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Risk of hiv transmission via precum in oral sex

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Dr.Strangelove:
Thanks for your detailed post.

I find myself coming to similar conclusions whereas in the past I've considered oral sex to be a near-zero risk.

I've seen all the studies and I am aware that most people in this particular forum do consider the risk for oral sex to be virtually zero.

But over time I have met quite a few poz guys and I'm always curious to hear their story. And there were a few that are absolutely sure they must have contracted HIV via oral sex, for example because they always used a condom for anal sex without exception and didn't have any condom breaks at the time. I have absolutely no reason to believe that they would lie about it (They are not ashamed to admit to have anal sex etc.) So, I start to wonder how safe oral sex actually is.
I know, these first-hand reports are anecdotal and the scientist in me wants to dismiss them and trust the studies but well I don't know...

I guess in many cases it's impossible to tell afterwards if the transmission happened through oral or vaginal/anal sex (unless the person really always used a condom for vaginal/anal sex and even in that case how can you trust selfreporting?).

My feeling is that with a very high viral load it is possible to transmit HIV orally even when the receiving partner does not have open sores or a meth mouth.

As someone who is undetectable though I am not concerned about passing it on to someone I have oral sex with.
 

Giancarlo:
Thanks too. I agree with everything you've written in your post.

I'd like to repeat the request that I made in my last post. My message was too long and the request was lost in the middle of it...
Could someone please give me the references of the 3 serodiscordant couples' studies that are mentioned in the previous messages? I'm sorry if the references are already available somewhere else.
Cheers.

jkinatl2:
Here's a bare bones search of AM I (I really need to get working on those cheat sheets before my current computer goes belly up again)


No incident HIV infections among MSM who practice exclusively oral sex.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WePpC2072)??Balls JE, Evans JL, Dilley J, Osmond D, Shiboski S, Shiboski C, Klausner J, McFarland W, Greenspan D, Page-Shafer K?University of California, San Francisco, San Francisco, United States

Oral transmission of HIV, reality or fiction? An update
J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

AIDS:  Volume 16(17)  22 November 2002  pp 2350-2352
Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan

Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:

Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117

Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.

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