Expert: Terry B - 6/10/2007

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 know that he is reckless with his sex life. he fingered me 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 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.
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: Dear Britt:

Peace to you.  I will attempt to share with you what I know and hope that this gives you what you need to answer your listed questions.

The challenges in calculating specific risk of HIV transmission for receptive cunnilingus (or for receptive fellatio) are great.  Experimentation would be dangerous, unethical, and nearly impossible; requiring a number of human subjects infected with HIV performed unprotected  cunnilingus only on persons who were not infected, then calculate the rate of transmission six months afterward.

Thus we look to retrospective studies of persons who have contracted HIV (often asking them for this information years later when they are diagnosed with AIDS) and try to isolate those cases where receiving unprotected oral sex is the only identified risk behavior.  This means eliminating any persons who performed intercourse during the period between their receptive oral sex and HIV positive test results.  As you might imagine, this is a small population from which to try to extrapolate information and project degree of risk for the general population.

Therefore it is reasonable that you cannot find clear and specific answers to your question although some opinions, based on the wider data on transmission and risk behaviors, have evidently been offered to you.

Blood, blood products, semen, vaginal secretions, and breast milk are the fluids identified as containing sufficient HIV to transmit the virus, one person to another, in a sexual encounter.  The amount of the fluid (as suggested by "visible blood") and the concentration of the virus in the fluid (highest at initial infection and late stage disease) are two important factors in determining whether an exposure becomes an infection in another person.  Another factor is the integrity (intact, not broken) of the skin and mucous membrane which is exposed to the fluid (why abrasions, infections, cuts and open sores increase risk) or another route such as injection directly into the bloodstream.  Yet other factors are frequency (how often exposed) and area (how much skin/mucousa are exposed).

Using the above information, you can estimate your risk of HIV transmission from a specific behavior.  In the course of my work I have rarely heard of persons who engage only in receptive oral sex all the time.  I am unaware of a "documented case" of transmission solely from receptive cunnilingus, though with the right combination of risks it seems possible.  Finding or not finding a single published case seems of less value than understanding transmission and risk.

You asked also about other sexually transmitted infections.  As you may know, HIV is not as easily transmitted as some of these.  You are at more significant risk of herpes, hepatitis, and other infections from the behavior you described.

I would recommend that you visit a trusted health professional and/or a counseling and testing center for a discussion with a face-to-face professional, testing, treatment if recommended, and advice on how to lower your risks.

I hope this helps.  I do wish you the best for your health and relief for your anxiety and fear.

Terry

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

QUESTION: oh i see. i heard receiving cunnilingus isn't a risk because you're only being exposed to saliva, is this true? that's all i've ever done.

Answer
Dear Britt:

Peace.  When I take the time to answer at length, please read carefully.  Your HIV risk is small from what I read of your situation; your risk of other sexually transmitted infections is much higher.  Please see someone for full testing and counseling.

Terry