POZ Community Forums
HIV Prevention and Testing => Do I Have HIV? => Topic started by: Question on June 08, 2006, 01:00:51 pm
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Is Oral Really Rare? In the study conducted that one is pos and neg no one got infected. The one conducting study are they really sure that in those study that no one uses condom for oral sex?
Why do some male reports that they got it from oral sex? But I havent read a female that says she got it from doing felatio?
Why is a male doing cunnilingus not risky? isnt it the same with doing felatio?
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Question,
It wasn't just one study, it was three and they were all conducted over many years. The longest one lasted ten years. They all had the same exact findings as well. The people who took part in the studies answered extensive questions concerning their sex lives and they were followed up frequently.
Some people will report that they "must have" gotten infected through giving blowjobs because they don't want to admit to or don't remember (drink, drugs, whatever) having unprotected anal intercourse.
Going down on a woman is totally different than giving a blowjob because the anatomy is different. The sperm of an hiv positive man is likely to contain hiv. However, the infectious sexual fluids that a woman produces are high up inside the vagina, in the thick mucus that surrounds and protects the cervix. It is unlikely for a tongue or mouth to come in contact with this cervicovaginal fluid.
Is there some specific reason you are asking these questions? We might be able to help you further if you tell us what's on your mind.
Ann
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I had protected sex. But thinking if oral is really rare. Because I read in the Living with Hiv Forum some said they got it from doing oral. So Im just confuse.
So the serodiscordant study took 10 years and no one got infected? How many couples participated in those studies?
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Question,
There were three studies all together.
On the one that lasted ten years (1990 - 2000): A total of 135 seronegative individuals (110 women and 25 men), whose only risk exposure to HIV was unprotected orogenital sex with their infected partner, registered 210 person-years of follow-up. After an estimated total of over 19 000 unprotected orogenital exposures with the infected partner not a single HIV seroconversion occurred. (del Romero, Jorgea; Marincovich, Beatrizb; Castilla, Jesúsc; et al; 2002) These people were seen by the researchers every six months, when they would undergo extensive questioning about their sexual practices as well as physical exams, including hiv testing.
I don't remember off hand how many were in the other two studies nor their duration. Maybe Jonathan will chime in with what he knows.
Ann
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I believe one study is still ongoing in San Fran. It involves gay men - last I heard, and maybe Jonathan has an update, but they were up to 400 men participating and no seroconverstions as of yet.
I worry too about oral. I don't allow guys to ejaculate in my mouth, but the precum is what worries the hell out of me. I promised myself, no more oral without flavored condoms. I guess it is what you do that makes you comfortable.
Pete
(formerly bosras - but had enourmous problems with signing in since the new forum started)
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prman1,
Yeah, the old usernames and passwords were not transferred from the old forum..... as a matter of fact, nothing was.
Everyone has to set up a new account in this new forum.
Morgan
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I was infected through unprotected oral sex. I used a condom for insertive anal sex, and I was not penetrated.
I don't dispute the studies listed above. I think it is rare. I think it is low risk. But it is not no risk.
I believe a person's viral load can have an effect. It is thought that most infections occur from a person who has an early infection. Their body hasn't fully controlled the virus and they are much more infectious. I believe this is the situation I may have encountered, but I don't know that for sure. I also clearly remember flossing my teeth before I went out that night.
I'm not sure what motive I would have to lie about this.
OP
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For the record,
None of the experts on this site have ever, to my knoweldge, suggested that performing fellatio carries no risk. It's considered low, but not no risk.
Receiving, on the other hand, IS no-risk. There has never been a documented case of contracting hiv through RECEIVING a blowjob. An important distinction.
Morgan
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On the other side of this forum, I like to provide support without judgment or question transmission vectors. Sometimes this means remaining silent.
On this side of the forum, I have to go by the science. I apologize if that offends anyone, but if anecdote is treated as data here, then we have failed in our attempt to use science-based risk assessment in this part of the forum.
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I wonder if full ejaculation plays a larger role in oral transmission. I have heard experts (USCF Roundtable discussion) say that oral sex with just exposure to precum would be an extremely rare way to transimt the virus. But I believe precum must play a large role. But who knows.
Jonathan, do you have any updates on the HOT Oral sex study in SF - that last update I read was in 2004 - it was up to 400 participants.
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I Have a question.
Example: If someone got infected today, his/her Viral Load is high the next day, two, three, four or five days after?
If a person has a high viral load would kissing, fingering, oral be risky now?
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If you got infected today, it takes several weeks to get a high VL. No, recieving oral would not matter or would fingering. They are not risks for HIV. Now it does increase the risk slightly for giving oral.
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I don't think I have disputed science. It says performing felatio is low risk not no risk. And if it is low risk that means it could happen. Also, an early infection and someone on medication are really two very different scenarios. I imagine I thought I could help some people be more careful because of my experience. Perhaps I was wrong in that assumption.
