1 Oral Q’s & A’s/E040, May 2003

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Many persons have inquired about the results of a study presented as a poster at

the National Conference on Retroviruses and Opportunistic Infections, held

January 30-February 2, 2000. The following questions and answers contain more

specific information about the presented study results.

Question: What is this study about?

Answer: This study, one component of a primary and recent HIV infection

study called the Options Project, is funded by the Centers for

Disease Control and Prevention (CDC) at the University of

California, San Francisco. The purpose of this particular study was

to ascertain the extent of HIV transmitted by oral sex among men

who have sex with men who were identified with HIV within 12

months of becoming infected.

Question: Hasn’t oral sex already been identified as a

method of transmitting HIV?

Answer: Yes.However, this is the most definitive study to date. Earlier

studies have been published. (See a bibliography at the end of

these questions/answers.)

Question: What is the risk of HIV transmission from

oral sex?

Answer: The likelihood of transmission of HIV from an infected person to

an uninfected person varies significantly depending on the type of

exposure or contact involved. The risk of becoming infected with

HIV through unprotected (without a condom) oral sex is lower

than that of unprotected anal or vaginal sex. However, even a

lower risk activity can become an important way people get

infected if it is done often enough. The Options Project found that

7.8% (8 of 102) of recently infected men who have sex with men

in San Francisco were probably infected through oral sex. Most

of these men believed that the risk was minimal or non-existent.

Primary HIV Infection

Associated with Oral

Transmission

HIV

Prevention
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Question: What are the exact ways that HIV was transmitted in this study?

Answer: Nearly half (3 of 8) of these cases reported oral problems, including occasional bleeding gums.

Almost all (7 of 8) of these men reported to have had oral contact with pre-semen or semen.

Question: How do you know if the study participants were telling the truth

about their sexual history?

Answer: Oral transmission of HIV is very difficult to single out as the only way that HIV is transmitted

because few people engage exclusively in oral sex. A number of specific questions were asked

by a trained evaluator. The participants’ risk behaviors were assessed by using clinical interviews, counselor intervention, epidemiologic interview, partner interview when possible, and

final disposition of transmission risk. Of the 8 cases, 4 reported protected anal intercourse,

without the condom breaking, with persons who were either HIV infected or had an unknown

serostatus. Men in this study who reported that they were uncertain if the condom was used

properly were eliminated from this study.

Question: Was this a surprise finding?

Answer: Yes and No. The risk of oral sex transmission (8%) in this study is higher than many researchers

had previously thought or found in other studies. More media attention appeared to be placed

on this particular study, probably because of the higher number of study participants. There

appears to be evidence that higher risk activities (anal sex) among men who have sex with men

is decreasing while lower risk activities (oral sex) among these men is increasing. Oral sex has

always been considered a lower risk activity but is certainly not risk free.

Question: What can be done to prevent HIV?

Answer: The study results emphasize that any type of sexual activity with an infected person is a risk of

HIV transmission. Oral sex with someone who is infected with HIV is certainly not risk free.

Prevention of HIV is more important than ever. Some persons have indicated that they are less

concerned about HIV because of new treatments and are being less careful. This study presents

a wake-up call to everyone – that HIV is far from over and remains a serious, lifelong disease

that is best to prevent. The surest way to avoid transmission of sexually transmitted diseases is

to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship

with a partner who has been tested and you know is uninfected. For persons whose sexual

behaviors place them at risk for STDs, correct and consistent use of the male latex condom can

reduce the risk of STD transmission. However, no protective method is 100 percent effective,

and condom use cannot guarantee absolute protection against any STD.

Question: Where can I get more information about transmission and

prevention of HIV?

Answer: CDC operates a toll-free, confidential National STD/AIDS Hotline which can assist callers with

these types of concerns. The English service (24 hours a day, 7 days a week) can be reached

by calling 1-800-342-2437 or 1-800-227-8922; Spanish (8:00 a.m. to 2:00 a.m. ET, 7 days a
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week) is 1-800-344-7432 and TTY service for Deaf and Hard of Hearing (10:00 a.m. to 10:00

p.m. ET, Monday-Friday) is 1-800-243-7889.

Bibliography:

Berrey M, Shea T. Oral sex HIV transmission (letter). J AIDS 1997; 475.

Bratt GA, Berglund T, Glantzberg BL, Albert J, Sandstrom E. Two cases of oral to genital HIV-1 transmission.

Intl J STD & AIDS 1997; 8:522-525.

Clifford L. HIV seroconversion and oral intercourse. AJPH 1991;81:698.

Edwards SK, White C. HIV seroconversion illness after orogenital contact with successful contact tracing.

International Journal of STD & AIDS. 1995; 6:50-51

Keet PM, Albrecht Van Lent IV, Sandfort TG, Coutinho RA, Van Griensven GJ. Orogenital sex and the

transmission of HIV among homosexual men. AIDS 1992;6:223-226.

(9 cases in a cohort of 102)

Lifson AR, O’Malley PM, Hessol NA, Buchbinder SP, Cannon L, Rutherford GW. HIV seroconversion in two

homosexual mean after receptive oral intercourse with ejaculation. AJPH 1991;80:1509-1510.

Quarto C, Germinario C, Troiano T, Fontana A, Barbuti S. HIV transmission by fellatio (letter). Europ J

Epidemiol 1990;9:339-340

(heterosexual female to male oral transmission)

Robinson ED, Evans BGl. Oral sex and HIV transmission. AIDS 1999;16(6):737-8.

Schacker T, Collier AC, Hughes J, Shea T, Corey L. Clinical and epidemiologic features of primary HIV

infection. Ann Intern Med 1996;125:256-264.

(4 cases in a cohort of 46 reported only oral risk)

Spitzer P, Weiner NJ. Transmission of HIV infection from a woman to a man by oral sex (letter). N Engl J

Med 1989;320:251.

CDC National STD and

AIDS Hotline:

English: 1-800-342-AIDS

Spanish: 1-800-344-SIDA

Deaf: 1-800-243-7889

For more information...

CDC National Prevention

Information Network:

P.O. Box 6003

Rockville, Maryland 20849-6003

1-800-458-5231

Internet Resources:

DHAP: http://www.cdc.gov/hiv

NPIN: http://www.cdcnpin.org