Risk of HIV Infection Through Receptive Oral Sex (Panel Discussion), HIV InSite (2003)

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This is a transcript from a panel discussion of medical experts on HIV transmission risks associated with receptive oral sex, specific factors that may affect these risks, and advice for health care providers and public health officials on counseling people who have or are thinking of having oral sex. The panelists agree that although receptive fellatio (oral sex given by a person that is seronegative to a person that is seropositive) without ejaculation is an extremely low risk behavior with no undisputed case reports, the biological possibility of transmission remains. Studies regarding receptive fellatio with ejaculation show that transmission is definitely possible, with some reports of occurrence on record. However, in context, this is still considered a low-risk behavior, and there is strong possibility that these studies are flawed on account of inaccurate self-reporting of sexual behaviors. 

Studies on transmission through oral sex with ejaculation seem to point to a conversion rate of one in 2,500, or somewhere between one and 5 percent of all transmissions of HIV. This estimate is not concrete, and the ratio is relevant only to the extent that all variables are controlled. From a public health perspective, as rates of HIV transmission continue to rise in disenfranchised and marginalized communities, promotion of oral sex over other sexual behaviors could theoretically result in lower transmission rates. It is still worth noting that oral sex poses a high risk of STI transmission and that the presence of STIs may increase the risk of HIV transmission.