I read alot of different studies back when I was waiting for my diagnosis. Studies that ranged from saying no risk to low risk to maybe we need to re-evaluate the risk. It was very frustrating. But I know the answer now.
op
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Newbie - was there ejaculation? I hear that could increase the risk...
Who knows these days. I am sticking with a condom for oral sex, although I doubt I will ever get a date. Very few people use them for oral sex.
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Folks,
Please, let's not hijack this thread with a discussion of the ins and outs of otherplaces' infection story. If otherplaces wants to discuss it further, he is welcome to start a new thread. Otherwise, stop the hijack, thank you.
The answer to the original question "Is oral [transmission] really rare?" is yes. Rare doesn't mean never, it means rare, as in it doesn't happen very often.
Ann
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I just dont understand "otheplaces" He hijacked this thread saying he got it from oral but in the living with hiv forum in the thread "Introduce yourself and meet others part 2" He wrote " She gave me HIV."
How can you perform fellatio with a She? So are you saying you get it from performing cunnilingus?
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Question,
It is exceedingly rare for a person to become infected from giving a blowjob and even more rare for someone to become infected from going down on a woman.
There have only been a handful of cases in twenty five years where cunnilingus was cited as the cause of infection, and all but one or two of these cases were disproved without doubt. In the remaining cases, extremely poor oral hygiene was implicated as the likely causative factor - and much doubt still remains over these cases. There has never been a fully, reliably documented case of transmission via cunnilingus.
Basically - going down on a woman is not a risk for hiv infection. Infectious fluids in a woman are found deep inside the vagina, in the thick mucus that protects the cervix. A person performing cunnilingus is unlikely to come into contact with these cervicovaginal fluids.
Ann
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There are no documented cases of HIV through cunnilingus.
Insofar as the oral sex studies are concerned, Ann mentioned the longest one to date, the romero study. In addition, there are two other studies, both in San Fransisco, one ongoing. Here is the abstract for one of them:
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, John Sb
aCenter for AIDS Prevention Studies, Department of Medicine, bDepartment of Stomatology, School of Dentistry, and cDepartment of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; dAIDS Health Project, San Francisco, CA, USA; and eSan Francisco Department of Public Health, San Francisco, CA, USA.
Sponsorship: This work was supported by a grant from NIDCR (1 R01 DE12911-01) and was presented in part at the 2nd National HIV Prevention Conference, Atlanta, GA, 14 August 2001.
Received: 3 January 2002; revised: 6 June 2002; accepted: 20 June 2002.
We examined HIV infection and estimated the population-attributable risk percentage (PAR%) for HIV associated with fellatio among men who have sex with men (MSM). Among 239 MSM who practised exclusively fellatio in the past 6 months, 50% had three partners, 98% unprotected; and 28% had an HIV-positive partner; no HIV was detected. PAR%, based on the number of fellatio partners, ranges from 0.10% for one partner to 0.31% for three partners. The risk of HIV attributable to fellatio is extremely low. >>
Here is another study:
<<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
BACKGROUND: Concern has remained high regarding the risk of acquiring HIV in association with oral sex. Systematic analyses show very low risk but case-reports exist documenting HIV acquisition from performing fellatio.
METHODS: Participants were recruited from anonymous testing sites (ATS) in San Francisco and were screened for sexual behavior as part of a case-control study to characterize the risk of HIV from fellatio. Eligible participants were over 18 years of age, did not inject drugs and exclusively practiced fellatio. Participants took part in a structured interview regarding sexual practices and oral health in the last 6 months. Each participant was screened for HIV infection, and received a standardized oral examination performed by a dentist.
