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Confused about oral

Question: 

Dear all,

I must say that I'm deeply confused based on what I've been reading here, on your helpline forum.

Regarding oral sex and mouth injuries, 90% of your answers are telling us that superficial cuts as bleeding gums are not deep fresh open cuts/wounds to be considered a transmission ports. The other 10% of the answers are suggesting bleeding gums as a good transmission port in the oral cavity. What to believe?

When I asked my question about performing fellatio, I was suggested to go and get tested since I had a mild bleeding gums inside my mouth.

So:

Bleeding gums need to be deep wounds and actively bleeding, like, gushing blood? What is it about? I really don't understand and I find it extremely confusing.

For HIV to enter the bloodstreem, there have to be deep, fresh gaping wounds - that's what I found out reading, as I mentioned before. But the answer of MY question wasn't like that.

Please explain to me.

All the best.

Answer: 

Hello and thank you for your inquiry.

We gather that you are looking for clarification about the risk of HIV acquisition when performing oral sex with bleeding gums.

We aim to provide accurate and specific answers to each individual query and/or situation using available online information and resources. At AIDS Vancouver, we categorize performing oral sex as a low risk activity. All of the practices assigned to this risk level present a potential for HIV transmission because they involve an exchange of body fluids. There have been a few reports of infection attributed to these activities (usually under certain identifiable conditions). Identifiable conditions would include sexually transmitted infections, open cuts and abrasions in the mouth or bleeding gums. In theory, bleeding gums can create an entry point for HIV and increase the risk of transmission.

There are a few documented cases where it appears that HIV was transmitted orally and those cases are attributed to ejaculation into the mouth. Saliva contains enzymes that break down the virus and the mucous membranes in the mouth are more protective than anal or vaginal tissue. (2) While the risk is low that you would acquire HIV in this manner, it is theoretically possible and that is why an HIV test was recommended.

According to the Centers for Disease Control and Prevention: In extremely rare cases, HIV has been transmitted by oral sex—putting the mouth on the penis (fellatio), vagina (cunnilingus), or anus (rimming). In general, there’s little to no risk of getting HIV from oral sex. But transmission of HIV, though extremely rare, is theoretically possible if an HIV-positive man ejaculates in his partner’s mouth during oral sex. (1)

When we talk about deep, fresh gaping wounds being necessary for HIV to enter the bloodstream, we are generally referring to surface skin wounds as opposed to wounds inside the oral cavity. In the case of skin wounds, the bodily fluid containing HIV has exposure to air before contacting the wound, which causes a rapid reduction in HIV concentration. (3) Unless the wound is fresh and still bleeding, the body has already sealed it, which would prevent the virus from entering your bloodstream.

Regards, AIDS Vancouver Helpline Volunteer, Dyson