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Author Topic: When is PEP Truly Needed? Confused.  (Read 5515 times)

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Offline prman1

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When is PEP Truly Needed? Confused.
« on: June 14, 2006, 02:51:17 PM »
What are some ways to lower the risk in giving oral sex to a man?  I know "most" men and women for that matter do not use condoms for oral sex.   However, I am always concerned about precum and the risk of it transmitting the virus.   I alway use a condom for anal - no question about it - and I have never had a condom break.  I also rim, which is know is very low risk for HIV (but not for other stds).  But you hear of so many people (gay men) aquiring HIV from oral sex and several state it was from pre-cum, which has concerned me. While I have givin oral in the past without a condom, I am willing to use a condom now as I never truly knew the risk was clearly out there.

I do have testing for stds every year and have been in a serodiscordant in the past - always protected sex (top with a condom here).  Just that dreaded precum question floats in my head.

Thanks everyone.  Ann is the bomb - very cool lady.  And Jonathan is one hot guy - I saw your personal page - very nice.

Offline jkinatl2

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Re: Oral Sex and pre-cum risks?
« Reply #1 on: June 14, 2006, 03:04:20 PM »
All available quantifiable data collected through serodiscordant study shows zero oral transmissions in monitored couples. Thats fellatio with swallowing. Some people claim to have gotten HIV through performing fellatio. To date, the data does not support this scenario, but to be conservative, we place performing fellatio as a low risk, but not a no risk situation.

Keeping a healthy mouth is important. No syphilis chancres, no cold sores, no open sores or cuts. Don't perform fellatio the day after a tooth extraction or serious dental work.

In the end, it's your call. If you wear a condom for penetrative vaginal/anal sex, and choose to perform unprotected oral sex, you are slashing your HIV risks to... well, some experts say zero, but absolutely close to zero at any rate.

You have to decide what level of risk you are comfortable with, and under what circumstances. I am uncomfortable saying it's zero risk, but with each study I read, and all the new data that comes pouring out, I grow less and less uncomfortable with that assessment.

Insofar as what people claim as their vector of infection, I submit that the plural of anecdote is not data. The three serodiscordant couple studies are quite compelling, and they mesh with what we know from simian and primate and lab studies to a degree that patient report post-infection NEVER did.

My vote will always be for the science, not the speculation.

Your vote is entirely up to you.

And.. thanks for the kind words :)

"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 Ann

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Re: Oral Sex and pre-cum risks?
« Reply #2 on: June 15, 2006, 04:36:09 AM »
pr, (I liked Bosra better!)

It always amazes me that people get so het up about getting hiv from oral but forget all about all the other sexually transmitted infections - you know, the ones that are much, much more easily transmitted and also MUCH more prevalent in the general population.

As Jonathan says, according to the quantifiable data, oral hiv transmission is very rare. On the other hand, oral gonorrhea and oral chlamydia are on the increase. Same for oral syphilis - the lips are the most common non-genital area for syphilis to turn up. These oral STIs are primarily transmitted from the penis to the mouth/throat. 

As oral STIs can often be present without symptoms - or a sore throat that is passed off as "nothing" (or worried about as ARS!) - many people don't realise they have one. The danger here is that under these conditions (untreated oral STI), hiv just might then become more of an oral danger. If you want to be able to give head with complete confidence, then make sure your oral health is tip-top. And that includes regular oral STI screening. It also means taking care of your mouth with regular brushing and visits to the dentist. It's pure common sense when you think about it.

Ann
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 prman1

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Re: Oral Sex and pre-cum risks?
« Reply #3 on: June 27, 2006, 07:53:17 PM »
Well, I have my yearly physical coming up and going to take the STD panel.   So I guess I am nervous and looking for some reassurance.  I was in a relationship for a few months with a man that was positive.  I was the top in the relationship and always wore condoms - lots of lube and didnt' have a condom break, tear, nada.  I did perform oral on him but never to ejaculation - and I rimmed him.   We broke up as he decided to move out of state.  since then I have been with a few other guys - one was positive - gave him oral and rimmed him, again no ejaculation.  I did get a terrible sore throat afterwards and swollen glands - about two weeks later, but it could have been a cold.  I also had a few other anal experiences all protected and and few other oral and rimming experiences.  I never had unprotected anal sex - never a condom break.  But the oral and rimming was unprotected and I am sure there was precum exposure.   

so there it is, any support or encourage would be great.   I have been dealing with some anxiety and depression lately, not sure why - but its gettomg worse so I am now on Paxil.   Also, having a some weird muscle things going on - shaky, tired legs and arms and fatigue.  Weird. Just hope its not related....I also run through all the sexual experiences in my head and think, hmmm....could precum of gotten in a cut in my mouth.  Awful.

