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Author Topic: Risk of hiv transmission via precum in oral sex  (Read 8375 times)

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Offline Newby7553

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Risk of hiv transmission via precum in oral sex
« on: September 23, 2013, 08:55:03 AM »
Hi , during July 2013 I had flu like symptoms which lasted about 2weeks. I was tested for HIV at the beginning of August and the result was positive, viral load 90,000 but a cd4 count of 760. I started treatment on 15 august , taking truvada and stocrin.

I have two questions ,

1)Assuming the drugs work how long does it usually take to reduce the viral load significantly ? My next blood test is mid October.

2) what is the risk of passing on HIV, at this stage of my infection, if my partner (hiv negative) gives me oral sex and gets small amounts of my precum in his mouth? I don't ejaculate and I am not not even close to ejaculating.

Offline jkinatl2

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Re: Risk of hiv transmission via precum in oral sex
« Reply #1 on: September 23, 2013, 03:43:06 PM »
Hi , during July 2013 I had flu like symptoms which lasted about 2weeks. I was tested for HIV at the beginning of August and the result was positive, viral load 90,000 but a cd4 count of 760. I started treatment on 15 august , taking truvada and stocrin.

I have two questions ,

1)Assuming the drugs work how long does it usually take to reduce the viral load significantly ? My next blood test is mid October.

2) what is the risk of passing on HIV, at this stage of my infection, if my partner (hiv negative) gives me oral sex and gets small amounts of my precum in his mouth? I don't ejaculate and I am not not even close to ejaculating.

The vlanket answer is: essentially zero.

Oral sex (particularly giving fellatio, which you are referencing) has been a hot topic for over a decade in HIV transmission theory.

Unless your partner's oral cavity has been compromised to an alarming degree (think, or Google "meth-mouth") his saliva contains over a dozen elements which render HIV inert and incapable of infecting. This is theoreticsal of course, since it has never been tested nor proven "in the wild."

There have been no fewer than three seeodiscrodant couples' studies performed from the mid-90's to mid 2000's. These studies involved hundreds of couples across two continents, with a wide range of medication choices and viral loads. These couples used condoms for penetrative anal and vsginal sex, but NO barrier protection for any form of oral sex.

And there were absolutely zero infections linked to oral sex. At all.

You really have nothing to worry about in that department. If your are on meds, then that's turning an essentially zero risk into as close to zero as medical science will allow.

If you wear a condom for anal sex you will avoid HIV.

As for how long before your viral load reaches undetectable, that depends on an awful lot of factors, including many dealing with your physiology. It is not unusual to see people drop to undetectable within a month or two. Others take longer.

However, even if the viral load is not undetectable at your firs tpost-med blood draw, it SHOULD have reduced DRAMATICALLY. Which, in my vernacular is more thsn significantly :)

"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

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Offline Jeff G

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Re: Risk of hiv transmission via precum in oral sex
« Reply #2 on: September 23, 2013, 04:26:59 PM »
Hi Newby . There is no need to post the same questions in multiple threads so I removed your other thread so you can discuss your concern in one place . Jk gave you some excellent advice to get started with . Thanks .   

Offline Newby7553

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Re: Risk of hiv transmission via precum in oral sex
« Reply #3 on: September 27, 2013, 04:57:13 AM »
Thanks for the helpful information, there are so many conflicting opinions on the Internet .......

Offline curious1here

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Re: Risk of hiv transmission via precum in oral sex
« Reply #4 on: September 29, 2013, 08:06:11 PM »
Like said above, if their mouth is health good as zero chance but if you have sores in your mouth, bleeds increases chances. Also want to mention in majority of men their semen is undetectable but in small percentage of men, it's still detectable even tho undetectable in their blood.

So even if someone is not on meds and have a high load, the chances are slim, but if someone is on meds much, much more difficult.

Offline Newby7553

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Undetectable viral load and risk of transmission
« Reply #5 on: October 21, 2013, 01:13:54 PM »
I have an undetectable viral load , what is the risk of passing hiv on if I have receptive anal sex with a non infected partner ( to put it more basically if I am fucked by a non infected partner)

Offline Jeff G

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Re: Undetectable viral load and risk of transmission
« Reply #6 on: October 21, 2013, 01:25:09 PM »
I have an undetectable viral load , what is the risk of passing hiv on if I have receptive anal sex with a non infected partner ( to put it more basically if I am fucked by a non infected partner)

There is no guarantee that a hiv positive person is indeed undetectable at any one time for various reason . This is why the decision to have unprotected intercourse should be carefully considered by both people who are going to be having unprotected sex .

