Risk of insertive oral sex

[Glupav85]

Hello All,
I'm 36 years old, hetero man.

Today I had vaginal sex with a female prostitute. The vaginal intercourse was protected with a condom. I've actually ask her to replace the condom, just in case and fearing of HIV and other STI's, I've only inserted my penis several times in her.

Then I've asked her to suck me, again with the condom. However, before I finished I removed the condom and put once my penis into her mouth. Then I've finished on her tongue.

At the end she blowed the two used condoms and they were not broken.
Do you think that I might be at risk of HIV, hepatitis or other STI ?
Thank you in advance

[Jim Allen]

The vaginal intercourse was protected with a condom

At the end she blowed the two used condoms and they were not broken.

HIV can't transmit through an intact latex or polyurethane condom. If a condom fails during the act of intercourse it's obvious. There is no reason to be stressing about intercourse or testing for HIV outside of standard yearly routine as long as this obvious issue did not happen.

Testing the condom after intercourse could damage the condom, as it's not designed as a reusable (re-stressed) product and this could lead you to mistakenly think that the condom was damaged during sex, when in fact you actually caused the damage after the intercourse by trying to "test" it. In short, testing the condom yourself before or after use is not a reliable way to tell you anything.

Testing condoms is a step shy of paranoia if you ask me. Instead, use condoms correctly and consistently and test out of routine yearly.

However, before I finished I removed the condom and put once my penis into her mouth. Then I've finished on her tongue.

Receiving a blowjob lacks the basic conditions required for acquiring HIV. Thus it makes sense that after nearly 40 years of this pandemic in terms of BJ's, there hasn't been a single documented case of HIV transmission to an insertive partner (the person being "sucked"), and you will not be the world's first.

Do you think that I might be at risk of HIV, hepatitis or other STI ?

Well, the HIV question regarding the specific activities & encounter posted here I've answered above.

STI's is another question altogether, yes, you did have risks for other STI's from these activities. Just about any sexual contact comes with risks for certain STI's depending on how those STI's are transmitted. However, no need to panic or stress, just get tested out of routine at least yearly like every sexually active person should.

Here's what you need to know to avoid HIV infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions. Consider talking to your healthcare provider about PrEP as an additional layer of HIV protection

Keep in mind that some sexual practices described as ‘safe’ in terms of HIV might still pose a risk for transmission of other STI's, so please do get tested regularly and at least yearly for STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

Also, note that it is possible to have an STI and show no signs or symptoms and, the only way of knowing is by testing.

Kind regards

Jim

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[Glupav85]

Dear Jim,

Thank you very much for your detailed reply.

Although I can agree that this way of "testing the condoms" after the act is not right, luckily both condoms were balloon like after this test. Hope that anyway this is some indication that they were intact.

However, one questions still makes me thinking on the HIV risks. You mention that insertive oral is not a route of transmission. Does this apply also for hypotheses as (for instance) if the lady has some STI' s in her mouth ? Or if I have some sti bacteria ?

I've read some articles stating that presence of STI s in the mouth can increase the HIV risk. Does this apply both to receptive and insertive oral ?

Thank you in advance !

[Jim Allen]

Hiya,

Does this apply also for hypotheses as (for instance) if the lady has some STI' s in her mouth ? Or if I have some sti bacteria ?

Makes no difference in regards to receiving oral sex. It's no HIV risk to you whatsoever and you will not be the world's first.

As for giving a blowjob, the mouth generally lacks a route for HIV to infect, and even if it was damaged saliva also acts to neutralize HIV by damaging the receptors needed to infect human cells. Giving a blowjob is such a minute HIV risk that we don't even recommend testing outside of standard yearly routine screening for STI's & HIV as every sexually active adult should.

Relax, move on with your life, continue to use condoms for any intercourse and test yearly for HIV & STI's.

[Glupav85]

Jim,

They actually suggest that insertive oral sex is a documented case of HIV transmission.

