Hi, Doctor. Not sure if I was asking for "too much" with my "follow-up" question. But if you could provide some insight, I very much would appreciate it.
Just in case I've bothered you, please accept my apology way in advance, Doctor.
Thank you for the response, Doctor.
I suppose some of my confusion results in not knowing "how" an insertive oral (person receiving oral sex) would get infected with HIV.
For example, we know that the inserter in vaginal sex can be infected IF his unprotected penis came into contact with infectious vaginal secretions as well as blood.
In addition, we know that if I perform cunnilingus on a woman, I could (although extremely unlikely) be infected via vaginal secretions or blood in my mouth.
In the case of "insertive oral," I have been literally brainstorming to figure out "how" the insertive partner can be HIV-infected. Thus far, the ONLY thing that I have been able to come up with is:
**a woman having blood in her mouth via bleeding gum, or dental surgery.
Since the woman giving the blow job is not going to have semen or vaginal secretions in her mouth, then I was only able to come up with the "blood scenario" above.
In addition, I tried to figure out ways in which saliva could be infectious. But I cannot figure out a way. It's not the saliva that would be infectious; rather it's blood (see above) in the saliva.
Basically is this the point that you have been trying to make: i.e., insertive oral is TRULY a near-zero risk, as shown by the example above??????
That's all, Doctor. Thank for the answers, and especially the advice abotu partner selection.
It's all relative: we do not ask or expect 100% success from other safety devices (people die in wrecks despite wearing seat belts) and it probably isn't wise for relationship development to be as rigid about sexual safety as your questions imply you might be. There is something to be said for spontaneous but caring sex that strikes a balance between safety, romance, and developing a relationship (most single persons' ultimate goal).
Condoms with every non-monogamous partner every time? Of course that's the official line and you can't go wrong from a safety perspective. But there are legitimate differences between commercial sex workers, bar pick-ups, and "church choir" members. In addition to condoms, one of the major sexual safety factors is choosing partners wisely, such as not paying for sex or hooking up with someone the same night you meet in a bar.
The risk of STD/HIV tranmission is very low for oral sex, especially cunnilingus, and I don't recommend barriers such as dental dams unless you know your partner actually is infected with HIV or another STD (or if the oral partner has a problem, such as an oral herpes outbreak). And in those cases of course you should avoid oral sex anyway.
You are right that the chance of transmission of HIV to the insertive partner in fellatio (to the guy receiving a BJ) is very low. On average, the people who post questions about it on this forum are more concerned than they need to be. Nothing has changed; the data have always indicated an extremely low risk of HIV transmission. There is some risk, however, for gonorrhea, herpes, and syphilis--but much lower than for vaginal or anal intercourse. Condoms lower the risk to zero. Most public health experts say condoms for fellatio are a good idea, but don't push too hard with this advice; it doesn't pass the "laugh test" for many sexually active persons.
Bottom lines: Choose your partners wisely (don't pay for sex, don't sleep with someone you juest met); for non-monogamous and casual relationships that you know aren't going to develop into romantic ones, use condoms for vaginal or anal sex, and for fellatio if you really want to--but otherwise don't worry so much about it. If you truly need 100% safety, you could cover up everything all the time. It just doesn't sound like much fun!
Good luck-- HHH, MD