If you are undetectable it greatly reduces the chance that you might transmit HIV its not zero risk due to other factors that may be present .

Offline Jeff G

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Re: Undetectable viral load and risk of transmission
« Reply #7 on: October 21, 2013, 01:59:42 PM »
All of your post are dealing with the same issue and you have been advised already in another thread on this subject . I merged your threads into one so that all of your thoughts and concerns about viral load and transmission and the replies are in one place .

Since this is something that you are struggling with I'm going to ask you again to not start multiple threads on the same subject . It will be helpful if you stay in one thread and elaborate a little more on how you are feeling and dealing with this issue .     
« Last Edit: October 21, 2013, 02:05:59 PM by Jeff G »

Offline Newby7553

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Re: Risk of hiv transmission via precum in oral sex
« Reply #8 on: November 05, 2013, 03:25:38 AM »
My viral load is <20 and my cd4 count is 775. I am taking truvada and stocrin meds.
I have no stds .

I have met a guy who is negative, who I have become close to, he is a pure top (only wants to receive oral and to fuck me) . I realise that I have to face up to telling him that I am HIV positive, but at this stage (we haven't had sex) haven't felt it appropriate or found the right moment to tell him.

He wants to have sex with me and I have told him that I will only have penetrative sex if he uses a condom which he is fine with.

Under these circumstances do I really need to tell him about my HIV status at this stage? I know that in a perfect world I should tell him , but if it just turns out to be a one night stand , so to speak, And we have had safe sex, is it really necessary to say given the very small risk of transmission.


Offline bocker3

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Re: Risk of hiv transmission via precum in oral sex
« Reply #9 on: November 05, 2013, 07:44:23 AM »
My viral load is <20 and my cd4 count is 775. I am taking truvada and stocrin meds.
I have no stds .

I have met a guy who is negative, who I have become close to, he is a pure top (only wants to receive oral and to fuck me) . I realise that I have to face up to telling him that I am HIV positive, but at this stage (we haven't had sex) haven't felt it appropriate or found the right moment to tell him.

He wants to have sex with me and I have told him that I will only have penetrative sex if he uses a condom which he is fine with.

Under these circumstances do I really need to tell him about my HIV status at this stage? I know that in a perfect world I should tell him , but if it just turns out to be a one night stand , so to speak, And we have had safe sex, is it really necessary to say given the very small risk of transmission.

Doesn't sound like a "one night stand" to me.  you said that you have become close, so it sounds like you two have made a connection.  If you have sex and don't tell him, it will only get harder to do so and you will likely cause it to become a single sexual encounter and slowly push him way.
Only you can decide what to do, but the fact that you are here asking tells me that you KNOW what you should do.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline LiveWithIt

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Re: Risk of hiv transmission via precum in oral sex
« Reply #10 on: November 07, 2013, 10:21:03 AM »
There has never been a documented case of oral transmission of HIV, and I"m sure out of the millions who have engaged in this that some of them have had lesions or abrasions  in their mouths and still no documented case. 
Pray God you can cope
I know you have a little life in you yet.
I know you have a lot of strength left.

Offline Giancarlo

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Re: Risk of hiv transmission via precum in oral sex
« Reply #11 on: November 15, 2013, 11:09:54 AM »
There has never been a documented case of oral transmission of HIV

How can you say that?
And how is that possible that no one has reacted yet after one week???
I was infected orally, and from what I read in many forums, I am far from being an isolated case. In fact, a French team found in a recent study that 25% of the patients enrolled in their study reported an oral transmission. I don't see any reason why they would be wrong. (The assumption that they would lie because they are too ashamed to acknowledge that they have had unprotected anal sex is really not convincing.)
http://journals.lww.com/jaids/Citation/2013/08150/Increasing_Frequency_of_Self_Reported_Orogenital.23.aspx

