Expert: John Thai, M.D. - 6/9/2007

Question
QUESTION: hi there. there isn't alot of information on the internet regarding the risks a woman faces from receiving oral sex. everybody around me is telling me that my fears and not warranted and i have no reason to worry, however, i remain paranoid. im in desperate need of some medical advice. generally, my sex life has been very innocent because im well aware of the risks out there, however, this summer i had a few encounters. i received oral sex from a guy i didn't know very well. i do know that he is reckless with his sex life. he fingered me vigorously first and then performed oral sex on me. i felt him cut me with his fingernail while fingering me before he went down on me. i felt his teeth but i didn't see any visible blood in his mouth. his mouth was very moist and full of saliva. i DID NOT perform oral sex on him, i only received. two weeks later, i received oral sex from a guy friend on two separate occasions. he fingered me and performed oral sex on me. his dental hygiene wasn't great but i didn't see any visible blood in his mouth. i didn't think much of either encounter because i assumed it was fairly harmless. however, a month later i developed bronchitis and was very sick. this whole year, i haven't felt myself (chronic headaches, tingling in my feet and being very tired). i informed my gynecologist about my encounter and he told me that i was at no risk and to forget about it, however, i remained paranoid. he told me that no woman has ever contracted HIV from receiving cunnlingus. he said only giving oral is a documented risk. he stated that unless that guy had visible bleeding coming from his mouth that i shouldn't worry. this world is full of scare tactics and it's really hard to differentiate fact from fiction. i heard acquiring HIV from receiving cunnilingus is almost not possible. i would really like to finally put my fears at ease and get my life back but i am horrified. i truly regret what i did and still have nightmares about it. im suffering and your response would mean the world to me. i was also told that people who receive oral sex are concerned with the transmission of herpes rather than HIV. Are my fears warranted? I heard receiving oral sex is the same risk as french kissing because you're only being exposed to saliva? im absolutely terrified! please write back.


ANSWER: Hi Britt,

STI can be transmitted via oral sex. Vaginal fluids and seminal fluids are readily present. Thus, bacterial and fungal infections are the most common transmission in oral sex. Herpes are also very common, as well. The likelihood of transmitting HIV via oral sex is less than 0.05%. The only route via oral sex is if you have an open oral wound/lesion, poor dentition, poor gums with easy bleeding, etc that makes you susceptible to contract HIV. The female transmitting HIV may have recently menstruated the same day and remnants of blood in her vaginal opening. It is not recommended to floss immediately prior or after oral sex. It increases your risk of contracting HIV. Only the individual with poor dentition will have an increased risk of contracting an infection during oral sex versus the individual who is receiving it, unless there was a "gush" of blood entering the vaginal opening.

As far as testing, it takes approximately 6-12 weeks for HIV to be detected in the blood after initial contraction. Thus, you will need to get tested 3 months after your initial sexual encounter to determine if you have been infected.

Regards,

John T, MD

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

QUESTION: i was a little confused about what you said. you're saying that the one giving oral sex is at risk but the one receiving is only at risk if blood gushed into her vagina?

i have a couple of other questions that need clarification.

1) is it true there are no documented cases of HIV transmission from a woman receiving oral sex?

2) an HIV specialist told me that saliva inhibits HIV and thats why you can't get it from receiving oral sex, true?

3) this is personal and kind of embarassing but i'll tell you anyways. the night before i received cunnilingus i masturbated with an electric toothbrush. i had some vaginal abrasions and i have constant irration down there. i was told this doesn't matter because they weren't bleeding and fresh and that HIV doesn't infect small cuts on the outside of the vagina?

3) I hear im being irrational, is this true?

4) why do so many websites call receiving cunnilingus a risk?

5) based on risk do i need a test or is it just needed to help my anxiety?

thankyou so much!!

Answer
No. Both are at risks for sexually transmitted infections during oral sex. The person performing the oral sex (aka cunnilingus) is at a HIGHER risk of contracting an infection versus the individual receiving it.

1) is it true there are no documented cases of HIV transmission from a woman receiving oral sex?

Wrong. Female-female oral sex has not been documented to have a risk for STI (i.e. HIV). Male-female has been documented to have a risk of less than 0.05%.

2) an HIV specialist told me that saliva inhibits HIV and thats why you can't get it from receiving oral sex, true?

The saliva can inhibit HIV. However, swallowing of a male's ejaculate or ejaculate left behind in the mouth can increase your risk of an infection. Your risk INCREASES if you have poor dentition (i.e. gingivitis, mouth ulcers, etc).

3) this is personal and kind of embarassing but i'll tell you anyways. the night before i received cunnilingus i masturbated with an electric toothbrush. i had some vaginal abrasions and i have constant irration down there. i was told this doesn't matter because they weren't bleeding and fresh and that HIV doesn't infect small cuts on the outside of the vagina?

Wrong. HIV and other infectious agents can enter any open wounds.

3) I hear im being irrational, is this true?

No. I believe you are currently experimenting and trying to understand your body. It is better to voice your concerns with your physician rather than catching an STI. I highly recommend that you schedule an appointment with your gynecologist to discuss your concerns and any available options to protect you.

4) why do so many websites call receiving cunnilingus a risk?

Like I've stated before, it is a risk! You're "saliva" will not protect you from any STI. I recommend that you speak to your physician and/or gynecologist about different types of contraceptives, especially a female condom and a male confom for oral sex (aka cunnilingus)

5) based on risk do i need a test or is it just needed to help my anxiety?

You will always need to be tested once you become sexually active. The current recommendation is to have a complete STI screening once every 3 months, and earlier if you have symptoms. You can either go to you physician or a gynecologist or an STI clinic provided for free by your local public health department.

Regards,

John T, MD