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Small study says risk from oral sex is low

Men's Fitness, April, 2003

The chance of contracting HIV during oral intercourse may be lower than previously reported, according to a preliminary report published in the journal AIDS.

Current safer-sex guidelines indicate that oral sex without a condom is unsafe but low-risk. A recent study in San Francisco attributed as many as 8 percent of primary infections to fellatio, while a London study, published in the British Medical Journal, put the total at 6 percent. But early results from the new analysis documented no cases of HIV acquisition through orogenital contact, establishing an individual risk factor of zero.

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That doesn't mean oral sex poses zero risk. Because of the nature of the epidemic, the "population-attributable risk percentage" estimate is important, as even a low-risk exposure could result in a substantial proportion of infections.

In the new study, the PAR percentage is extremely low, rising as partners increased from one (0.18 percent) to two (0.25 percent) to three (0.31 percent). The cumulative risk for those with one to three partners would then be 0.74 percent.

THE STUDY GROUP

Subjects were chosen from an anonymous HIV-testing site in San Francisco. Of 10,283 clients, 413 (4 percent) were eligible, having reported active oral intercourse but no anal or vaginal sex within six months; nor had they injected drugs. Of those, 239 (2.3 percent) took part, all gay or bisexual men, with a median age of 39.

The median number of partners in the previous six months was three, with 98 percent of the encounters unprotected. Thirty-five percent of the subjects reported oral contact with semen, with 70 percent of them swallowing. Fellatio on a known HIV-positive partner was reported by 28 percent; of those, 81 percent did not use a condom, and 39 percent had swallowed ejaculate.

The results are based on a small, short-term sample, yet they mirror a longer look at heterosexual, HIV-mixed couples in Spain. Despite recording more than 19,000 unprotected orogenital exposures over 10 years, the Spanish study, also published in AIDS, found that no seroconversion attributable to oral sex occurred among the 135 HIV-negative partners.

COFACTORS

Current research cannot eliminate the chance that the probability of infection isn't higher. Additional factors--such as cuts, sores or inflammations in the mouth, the presence of other sexually transmitted diseases, the level of viral load, or the amount of pre-ejaculatory fluid--could conceivably contribute to orogenital HIV infection. Using a condom during oral sex also reduces the transmission risks of herpes, gonorrhea, chlamydia, syphilis, hepatitis B and the human papilloma virus.

Still, investigators point to "the striking difference in the risk of HIV between those who report exclusively fellatio and those who report higher-risk behaviors," particularly unprotected anal sex.

"If individuals believe that the risk of HIV from fellatio is high or on a par with well-documented high-risk exposures such as anogenital sex, they may not feel that sexual behavior choices make a difference," the authors conclude. "Acquiring HW through fellatio is significantly less [likely] than from anal sex, and therefore one's choice of sexual practices do matter."

CONDOM COMEBACKS

What to say when your partner doesn't want to use protection

The excuse:

"I read a study that said you probably don't need them for oral sex."

The response:

"Probably? Well, shut my mouth."

Small study says risk from oral sex is low

Men's Fitness, April, 2003

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