HIV Digest	HIV Digest Archive

Since HIV was identified as being sexually transmitted, there has been considerable interest in the risk associated with performing fellatio. Although early studies found no independent risk for fellatio, the high correlation among multiple sexual practices raised the possibility that risk existed but could not be detected. Subsequently, case reports accumulated, largely among men who denied other risk behaviors. Researchers acknowledged that fellatio, although not an efficient route of infection, nonetheless appeared to carry a small risk. Current safe sex guidelines specify that unprotected orogenital sex is unsafe but low risk.

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But preliminary results from an ongoing study investigating orally acquired HIV infection demonstrate that HIV-infection from oral sex is extremely rare.

From December 1999 to 2001, individuals seeking HIV testing at an anonymous testing site in San Francisco were screened to identify those who in the past six months reported no anal or vaginal sex, had not injected drugs, and had performed fellatio on at least one male partner. Eligible participants completed a pre-HIV test survey, measuring a six-month history of sexual practices. Post-interview HIV serology was conducted to determine participants' HIV serology. Of 10,283 anonymous testing site clients, 413 (four percent) were eligible, and 243 (2.3 percent) participated. Of those, 239 (98 percent) were men, whose median age was 39 years, and all were MSM. Four women were dropped from the analysis.

No recently acquired HIV infections were detected and the estimated probability of orally acquired HIV was zero. The median number of fellatio partners in the past six months was three, almost all (98 percent) were unprotected. One-third (35 percent) reported getting semen in their mouth, and of those, 70 percent swallowed it. 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.

"These data confirm that the risk of HIV infection attributable to fellatio among MSM and in the MSM population is especially low," the study authors conclude. "It is important that health professionals, including HIV counselors have valid information to impart to their sexually active clients. 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. Acquiring HIV through fellatio is significantly less risky than from anal sex, and therefore one's choice of sexual practices do matter."

Editor's Note: from AIDS