From now on, condoms for oral (though my dating chances are going to be few) and no anal or rimming unless in a ltr.   Ann, your line "Use condoms for anal or vaginal intercourse and you will avoid hiv infection. It really is that simple"  has helped me more than you can imagine.   

Offline Andy Velez

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Re: Oral Sex and pre-cum risks?
« Reply #4 on: June 27, 2006, 08:55:54 PM »
Nothing you are reporting leads me to expect other than a negative HIV test result.

As others have mentioned there are other STDs out there, so since you're sexually active you should regularly have a full panel of STD tests done -- at least annually and every six months would be even better.

Good luck with your test. I expect you to come out of this ok.

Cheers,
Andy Velez

Offline Ann

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Re: Oral Sex and pre-cum risks?
« Reply #5 on: June 28, 2006, 04:51:14 AM »
pr,

Let us know when you get that negative result.

Those things you've been experiencing... if they came on after you started the Paxil, that could very well be the culprit. Ask your doctor.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...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 chaton

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Re: Oral Sex and pre-cum risks?
« Reply #6 on: June 28, 2006, 11:05:10 AM »
Re-posted in a new thread as requested by RapidRod
« Last Edit: June 28, 2006, 11:37:30 AM by chaton »

Offline RapidRod

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Re: Oral Sex and pre-cum risks?
« Reply #7 on: June 28, 2006, 11:12:13 AM »
You're correct, your post should not have been posted here. Put your post in YOUR OWN thread.

Offline prman1

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Re: Oral Sex and pre-cum risks?
« Reply #8 on: June 28, 2006, 11:42:45 AM »
The muscle aches came on before the Paxil, so hopefully, the Paxil will kick in.  I think I will stop looking on the internet for risk transmissions - it drives one nuts.   The oral has me a little wigged out.  I know oral can transmit the virus, but since I never have taken ejaculation in my mouth - the risk must be low.  Also, with the anal protected sex, I always check the condom afterwards - sometimes even putting water in them to see if they have holes.

From now on, condoms for oral - and no anal or rimming unless in a LTR after we both tested and test again after 3 months.

Offline prman1

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When is PEP Truly Needed? Confused.
« Reply #9 on: January 15, 2007, 07:29:44 PM »
Hi,

I have written a question or two on here in the past year and you all have been so helpful and great.   My question centers around PEP.  I have read on CDC site that anytime  infected fluids - semen, anal fluids, etc. comes in contact with your mouth PEP is recommended.   I am confused.  I always have protected anal sex- always - I pride myself in that - never a condom break or slip.  Thanks to Ann's condom link - I realized I am doing something right!  Thanks Ann! 

But I do give oral on occasion (never had ejaculation in my mouth) and Rim - If by chance precum or infected anal fluid got in my mouth should I have taken PEP?

I just wanted your opinions as I find the PEP advice from the CDC confusing.

Thanks!

Offline RapidRod

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Re: When is PEP Truly Needed? Confused.
« Reply #10 on: January 15, 2007, 07:31:07 PM »
Please keep all your questions and thoughts in your orginal thread.

Offline Ann

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Re: When is PEP Truly Needed? Confused.
« Reply #11 on: January 15, 2007, 07:45:19 PM »
pr,

I've merged your new thread into your original thread - where you should post all your additional thoughts or questions. It helps us to help you when you keep all your additional thoughts or questions in one thread.

If you need help finding your thread when you come here, click on the "Show own posts" link under your name in the left-hand column of any forum page.

Please also read through the Welcome Thread so you can familiarize yourself with our Forum Posting Guidelines. Thank you for your cooperation.

Personally, I would only recommend PEP to the receptive partner in unprotected intercourse. I would only recommend it for the insertive partner if their partner was known to be hiv positive. PEP is not something to be taken lightly.

If your situation doesn't fit what I just wrote, then that is a situation where I would not recommend PEP. A doctor's advice may vary. My opinion is based on what I know about transmission risks, as well as what it's like to take PEP.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...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 prman1

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Re: When is PEP Truly Needed? Confused.
« Reply #12 on: January 15, 2007, 07:58:12 PM »
Thank you, Ann.  I just wanted to confirm what I thought.  The CDC site scared me.   I don't have unprotected anal sex either as a top or bottom - I never had.

Thanks for your time.


Offline RapidRod

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Re: When is PEP Truly Needed? Confused.
« Reply #13 on: January 15, 2007, 08:06:48 PM »
You don't get infected by rimming and give head is so close to being nil that it wouldn't be considered by most doctors for recommendation of PEP.

Offline prman1

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Re: When is PEP Truly Needed? Confused.
« Reply #14 on: April 16, 2007, 08:52:41 PM »
not sure if I should post a new question here or not, but I thought I would play it safe and post here under my other post.

