ONE of the 20th century’s major poets, T.S Eliot, once said: “Only those who will risk going too far can possibly find out how far one can go.”

When it comes to sexually transmitted infections, taking risks and going too far may mean visits to the doctors for chlamydia or gonorrhea.

Although the infection and urethral discharge may seem troublesome, most individuals can get away as the problems can often be resolved, without much long-term consequences.

For some risk takers in sexual promiscuity, contracting viral infections such as herpes or HPV (Human Papilloma Virus) may not be cured with antibiotics.

However, the “inconvenience” of utilising antiviral medications during the outbreaks often seemed regrettable but acceptable for many “offenders” with calculated risks.

How high is the risk of transmission when engaging in sexual activities is often the subject of discussion in my clinic.

Patients want me to outline the exact risk of transmission with each mode of sexual contact, sadly, this is also with the reference to the ultimate price for contracting serious infections such as HIV.

In light of the awareness campaign of the World AIDS Day last Thursday, we address the issue of calculated risks for HIV infections.

Dear Dr G,

I read with interests your article last week on the issues regarding the reduction of risks of HIV transmission with a known HIV partner.

Of course, the sad reality is that when we engage in sexual activity for the first time, we often do not know the past sexual encounter of the partner. And of course, not knowing the HIV status of the person may potentially put us at risk.

I have met several sexual partners on casual occasions and foolishly engage in unprotected sex in the past.

I must admit the anxiety following the encounters were tremendous, and I hated the experience of uncertainty and fear, while waiting for the complete six months to ensure I did not contract HIV.

I must say I have been lucky that I have not contracted any sexually transmitted infections so far. But it would be helpful, if you can tell me what exactly are my risk of getting infected with HIV with each oral sex, vaginal or anal intercourse.

I think this will help me (and your other readers) to work out a “calculated risk” when considering “going too far”.



The likelihood of HIV transmission from a person with HIV to a HIV-negative individual depends on the mode of sexual activity.

The highest risk behavior that can transmit the virus is by unprotected anal sex, and the other risky mode of transmission include unprotected vaginal intercourse, needle sharing and vertical transmission from mother to babies.

The exact risk of HIV transmission is difficult to be outlined with different modes of sexual behaviours, as the viral load of the infected person is not always known.

On the other hand, the state of immunity of the HIV negative partner is also difficult to quantify.

However, clinical data is available to help individuals to work out exactly how risky is each encounter during sexual contacts.

Fellatio and cunnilingus (better known as oral sex) is the sexual act that involves one person kissing and licking the other person’s genital.

Clinicians all agree the risk of HIV infections is low, but it is definitely not risk-free. In fact, some studies actually quoted risks as high as 3%. HIV is not transmissible through saliva alone.

The risk of HIV transmission during oral sex depends on bodily fluid containing the virus (semen and vaginal secretion) transmitting into the blood stream of the HIV negative person with the presence of inflammation; cuts or sores in the oral cavity.

The scientific finding concluded the risk of an HIV man contracting the infection from a HIV positive person is very low, or near impossible.

There is also no documented case of someone being infected with HIV through receiving cunnilingus from a woman with HIV.

Globally, the most frequent route of transmission is unprotected vaginal intercourse.

There are differences in biological risks of viral acquisition for men and women, also high and low-income nations.

A woman is twice as likely to contract HIV from a viral-positive male partner, and in low-income countries, the transmission rates are higher and seems to be similar in both sexes.

The calculated risk of viral transmission to female having sex with HIV positive men is 0.08% (translated to 1 in 1,250) and risk to male with infected female is 0.04% (translated to 1 in 2,500). In low-income nations, the risk is 1 in 300 for both sexes.

Unprotected anal intercourse carries the highest risk of HIV transmission.

The virus is more likely to pass from a HIV-positive insertive partner to the receptive partner.

In a recent study in Australia, the accurate calculation of per-act-risk of receptive anal intercourse to both men and women is estimated to be 1.4%. This translates to 1 in 70 risk of contracting HIV.

When it comes to sex, it is human nature to take risk and be curious. Dr G’s advice is, “Never be reckless. It is often a decision we can consciously make, even in the heat of the sexual moment.”

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