Report of AIDS Given by Woman to Man as Result of Oral Sex Met With Caution

In what is believed to be the first reported case of transmission of the AIDS virus from a woman to a man through oral sex, two physicians reported this week that a 60-year-old man appears to have developed AIDS as a result of oral sex with a prostitute.

But experts in AIDS transmission and epidemiology immediately raised reservations about the report, published as a brief letter to the New England Journal of Medicine. While such a case is theoretically possible, they said Tuesday that research suggests it is highly unlikely.

‘Unproven Report’

“In terms of relative risk, this is not what we consider a high-risk sexual activity,” said Dr. Robert Edelman, an AIDS researcher at the University of Maryland School of Medicine. “But if you want to be absolutely safe, you better know who your partner is.”

“This is not a study,” cautioned Dr. Constance Wofsy, co-director for AIDS activities at San Francisco General Hospital. “This is a single, observational, unproven report of a man who says he had sexual relations with a woman he thought used intravenous drugs.”

The New England Journal publishes about a dozen letters in each weekly issue, along with longer articles critiqued in advance by panels of so-called peer reviewers. The editor of the Journal could not be reached Tuesday to say whether letters are subject to similar review.

According to the letter, from physicians at the Lahey Clinic Medical Center in Burlington, Mass., the man reported no other activities that would have placed him at risk of infection. He reported no homosexual sex, no blood transfusions and no use of intravenous drugs.

The man, unidentified in the report, was living with his wife. But he said he and his wife had not had sex for many years. She is not infected with the human immunodeficiency virus, which causes AIDS. For several years, the man had been impotent--a condition attributed to his diabetes.

The man’s only extramarital affair, he said, had occurred during the two years before he was hospitalized with symptoms of AIDS. He said he had frequented one prostitute with whom, he said, he engaged only in oral sex.

On one occasion, the man said, he saw the woman inject herself with drugs--suggesting she was an intravenous drug user who might have become infected by sharing needles. The virus is transmitted through the exchange of body fluids through sex, transfusions and injections.

Health Education

“This case report suggests that oral sex alone can transmit HIV, even when there is no coincident exchange of blood,” Drs. Peter G. Spitzer and Neil J. Weiner wrote in the letter. The man did not recall having any exposure to the woman’s blood.

Spitzer and Weiner concluded that public health education about so-called safe sex practices should warn against exposure to body fluids not only in vaginal and rectal intercourse but also during other sexual practices, such as oral sex.

While numerous authorities on AIDS transmission agreed Tuesday with the advice in the letter, and said they had been offering it for years, they raised questions about the reliability of the report.

“To prove this case, you would have to have testing of the woman, and of the man before he met her,” Wofsy said. Also needed would be verification that he had not engaged in other risky activities that he did not acknowledge to his doctors, she said.

The virus has been found in saliva and semen, as well as in the vaginal and cervical secretions of infected women.

But it remains unclear under what conditions those fluids might be absorbed into a sexual partner’s blood stream, leaving them infected. One possible route might be through sores or breaks in the protective lining of the mouth--perhaps microscopic breaks left by biting or scraping one’s cheek or tongue.