You call for "documented cases of oral transmission of HIV", but what would that be anyway? You put a guy in a room and make him suck poz guys for a few months without letting him go out of the room, and then test him?
Nov 2011: HIV-
Jul 2012: HIV+
Aug 2012: VL 8,900 / CD4 822 (28%)
Oct 2012: VL 13,500 / CD4 887 (30%)
Jul 2013: VL 9,000 / CD4 ?
Sep 2013: VL 24,000 / CD4 625 (34%)
Oct 11th 2013: Start Atripla
Nov 7th 2013: VL 84 / CD4 665 (37%)
Dec 11th 2013: VL UD (<40) / CD4 960 (35%)

Offline jkinatl2

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Re: Risk of hiv transmission via precum in oral sex
« Reply #12 on: November 15, 2013, 10:08:19 PM »
Yeah, once you move past the patient report (which is notoriously unreliable) the amount of HIV transmission documented from performing fellatio becomes less than negligible.

Which is why, in AM I INFECTED, we present performing fellatio as being a form of safer sex in all but the most outrageous circumstances (insertive partner with a huge viral load, receptive partner with "meth mouth" or similar slaiva-inhibiting situations not found in everyday life).

That, and the three serodiscordant couples' studies are the basis of the science we use to determine HIV risk on this controversial topic.


*edited to add: Yay! Shitstorm!

« Last Edit: November 15, 2013, 10:37:06 PM by jkinatl2 »
"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

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Offline Ann

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Re: Risk of hiv transmission via precum in oral sex
« Reply #13 on: November 16, 2013, 03:40:26 AM »
It's also very telling that there has never been a documented case of a woman who claimed to have been infected through a blowjob. There has also never been a case of a woman claiming a blowjob as their transmission route in patient disclosure studies.

Given that there are more women in the world who give blowjobs than there are men, and there are more women world-wide living with hiv than men, it makes men's claims of the blowjob route rather dubious.

"Documented case" means that the virus has been verified to have come from the claimed source.
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Giancarlo

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Re: Risk of hiv transmission via precum in oral sex
« Reply #14 on: November 18, 2013, 06:50:22 AM »
Well, I have to admit, all the things that you say are exactly the kind of arguments that really convinced me that I was playing safe in the last 10 years, even when I was frequently performing blowjobs to casual partners.
And now here I am, on a poz forum... :-\

Telling a girl, who is panicking after doing a single blowjob to a single heterosexual guy, that she is most probably safe, is one thing.
Telling an homosexual guy that he will never get into any kind of troubles if he gives blowjobs to many casual partners on a regular basis during 10 years or more, is another thing.
The first thing is true, the second is not. Stating that there has never been any documented case of oral transmission of HIV is misleading! I don't claim that the risk of oral transmission is as high as the risk of unprotected anal transmission. But I am sure that it is not negligible in a context of long-term frequent exposure. And I think that you don't need meth-mouth or open sores in your mouth or whatever for the oral transmission to occur, you just need a partner during his primary infection, or any untreated partner with a high viral load. I also believe that the risk of transmission is also increased by the presence of a pharyngeal infection (such as chlamydia or gonorrhea, or even a simple tonsillitis).
A partner during his primary infection is maybe "not found in everyday life", but it definitely can be found a few times in 10 years of a sexually active gay guy's life.

From what I have understood, oral transmission of HIV is not uncommon at all in MSM (at least it is very often reported), while it seems to be very rare (or very rarely reported) in heterosexual women. In any case, we have to understand why: why oral transmission is effectively more frequent in MSM, or why is it frequently (wrongly) reported in MSM and never (wrongly) reported in heterosexual women.
I can think of many reasons why oral transmission could be more frequent in MSM, but I don't see any reason why women would be less prone to wrong reporting of oral transmission than MSM.
Before going into more details, could you please give me the references of the 3 serodiscordant couples' studies that you refer to?

Now a few hints of why I think that oral transmission is not negligible in the MSM community (while it is negligible in the heterosexual community).
MSM statistically have more partners and the prevalence of HIV is higher. They also tend to do deeper blowjobs (deep throat) and the prevalence of other STI is also higher (for example pharyngeal chlamydia, which is increasingly common), which increases the risk of HIV transmission. It is also common practice in the MSM community to always use condoms for anal intercourse while never using any protection for blowjobs, so for many people it is quite easy to come to the conclusion that they were infected while doing a blowjob. In the heterosexual community, the occurrence of unprotected vaginal or anal sex is usually high so it is more difficult to rule out any other transmission route than oral sex. The effect of oral transmission is masked out because when both unprotected vaginal/anal and oral sex are reported, it is always assumed that the transmission was caused by the vaginal/anal sex.

