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Author Topic: Conflicting Reports for HIV via Oral Vaginal Sex  (Read 1126 times)

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Offline rockin00

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Conflicting Reports for HIV via Oral Vaginal Sex
« on: July 11, 2013, 01:32:37 PM »
Hi there,

First I want to say this website and forum are an amazing resource. Second I searched many of your previous posts and I'm a bit confused. You're pretty adamant that a male CANNOT get HIV by performing oral sex on a women. However there is slightly conflicting information in your link in the welcome thread as well as the CDC here: http://www.cdc.gov/hiv/resources/qa/transmission.htm  and here: http://www.positive.org/Home/faq/oral.html

These sources mention that there is a possibility for HIV from oral-vaginal sex. I'm asking because it's been six days since I performed oral vaginal sex on a girl I met (who hasn't had sex in while by her own words) and I've been feeling weird symptoms ever since. Fatigue, diarrhea and a very stuffy semi sore throat. 

Are these other sources over hyping the risks? Also how soon after exposure would someone begin to feel HIV symptoms.

Thank you!

Offline RapidRod

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Re: Conflicting Reports for HIV via Oral Vaginal Sex
« Reply #1 on: July 11, 2013, 02:17:11 PM »
HIV is not transmitted by oral sex.

Offline jkinatl2

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Re: Conflicting Reports for HIV via Oral Vaginal Sex
« Reply #2 on: July 11, 2013, 02:27:29 PM »
The CDC also states that HIV can be spread through kissing, yet there are no documented cases of that.

We base our risk assessment on clinical data - something that aggregates (of which the CDC is one) simply haven't done.

Not sure what to tell you. The science is sound behind our risk assessment. Not only the clinical data based on the mechanism of HIV transmission, but also on the wealth of statistical data along with no fewer than three long-term studies that tracked serodiscordant couples.for three, five and ten years. The serodiscordant couples used condoms for penetrative anal and vaginal sex, but no barrier at all for oral sex.

All three studies show zero infections over 3,5, and 10 years.This is despite an estimated 19,000 unprotected exposures, of which an estimated 17,000 resulted in ejaculation into the receptive partner’s oral cavity. This despite a wide variety of medical situations, viral loads, and other variables.

source
J del Romero and others. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 2002; 16:1296-97.

Grulich AE, Prestage G et al. Oral sex as a risk factor for HIV: a review of Australian data, HARD Conference, Sydney, 2000.

Page-Shafer K et al. Risk of infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men. AIDS 16, 17, 2350 – 2352, 2002 (an abstract of both these studies is below).

Myself, I give more weight to first-tiered peer reviewed studies, preferably published, preferably repeated by independent researchers. Anecdotal cases are simply reports by doctors who may or may not have an intimate understanding or knowledge of their patient, and may or may not utilize the most rudimentary investigational techniques (such as interviewing the partner(s), repeat interviews, et al). Like I keep saying, the plural of anecdotwe is not data.

That isnt a "blanket" answer. It is a carefully considered response based on science, statistical analysis, and the cumulative investigation of this pandemic for about 25 years. Many doctors say many things. Many doctors put on gloves before they shake an HIV positive person's hand. Many doctors like getting published. Many doctors have given false or misleading information on the topic of HIV because infectious disease is a small portion of their body of knowledge - and you know what they say about a little knowledge - couple that with a big ego and you have people authoritatively spouting off about stuff they know a fraction about.

Continued in next post...
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline jkinatl2

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Re: Conflicting Reports for HIV via Oral Vaginal Sex
« Reply #3 on: July 11, 2013, 02:30:28 PM »

http://www.aegis.com/conferences/12wac/60770.html

Neutralizing effect of secretory IgA to HIV in parotid saliva of HIV-infected patients.

Int Conf AIDS 1998 Jun 28-Jul 3; 12:1142 (abstract no. 60770)

Moja P, Desgranges C, Pozzetto B, Lucht F, Genin C
Gimap University of St.-Etienene, France.

BACKGROUND: The aim of this study was to test S-IgA purified from secretions of HIV seropositive patients in a neutralization assay to determine whether specific S-I&A can protect from HIV infection.

CONCLUSION: These data demonstrate that secretory IgA, which is the predominant isotype in secretions, can inhibit HIVMN infection of MT4 cells. HIV neutralization has been carried out with CD4+ T cell line adapted virus strain as a standardized model system, but the use of mucosal autologous primary isolates in neutralization test would be useful to estimate the actual protective effect of these antibodies in each patient.


http://www.aegis.com/conferences/12wac/21143.html

Saliva neutralizes HIV-1 infection by displacing envelope gp120 from the virion.