Thanks

[Jim Allen]

Yes, I am aware, I'm not kept here for my wonderful personality.

How to explain ...

It's an anecdotal story you mentioned, not a fact and it is not a documented case. A lot has changed since the 1980s. The guy in the story you wanted to share acquired HIV in 89 and denies having any risks, he mentioned receiving a blowjob from a woman who was not contacted. Even at the time, the author should have known better than to write this letter.

Reminds me of a 1987 transmission wherein the author mentions that transmission was between partners who were both IV drug users, sleeping with each other without the usage of condoms and yet the author felt the kissing was the route

Thankfully, we moved away from relying on stories to understand the vectors of transmission.

Post-1994 era (Post HAART) we scientifically could confirm the biological requirements for the virus to infect, its lifecycle and the barriers to HIV infection. Transmission claims & nonsense hypothetical ideas from the 80's era like toothbrushes, toilet seats, sharing utensils, doorknobs, etc that were based on things like outdated misinformation, homophobia, stigma, fear and morals were disproven and stopped.

Since that time there have also had a number of long-term studies to help confirm true transmission vectors and the tools used to investigate claims and confirm transmission vectors claimed are more advanced. In short, since then it's become the most studied virus in the world.

You had no HIV risk from getting your penis sucked as it simply does not meet the biological conditions required for HIV to transmit to you. You will not be the world's first and stop looking at really outdated speculation. 

[Jim Allen]

If you want to do some light post-1990/1994 reading relevant to the subjects you have brought up I can help get you started.

2018
https://doi.org/10.1016/j.eclinm.2018.08.001

STI Risk Perception in the British Population and How It Relates to Sexual Behaviour and STI Healthcare Use: Findings From a Cross-sectional Survey (Natsal-3)

We have identified falsely optimistic views of personal STI risk among a substantial proportion of those at risk of STIs in the British population, which could have a negative impact on efforts to promote safe sex and STI testing, and the control of STIs.

Among those classed as having ‘unsafe sex’ in the past year (comprising approximately 1 in 5 sexually-active 16–44-year-olds), 39.2% of men and 51.0% of women rated themselves as not at all at risk of STIs

2018
https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(18)30062-6/fulltext

Non-disclosed men who have sex with men in UK HIV transmission networks: phylogenetic analysis of surveillance data

Jim: In short they analysed the genetic code of the virus from HIV-positive people and came to the conclusion that some of the self-reported heterosexual mens HIV was more than likely actually non-disclosed MSM.

2018
http://journals.sagepub.com/doi/abs/10.1177/0032885517753163

Underreporting in HIV-Related High-Risk Behaviors: Comparing the Results of Multiple Data Collection Methods in a Behavioral Survey of Prisoners in Iran

Participants reported more sexual contact in prison for their friends than they did for themselves. In men, NSU provided lower estimates than direct questioning, whereas in women NSU estimates were higher. Different data collection methods provide different estimates and collectively offer a more comprehensive picture of HIV-related risk behaviors in prisons.

2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268760/

Socially desirability response bias and other factors that may influence self-reports of substance use and HIV risk behaviors: A qualitative study of drug users in Vietnam

The accuracy of self-report data may be marred by a range of cognitive and motivational biases, including social desirability response bias

2018
http://emj.bmj.com/content/35/1/46
Self-perceived risk of STIs in a population-based study of Scandinavian women

Subjective perception of risk for STI was associated with women’s current risk-taking behaviours, indicating women generally are able to assess their risks for STIs. However, a considerable proportion of women with multiple new partners in the last 6 months and no condom use still considered themselves at no/low risk for STI.

2018
https://www.tandfonline.com/doi/abs/10.1080/09540121.2017.1384787

Social desirability bias and underreporting of HIV risk behaviors are significant challenges to the accurate evaluation of HIV prevention programs for orphans and vulnerable children (OVC) in sub-Saharan Africa

2017
https://www.ncbi.nlm.nih.gov/pubmed/28509997

Social Desirability Bias and Prevalence of Sexual HIV Risk Behaviors Among People Who Use Drugs in Baltimore, Maryland: Implications for Identifying Individuals Prone to Underreporting Sexual Risk Behaviors.