Given that there are more women in the world who give blowjobs than there are men
This is true in the western world, where HIV prevalence is very low in the heterosexual community.

and there are more women world-wide living with hiv than men
This is true in the rest of the world. I am not convinced that blowjobs are a common sexual practice in, say, rural Africa, where the prevalence of HIV is very high in the heterosexual community. (Actually I have no idea, I don't mean to be offending here.)

"Documented case" means that the virus has been verified to have come from the claimed source.
Yes you can verify that the transmission occurred from patient A to patient B. But how can you verify that it was an oral transmission? You can only rely on self-reporting for that.

Hope to keep exchanging on this topic.
More on that later (when I have read the three studies that you mention).
Nov 2011: HIV-
Jul 2012: HIV+
Aug 2012: VL 8,900 / CD4 822 (28%)
Oct 2012: VL 13,500 / CD4 887 (30%)
Jul 2013: VL 9,000 / CD4 ?
Sep 2013: VL 24,000 / CD4 625 (34%)
Oct 11th 2013: Start Atripla
Nov 7th 2013: VL 84 / CD4 665 (37%)
Dec 11th 2013: VL UD (<40) / CD4 960 (35%)

Offline Dr.Strangelove

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Re: Risk of hiv transmission via precum in oral sex
« Reply #15 on: November 18, 2013, 08:45:15 AM »
Thanks for your detailed post.

I find myself coming to similar conclusions whereas in the past I've considered oral sex to be a near-zero risk.

I've seen all the studies and I am aware that most people in this particular forum do consider the risk for oral sex to be virtually zero.

But over time I have met quite a few poz guys and I'm always curious to hear their story. And there were a few that are absolutely sure they must have contracted HIV via oral sex, for example because they always used a condom for anal sex without exception and didn't have any condom breaks at the time. I have absolutely no reason to believe that they would lie about it (They are not ashamed to admit to have anal sex etc.) So, I start to wonder how safe oral sex actually is.
I know, these first-hand reports are anecdotal and the scientist in me wants to dismiss them and trust the studies but well I don't know...

I guess in many cases it's impossible to tell afterwards if the transmission happened through oral or vaginal/anal sex (unless the person really always used a condom for vaginal/anal sex and even in that case how can you trust selfreporting?).

My feeling is that with a very high viral load it is possible to transmit HIV orally even when the receiving partner does not have open sores or a meth mouth.

As someone who is undetectable though I am not concerned about passing it on to someone I have oral sex with.
 

Offline Giancarlo

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Re: Risk of hiv transmission via precum in oral sex
« Reply #16 on: November 20, 2013, 11:19:36 AM »
Thanks too. I agree with everything you've written in your post.

I'd like to repeat the request that I made in my last post. My message was too long and the request was lost in the middle of it...
Could someone please give me the references of the 3 serodiscordant couples' studies that are mentioned in the previous messages? I'm sorry if the references are already available somewhere else.
Cheers.
Nov 2011: HIV-
Jul 2012: HIV+
Aug 2012: VL 8,900 / CD4 822 (28%)
Oct 2012: VL 13,500 / CD4 887 (30%)
Jul 2013: VL 9,000 / CD4 ?
Sep 2013: VL 24,000 / CD4 625 (34%)
Oct 11th 2013: Start Atripla
Nov 7th 2013: VL 84 / CD4 665 (37%)
Dec 11th 2013: VL UD (<40) / CD4 960 (35%)

Offline jkinatl2

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Re: Risk of hiv transmission via precum in oral sex
« Reply #17 on: November 21, 2013, 12:52:05 AM »
Here's a bare bones search of AM I (I really need to get working on those cheat sheets before my current computer goes belly up again)


No incident HIV infections among MSM who practice exclusively oral sex.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WePpC2072)??Balls JE, Evans JL, Dilley J, Osmond D, Shiboski S, Shiboski C, Klausner J, McFarland W, Greenspan D, Page-Shafer K?University of California, San Francisco, San Francisco, United States

Oral transmission of HIV, reality or fiction? An update
J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

AIDS:  Volume 16(17)  22 November 2002  pp 2350-2352
Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan

Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:

Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117

Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.
"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

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