyone hiv...because of bad information.

Answer
Dear Jerry:

Peace and all good things.  First, the CDC has always said that oral sex was unsafe, though less dangerous than anal or vaginal sex.  My training in 1991 included demonstration of how to slip a condom into one's mouth at an opportune time and slip it onto the (simulated) penis of the recipient.  Whether you choose to ignore the risk because it is 'theoretical' doesn't shift the responsibility to science.  Abstaining and consistent, correct condom use are the two most effective ways to prevent HIV transmission.

Regarding studies, let's address the confusion for a moment and why it is difficult to give you good clinical data.  

1) Most of what we know about HIV transmission is from reports; it is clearly unethical to set up a trial where various behaviors are monitored for whether they transmit HIV.  
2) I would guess that most people infected have more than one possible exposure; we would need isolate those who were only receptive in oral sex without other risk behaviors, a very small group.
3) Taking the above into consideration, a study WAS conducted that showed risk from oral sex:

http://www.cdc.gov/hiv/resources/factsheets/oralsexqa.htm

The above report reports that frequency of exposure is a factor; and I didn't go deep into the study to compare whether performing oral was riskier than receiving oral - but you may do so by searching at the 7th National Conference on Retroviruses and Opportunistic Infections, held January 30-February 2, 2000.

I hope this helps.  If you are going to be sexually active you need protect others from risk of infection; if you are giving head, you need to apply a condom to protect your partner; if you are receiving, the same.  

Best to you and yours,

Terry