Int Conf AIDS 1998 Jun 28-Jul 3; 12:267 (abstract no. 21143)

Malamud D, Nagashunmugan T, Friedman HM, Davis CA, Abrams WR
Dept. Biochemistry Univ. Penn Dental Med., Phila 19104-6003, USA.


BACKGROUND: Incubation of HIV-1 with human saliva decreases infectivity. This inhibition is specific for HIV-1, with no effect on adenovirus, HIV-2 or SIV and appears to work at the level of the virus rather than the host cell. We have now identified an active protein fraction and provide evidence that the mechanism of action involves stripping of gp120 from the virus.

CONCLUSION: The specific inhibition of HIV-1 infectivity by human submandibular saliva is associated with removal of gp120 from the virus. The active fraction contains several proteins, including two high molecular weight glycoproteins.

http://www.aegis.com/conferences/4croi/412.html

Mechanisms of anti-HIV-1 activity of human submandibular saliva.

Conf Retroviruses Opportunistic Infect 1997 Jan 22-26; 4th:140 (abstract no. 412)

Nagashunmugam T, Malamud D, Davis C, Friedman HM; University of Pennsylvania, Philadelphia, PA.

Human submandibular saliva contains factors that reduces HIV-1 infectivity in vitro. The mechanism of action of these salivary proteins is unknown. We asked if salivary proteins act at the level of the virus or, instead, on the host cell. Monoclonal antibodies were used to detect cell surface receptors (CD3, CD4, CD7, HLA-DR, LFA-1, and LFA2) on peripheral blood derived mononuclear cells (PBMCs) treated with media or saliva. Our results show that saliva did not block these receptors nor lower the intensity of detection. PBMCs pretreated with saliva showed no inhibition when subsequently infected with HIV-1HxB2. These results suggest that saliva does not exhibit anti-viral activity by modifying the host cell. Saliva did not block binding of gp120 to CD4 nor did it lyse the virus. Incubation of HIV with submandibular saliva did lead to viral aggregation. Virus-saliva aggregates were subjected to centrifugation on a 10-60% sucrose gradient, fractionated and assayed for p24 antigen. The HIV-saliva complex sediments at a higher density compared with virus alone. Analysis of the gradient fractions for gp120 shows that the env protein is displaced from the virion. These results suggest that one mechanism of salivary anti-HIV activity involves removal of gp120 thereby decreasing HIV infectivity. This work was supported by NIH grants DE09569 and RR00040.


COntinued in next post...
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline jkinatl2

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Re: Conflicting Reports for HIV via Oral Vaginal Sex
« Reply #4 on: July 11, 2013, 02:31:27 PM »

Here is an article from aegis:

The body has an arsenal of virus-fighting chemicals called defensins that inhabit the mucous membranes lining our various orifices -- mouth, nose, rectum, vagina, etc. These chemicals are called human beta-defensins (hBDs). The body normally only calls them into action when the cells lining the membranes (called epithelial cells) are injured.

The mouth, however -- perhaps because it's usually the first port of call for most foreign substances -- has a permanently high level of defensins, and researchers have found that this permanent state of "Amber alert" is stimulated by the presence of oral bacteria, which cause the mouth to secrete hBDs.

Researcher Dr. Aaron Weinberg of Case Western University in Cleveland, Ohio said: "In the mouth, [defensins] are permanently induced above baseline levels. We've discovered that there are certain organisms unique to the oral cavity that have the ability to induce them."

The high level of hBDs in the mouth mean that it is easy for the body to switch to "red alert" when it is invaded by a germ it doesn't recognize -- including HIV.

Dr. Weinberg's team found that oral epithelial cells secreted four to 78 times the normal amount of oral defensins when HIV was introduced into the test tube with them.

"These beta defensins, once induced, have anti-retroviral activity," Dr. Weinberg said. "HIV failed to infect these cells, even after five days of exposure. We have a hunch that the oral cavity is therefore uniquely resistant to HIV infectivity."

The defensins appear to work not by directly attacking HIV but by temporarily "locking the doors" the virus uses to get into cells -- they stop it attaching itself to the "co-receptor" molecule called CXCR4 that normally dots the surface of epithelial cells.

