Question
Are there UK guidelines on oral sex?
20 November 2010. Related: All topics, HIV transmission.
Could you please show me official UK guideline that says receiving oral sex or insertive oral sex is not risk at all?
Answer
Guidelines are generally produced by medical organisations as a collection of current knowledge and best practice.
In this sense they are only ‘guidelines’ and don’t carry the official status that you are perhaps looking for.
This document from the British Association of Sexual Health and HIV (BASHH) on use of PEP may be useful for you.
UK National Guideline for the use of post-exposure prophylaxis for HIV following sexual exposure [published Int J STD & AIDS 2006]
These guidelines state that for the purpose of prescribing Post Exposure Prophylaxis (PEP), oral sex, even with an HIV-positive partner would not be seen as sufficiently high risk without ejaculation.
The risk for one man to give oral sex to another man (ie if you are giving another man a blow job) is quoted at from 0 to 0.04% (reference 13).
Although receptive oral sex perhaps accounts for 5% of HIV infections, these cases are usually explained by important co-factors:
- cuts or sores in the gums or mouth of the person giving oral sex (ie a route from infectious semen into the blood)
- very high viral load in the HIV-positive person (that makes cum or even pre-cum highly infectious compared to someone in chronic infection or who is on HIV treatment).
The risk for insertive oral sex (someone giving you a blow job) is likely to be zero because HIV is either not infectious in saliva or so unlikely to be infectious in sufficient quantities to efficiently be able to transmit. It is possible to invent potential risk situations – direct blood contact for example – but that is so remote from real life as to rarely have any practical relevance.
Please, before getting upset, or rude, take time to read the explanation above.
Saying that up to 5% of infections in gay men could be related to giving oral sex is not the same as saying the risk of giving oral sex is 5% per exposure.
Another example of this statistic is like saying that if 60% of new HIV diagnosis in the UK are in gay men, this doesn’t mean the risk of catching HIV next time two gay men have sex is 60%.
As I said above, one is a population risk and one is an estimate of a per-risk exposure.
I do not disagree with your rough figures or the interpretation in your last comment, and we base our information on this site on the same sources. However, the estimate of 0-0.04% is also based on very limited data and it is not much use in an individual situation. I think you may be underestimating this.
The reason it is not helpful – or at least can underestimate the risk in any single exposure between two real people – involves thinking about the other factors than might explain why HIV can be transmitted by giving oral sex.
The lower estimate – 0% – is easiest to talk about. Oral sex in general is low risk, and if you add the impact of undetectable viral load from a person who is on treatment, then millions of people every day globally have give oral sex to an HIV-positive person and do not catch HIV. Otherwise the rates of HIV in gay men would be considerably higher than they are. However, the risk in not zero, because I believe there is evidence to support the reports that some people have caught HIV when their only risk was giving oral sex.
The upper estimate of 0.04% is more complicated. It is probably derived from population studies and worked backwards – ie looking at risk factors reported by x number of people and their reported risk factors.
For some situations this upper risk must be much higher. So I disagree with your interpretation that it ‘includes all factors’. It will have been derived from a group of say 10,000 gay men who all give oral sex and 4 become HIV-positive. For those four people their risk factors will vary and include: having HIV positive partners, higher viral load, cut gums etc. If you then look at the risk of oral sex in all the partners fulfilling these criteria, the denominator of 10,000 will drop considerably, perhaps to 100, and the risk for people with those criteria now becomes 4%.
For example:
– if the HIV-positive person is in seroconversion, say with a viral load of 10,000,000 copies/mL, and
– the HIV-negative person has poor gum health, or recently brushed their teeth, or eaten a packet or crisps that scratched a gum etc, and
– the guy takes cum in his mouth
then the individual risk here could easily be 90% or 50% or 10% or 1% (I can’t say which because this level of detail doesn’t exist in the studies used for the guidelines), all of which are far higher than 0.04% for this individual single exposure. The risk would be higher still if there are other risk factor such as STIs (that have suppressed the HIV-negative mans immunity) or if the HIV-negative person is genetically more susceptible to HIV infection.
The upper limit of 0.04% doesn’t mean that this is the upper limit for any individual exposure.
The general risks behind HIV transmission is fairly well understood, but the estimated figures are not supported by very many studies. Very few of those studies allow for viral load for example which is probably the most significant risk factor for any for any mode or transmission, and none of them account for genetics.
Genetics is particularly important. Large population studies find strong associations between genetics and the risk of catching HIV. The same genetic changes also relate to how fast HIV progresses once someone becomes HIV-positive. See the report from a few years ago:
http://i-base.info/htb/7244
Just because we can’t test for genetics, doesn’t mean it is a factor that should not be considered.
HIV prevention guidelines and many of the community projects involved in prevention too often simplify transmission and miss aspects that are essential if people are to be able to make their own informed decisions about the risks they are happy to take. Someone who thinks their risk from giving oral sex is 0.04% (ie 4 in 10,000) for any act of oral sex is not getting accurate information.
Many people have fixed their ideas, particularly about oral sex, and have already decided what is right in a way that is black or white. The grey area is more complex, more interesting, and more relevant to broadening knowledge about transmission and empowering people to more confidently enjoy sex, whatever their HIV status.
Prevention information needs to talk about the range of these other risk factors.
Low risk from oral sex really doesn’t mean much. Neither does a range of 0-0.04% when you are deciding what risks you are happy with for you and your partners health, especially in circumstances where you may know very little about your partners health.
Dear Team,
You are giving totally false information to people.
If you give oral sex to a person, let’s make more clear for you, if you suck a person’s penis, the chance is 0-0.04% for the sucker.
If you receive oral sex, if a person sucks your penis, your risk is zero. That is because saliva is not infectious. Moreover, it inhibits HIV virus.
READ the PEP Guideline again. Or visit freedomhealth.com. Or aidsmeds.com. Or visit aids.ch (Switzerland HIV Ass.). Or visit Canada HIV Association. Or visit Australia HIV Association.
How do you give answers to questions while you do not have a basic idea on hiv transmission?
The risks from oral sex are based on different types of studies.
The comment from eak is mixing up two different type of statistic.
One is an estimate of single per exposure risk – ie 0 to 0.04 per exposure. The other, the 5% referred to in the next sentence, comes from epidemiological studies of infections and is an upper limit recognising that this could be a high estimate. It will be confounded by the fact that most people at risk through oral sex also have other higher risks from unprotected vaginal and anal sex.
The 5% risk has been reported in some cohorts of gay men by individuals who are certain that oral sex has their only risk factor.
We can only go on the scientific research that has been published. If you have data to support this statement then we would be very interested to read it. Thanks.
I am sorry but you are not right.
receptive oral sex risk is up to 0.04 that includes all co-factors.
5% is totally wrong information.