2017 --In regards to STI's
https://journals.lww.com/stdjournal/toc/2017/07000
Sexually Transmitted Diseases: July 2017 - Volume 44 - Issue 7 - p 390–392

Is Patient-Reported Exposure a Reliable Indicator for Anogenital Gonorrhea and Chlamydia Screening in Young Black Men Who Have Sex With Men?

Among 485 young black men who have sex with men recruited in Jackson, MS, 90-day anal sexual exposure significantly predicted rectal infection, but 19.4% of rectal infections would have been missed among men denying receptive anal sex. Reports of consistent condom use were associated with lower infection rates only in men reporting insertive anal sex.

2016
https://www.sciencedirect.com/science/article/pii/S0010782416305418
Could misreporting of condom use explain the observed association between injectable hormonal contraceptives and HIV acquisition risk?

Jim - Not a conclusive or in depth study but under the study participants it did find: 9 out of every 20 sex acts reported with condoms are actually unprotected

2013

Rollins School of Public Health, Emory University, and the Kensington Research Institute, Silver Spring, MD 20910, USA https://www.ncbi.nlm.nih.gov/pubmed/14655794

"At risk" women who think that they have no chance of getting HIV: self-assessed perceived risks.

more than one-half of the "no perceived risk of HIV" sample had engaged in at least one risky practice during the preceding year and more than one-quarter had engaged in at least two such behaviors


2009
The Validity of Teens’ and Young Adults’ Self-reported Condom Use
https://jamanetwork.com/journals/jamapediatrics/articlepdf/380711/poa80067_61_64.pdf

A significant degree of discordance between self-reports of consistent condom use and YcPCR positivity was observed. Several rival explanations for the observed discordance exist, including (1) teens and young adults inaccurately reported condom use; (2) teens and young adults used condoms consistently but
used them incorrectly, resulting in user error; and (3) teens and young adults responded with socially desirable answers

BMC Public Health 2007
https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-60

Analyses of data from the Demographic and Health Surveys, Sexual Behaviour Surveys and from other countries show a similar pattern indicating under-reporting
It is probable that as HIV campaigns encouraging delayed sexual debut and abstinence before marriage reach the population, people will report behaviour
assumed to be more socially desirable.

there are some signs of differential reporting bias in our study. We found that controlling for less risky sexual behaviour substantially reduced the association between HIV and survey time among urban men, but less so among women; this may suggest that self-reports from men about sexual behaviour are more reliable. Studies suggest that respondents, especially women, tend to under-report the number of lifetime sexual partners . Therefore, analyses of associations with, and changes in, self-reported sexual behaviour should be interpreted with caution.

2010
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957626/

Self-presentation bias (wishing to be viewed in a positive light) may result in patients underreporting behaviors they perceive to be stigmatizing

Approximately a third of the men in the sample reported that they did not disclose all of their risk behaviors to the HIV counselor during the face-to-face risk assessment. These results echo similar studies of risk disclosure to medical providers


J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

In total, almost 19,000 instances of unprotected oral sex were estimated to have occurred involving the 135 couples over the ten years of the study,
but not a single case of HIV transmission was detected. The study authors conclude that:

“this seems to point to a very low probability of HIV transmission related to this practice.”
Reference

Romero J et al. Evaluating the risk of HIV transmission through unprotected orogential sex. AIDS 16:9:1269-97, 2002.

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.

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.

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.

[Jim Allen]

Start with these, work your way forward, avoid the anecdotal survey stuff, and things from the 1980s.

Off-topic slightly but if you are still interested in more I would recommend reading up on the basic lifecycle of HIV within the body, it's interesting stuff.

Anyhow, I wish you well and hope this helps.

Take it easy.