This discovery may explain why it is so difficult to get HIV orally. It may also point the way to inducing the same kind of immune response in other body cavities. Dr. Weinberg said: "If we can isolate the organisms from the oral cavity that induce beta-defensins ... and apply them to the susceptible sites, we can artificially induce hBDs to be produced under normal conditions, which would then prevent HIV infection."

The concept is similar to one already explored using genetically modified bacteria to secrete antiviral chemicals (see http://uk.gay.com/article/hiv/prevention/2154), but in this case the bacteria used would be ones that normally live in the body.

More links and abstracts:

http://archinte.ama-assn.org/cgi/content/abstract/159/3/303

Baron, S., Poast, J., Cloyd, M. W. (1999). Why Is HIV Rarely Transmitted by Oral Secretions?: Saliva Can Disrupt Orally Shed, Infected Leukocytes. Arch Intern Med 159: 303-310

Saliva Can Disrupt Orally Shed, Infected Leukocytes

Samuel Baron, MD; Joyce Poast, BS; Miles W. Cloyd, PhD


Arch Intern Med. 1999;159:303-310.

Background Oral transmission of human immunodeficiency virus (HIV) by the millions of HIV-infected individuals is a rare event, even when infected blood and exudate is present. Saliva of viremic individuals usually contains only noninfectious components of HIV indicating virus breakdown.

Objective To determine whether unknown HIV inhibitory mechanisms may explain the almost complete absence of infectious HIV in the saliva.

Methods Since most of the infectious HIV that is shed mucosally by asymptomatic individuals is found in, produced by, and transmitted by infected mononuclear leukocytes, we determined whether saliva, which is hypotonic, may disrupt these infected cells, thereby preventing virus multiplication and cell-to-cell transmission of HIV. Specifically, we measured (1) whether mononuclear leukocytes were lysed by saliva and (2) whether the lysis by saliva inhibits the multiplication of HIV and other viruses in infected leukocytes and other cells.

Results Saliva rapidly disrupted 90% or more of blood mononuclear leukocytes and other cultured cells. Concomitantly, there was a 10,000-fold or higher inhibition of the multiplication of HIV and surrogate viruses. Further experiments indicated that the cell disruption is due to the hypotonicity of saliva.

Conclusions Hypotonic disruption may be a major mechanism by which saliva kills infected mononuclear leukocytes and prevents their attachment to mucosal epithelial cells and production of infectious HIV, thereby preventing transmission. Implications for the known oral HIV transmission by milk and seminal fluid, as well as potential oral transmission to contacts and health care workers, are considered. This effective salivary defense may be applicable medically to interdict vaginal, rectal, and oral transmission of HIV by infected cells in seminal fluid or milk by the use of anticellular substances.

Continued in next post....
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline jkinatl2

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Re: Conflicting Reports for HIV via Oral Vaginal Sex
« Reply #5 on: July 11, 2013, 02:33:08 PM »

<< Typical studies of sexual behavior have been flawed in two important ways. First, there are many instances of biased sampling that limit the degree to which data can be generalized. Studies either focus upon only limited age groups (Oliver & Hyde, 1993), do not obtain random samples, or do not control for volunteer bias (Michael, Gagnon, Laumann, & Kolata, 1994). ...

The second typical flaw of sex research is that the majority of data is taken from self-reports of sexual behavior. Oliver & Hyde (1993) noted the prevalence of self-report studies of sexual behavior in their recent meta-analytic review. This is common practice in social research, where actual behaviors cannot be observed. However, the validity of self-reports must be questioned, especially if the information asked for is "sensitive, potentially incriminating, or embarrassing." (Akers, Massey, Clarke, & Lauer, 1983, p.234 ). Participants may perceive that they deviate from a social norm and may misrepresent their behavior so as to appear more like the norm (Akers, Massey, Clarke, & Lauer, 1983; Arkin & Lake, 1983; Campanelli, Dielman, & Shope, 1987; Cohen & Shotland, 1996; Gaes, Quigley-Fernandez, & Tedeschi, 1978; Hansen, Malotte, & Fielding, 1985). This makes data collected from self-report studies untrustworthy and has the secondary effect of perpetuating a false norm.
From: Gender Differences in Sexual Behavior
Examined Using a Bogus Pipeline
by Jason Marbutt
http://bespin.stwing.upenn.edu/~upsych/Perspectives/1999/marbutt.htm>>