I am dating a new guy, he is hiv postive.  Great guy.  Well, I went with him to his doctor.  His cd4 is very good but his viral load is high.  He is not on meds.  In talking with his doctor about safe sex, she told us not only should I use a condom as a top (which I always have done my entire life), but that he should wear a female condom as well.  Both of us "wearing" condoms?   I asked if that was really needed and she said to play it safe, do it.  I then asked her opinion on oral sex and she said he can do it to me but I should only do it with him with a condom.  If I do it without one the risk would be classified as medium.  I don't take ejaculate in my mouth and won't.  But she said even precum contains concentrations of the virus and is as equal as having unprotected sex as a top.  Then asked about rimming him and she said the jury is out on whether the concetrations of the virus is in the anal fluid so don't do it.  Huh?

I am so confused now.  Is his Doctor, well, crazy?  I never heard this before and it really got me thinking.   I thought I was doing it right (condoms and lots of lube for anal sex, oral without ejaculation and rimming before we have anal or before fingering).   But maybe I am not.  She is generally pretty good and quite an expert.  But I wonder if she is right or not.   I would love to hear your thoughts.


Offline RapidRod

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Re: When is PEP Truly Needed? Confused.
« Reply #15 on: April 16, 2007, 09:17:06 PM »
Look for another doctor that knows what they are talking about. You were just told a bunch of hogwash.

Offline prman1

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Re: When is PEP Truly Needed? Confused.
« Reply #16 on: April 16, 2007, 09:29:48 PM »
I thought it was a bit over the top.  NEVER heard those things before.   Extreme a bit.  It's his doctor and he likes her.  AND, he wants to follow her advice.  So I a stuck.

Offline Ann

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Re: When is PEP Truly Needed? Confused.
« Reply #17 on: April 17, 2007, 06:26:44 AM »
pr,

Using two condoms, whether it is two condoms on the penis or a one on the penis and a female condom, is a recipe for disaster. Two condoms together will create friction - even with lube - and will quite possibly cause one or both to break. ONE condom with PLENTY of lube is ALL you need for anal. Make sure you read through the condom and lube links in my signature line for the CORRECT usage.

She is correct about him giving you a blowjob. No risk.

As for you giving him one, if your oral health is good, what you have been  doing is fine. It's up to you whether you use a condom or not.

The jury is NOT out where rimming is concerned. It is NOT  a risk for hiv infection. Intestinal bugs and parasites, yes. Hiv, no.

It sounds to me like his doctor isn't entirely comfortable with man on man sex.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...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 prman1

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Re: When is PEP Truly Needed? Confused.
« Reply #18 on: April 18, 2007, 08:56:17 PM »
Thanks.  I thought it was a bit much.   She rather scared the hell out of me as I am very safe with sex.   I tried condoms for oral, even flavored, but I simply can't get used to them, they make me gag.  So I will keep doing what I am doing as I have for 15 years!

 I thought her advice is wrong and I appreciate your comments.

Offline prman1

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Re: When is PEP Truly Needed? Confused.
« Reply #19 on: May 17, 2007, 07:52:46 PM »
I noticed on Doctor Gallant's website at John Hopkins that he states that oral sex without a condom is pretty risky.  I noticed he put it above insertive vaginal sex.   Then Dr. Bob puts it at minimal risk and Dr. H on medhelp puts it at very low risk.   I find it all confusing.  I tried condoms even flavored and I literally gag.   What ways can you reduce transmission of HIV without using a condom?   I rarely have cuts in my mouth and woundn't give oral with cuts..but I worry about possible fillings, etc.  I got the dentist every 6 months.

Thanks.  It seems oral sex is one those questions that gets asked a lot on here.


Offline Matty the Damned

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Re: When is PEP Truly Needed? Confused.
« Reply #20 on: May 17, 2007, 07:57:11 PM »
Dr Gallant is not correct. Yes I know that sounds like a big call.

Unprotected oral sex is at best a theoretical risk. There are no documented cases of the virus being transmitted in this way.

MtD

Offline RapidRod

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Re: When is PEP Truly Needed? Confused.
« Reply #21 on: May 17, 2007, 07:57:55 PM »
For you, don't have oral sex at all.

Offline Ann

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Re: When is PEP Truly Needed? Confused.
« Reply #22 on: May 18, 2007, 07:20:20 AM »
pr,

While transmission occuring during giving a blowjob is theoretical at best, you might feel more confident if you make sure your oral health is good and don't let them cum in your mouth.

There have been long-term studies of couples where one is positive and one is negative. In the couples who used condoms for anal or vaginal intercourse, but no barrier for oral activities, not one of the negative partners became infected with hiv. Not one. This shows us two things. One, condoms are very effective for the prevention of hiv transmission. Two, oral sex is a much lower risk than previously believed. We now have the evidence that oral sex is a theoretical transmission route. Theoretical means it doesn't happen in the real world - it rarely, if ever, happens outside the imaginations of paranoid people.

Ann


Condoms are a girl's best friend

Condom and Lube Info  



"...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

 


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