<<nt J STD AIDS. 1995 Nov-Dec;6(6):392-8. Unique Identifier : AIDSLINE MED/96256039
Brody S

Abstract: To determine the truthfulness of patients' and research subjects' self-reports of their sexual and drug use histories in studies of human immunodeficiency virus (HIV) transmission and acquired immunodeficiency syndrome (AIDS) risk factors, studies of or pertinent to lying about AIDS risk factors were extracted from MEDLINE and PSYCLIT. The present paper describes normal and pathological motives for misrepresenting risk factors, and reviews the literature on such underreporting. There is much evidence for lying about anal intercourse and intravenous drug use risk factors, implying that the estimates of risk for vaginal transmission of HIV (particularly in Pattern-I industrialized countries) have been inflated. Research on HIV/AIDS behavioral risk factors must include sophisticated methods for the assessment of self-report validity, such as the use of behavioral markers, improved lie scales and interview methods, and physical methods.>>

You will note that almost every single article about oral sex refers mainly/only to receptive fellatio (sucking penis and swallowing semen). There is a dearth of study regarding the viability of cunnilincual transmission because such an event has yet to be conclusively quantified - and has been that way since the advent of the AIDS pandemic, when the lesbian community remained (and remains) almost entirely unaffected. Moreover, it was lesbians who took over then their gay male brethren became too tired, too sick, or too dead to continue caring for others.

Once you look outside the unreliable world of patient report after the fact, you will find that the clinical evidence agrees with the raw data; cunnilingus is not a viable risk for HIV transmission.

I have not even begun to go into the fact that the fluids encountered in cunnilingus are not infectious. They are lubricating fluids produces near the entrance to the vagina, by Bartholin's glands. These fluids are no more infectious than sweat or tears (read:not).

Infectious fluids in an HIV positive female are found near the cervix, in a thick mucosal material that does not migrate. This thick mucosa can only be encountered with an erect penis. And even then, only the glans and dendritic cells around an uncircumcised penis are vulnerable. That is also why it is exponentially more difficult for HIV to be transmitted from female to male.

I hope that this has made things more clear.


"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline rockin00

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Re: Conflicting Reports for HIV via Oral Vaginal Sex
« Reply #6 on: July 11, 2013, 02:49:19 PM »
Thank you so much for your detailed and informative reply. You calmed me down a whole lot. It's just sad that there are so many so called credible websites out there give out this misinformation and scare the heck out of us.

Thank you again for clarifying.

Offline Ann

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Re: Conflicting Reports for HIV via Oral Vaginal Sex
« Reply #7 on: July 11, 2013, 07:08:25 PM »
Rockin,

If you ask me, it's not just sad that so many websites and other sources of hiv information continue to publish outdated or just plain wrong misinformation about hiv, it's outright criminal. Hiv positive people have been incarcerated for engaging in activities that carry absolutely no risk. It's an institutionalised circle-jerk of fear and loathing, stigma and discrimination and the sooner someone puts an end to it, the better for us all. The only thing misinformation does is stops people from testing.

And speaking of testing, while you don't need to test specifically over oral sex, as a sexually active adult you should be having a FULL sexual health check up at least once a year. A woman doesn't have to be "promiscuous" or a sex worker to be hiv positive - I'm a poz woman and I was in a (turned out to be one-sided) monogamous relationship when I acquired my infection. I didn't know for four years either, so asking the woman (or man) you're with what their hiv status is is nothing more than an exercise in futility.

Here's what you need to know in order to avoid hiv infection:

You need to be using condoms for anal or vaginal intercourse, every time, no exceptions until such time as you are in a securely monogamous relationship where you have both tested for ALL sexually transmitted infections together.

To agree to have unprotected intercourse is to consent to the possibility of being infected with an STI. Sex without a condom lasts only a matter of minutes, but hiv is forever.

Have a look through the condom and lube links in my signature line so you can use condoms with confidence.

Anyone who is sexually active should be having a full sexual health care check-up, including but not limited to hiv testing, at least once a year and more often if unprotected intercourse occurs.

If you aren't already having regular, routine check-ups, now is the time to start. As long as you make sure condoms are being used for intercourse, you can fully expect your routine hiv tests to return with negative results.

Don't forget to always get checked for all the other sexually transmitted infections as well, because they are MUCH easier to transmit than hiv. Some of the other STIs can be present with no obvious symptoms, so the only way to know for sure is to test.

Use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection. It really is that simple!

Ann
Condoms are a girl's best friend

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