RESULTS: Of the 18,805 ATS clients 6% were eligible, and 447 agreed to participate. 439 were men (99%); 6 women and 2 male-to-female transgenders were dropped from analyses. All 439 male participants were MSM, median age was 40.5 years (interquartile range (IQR) 32-48); 50% of men reported 5 previous HIV tests (IQR 3-10). Participants reported a median of 3 (IQR 1-10) fellatio partners in the last six months. Almost all (94%) reported not using condoms when performing fellatio; 67% of those had ejaculate in the mouth, and 66% of those swallowed semen. Overall, 19% of the men reported having an HIV positive or unknown serostatus partner; of those 28% were exposed to ejaculate, and 26% also swallowed semen. We observed no incident HIV infection in 1,519 person years of exposure. The estimated probability of orally acquired HIV infection was 0 (95% CI: 0, 0.8%). Conclusion A small percentage of men who test for HIV practice exclusively oral sex. Men who practice fellatio exclusively rarely use condoms including with HIV positive or unknown serostatus sexual partners. No HIV infections were observed in our sample. Among MSM, the probability of acquiring HIV from oral sex was significantly lower than for other sexual practices, especially anal sex.>>
http://www.aegis.com/news/ads/2002/AD022319.html (http://www.aegis.com/news/ads/2002/AD022319.html)
http://www.gayhealth.com/templates/1149943587375821502878/news?record=647&trycookie=1?record=647 (http://www.gayhealth.com/templates/1149943587375821502878/news?record=647&trycookie=1?record=647)
There is, of course, debate in this area. Notably between the researchers (Shafer and Romero) and the director of the CDC:
<<Dr. Page-Shafer told National Public Radio. "Our results suggest that oral sex is safer sex.>>
<< However, Ronald Valdiserri, M.D., M.P.H., of the CDC said, "We know it's possible to transmit HIV through oral sex, but it is not a common event. We want to stress that low risk is not the same as no risk.">>
However, Shafer is speaking from quantifiable data, whereas Valdiserri is speaking from the accumulation of anecdotal evidence. Also, as a spokesperson for the CDC, I really can't take him that seriously as an objective scientist insofar as sexuality is concerned. The CDC, after all, promotes an abstinence-only agenda, and links to web sites which spread blatent misinformation about condoms. This is a direct result of the current administration, and it is important to remember that the CDC is a governmental agency first and foremost.
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She was a m to f transexual. I've said this before. I'm not going to explain this every time I mention her. She was a she.
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is receptive anal sex far riskier than receptive vaginal sex? is it because of blood?
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comments experts?
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Don't do either of them unprotected, unless you are in a monogamist relationship and the both of you have tested negative together. Both are high risk for HIV when not protected.
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how about receptive fingering? if theres a cut or some blood in the finger of the one fingering, would that be risk to the receptive partner?
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Jonathan, do you have any updates on the HOT Oral sex study in SF - that last update I read was in 2004 - it was up to 400 participants.
The newest stuff i could find on the HOT study is here:
http://www.caps.ucsf.edu/hotstudy/HOTDansThoughts.html (http://www.caps.ucsf.edu/hotstudy/HOTDansThoughts.html)
It's an op ed piece by one of the researchers.
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Fingering is not a risk for HIV under any remotely normal circumstances. It is a theoretical risk if an HIv positive person cuts OFF the top of his/her finger and places it inside another person's anus or vagina. But even then, no infections have ever been attributed to fingering.
Fingering is considered safer sex.
Finger away.
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I have emailed the HOT study coordinator to see if there are any updates. Once I receive a response, I willl pass it along to you. I have read that the study is now over 400 men (up from the 198 a few years ago), and they still have yet to find a transmission of HIV from receptive oral. Here is the latest information I found from gay.com:
"On the question of how many times the guys who are staying negative have sucked HIV-positive guys, Page-Shafer said such data was not collected in the past but is being collected now as the study continues. That data has not been analyzed. However, the study, which now has over 400 participants, still has not had anyone test positive.
"We changed our questionnaire to ask more of the questions that you are asking," she said. "We are collecting per-act data now -- how many partners that you know are positive, and how often."
Page-Shafer dismissed my question about pre-cum. "Pre-cum doesn't make any difference," she said. "If pre-cum was a factor, we'd be seeing a whole lot more infections."
If gay men would give up unprotected anal sex, she said, and enthusiastically embrace unprotected sucking instead, the AIDS epidemic would eventually end all by itself."
Thanks, Jonathan, stay cute.
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<<If gay men would give up unprotected anal sex, she said, and enthusiastically embrace unprotected sucking instead, the AIDS epidemic would eventually end all by itself.">>
It makes me unpopular sometimes, but this is the philosophy I embrace as well, based solely on the science at hand.
plus... (blushing @ the cute comment) thanks :)
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I have read that the study is now over 400 men (up from the 198 a few years ago), and they still have yet to find a transmission of HIV from receptive oral. Here is the latest information I found from gay.com:
prman1:
Would you mind posting a link to that article on gay.com? I find it reassuring and would love to read more. Thanks.
- rick
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http://www.planetout.com/news/feature.html?sernum=457
Beware, its more of an opinion piece than any else. The comments from Kimberly Page-Shafer is in the article. I believe they are up to 400 particpants and no transmissions. However, I haven't seen an update since 2003....
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It's an interesting piece. However, the author might have pointed out that Kimberly Page-Shafer and Jeff Klausner's enthusiasm comes not from a single study, but from the result of their second, combined with the Spanish Romero study. In the Romero study, which I've read, there WAS a variety of viral loads and other conditions at play.
I will be extremely interested in reading about the circumstances leading to receptive oral transmission, when one pops up in one of these studies.
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If gay men would give up unprotected anal sex, she said, and enthusiastically embrace unprotected sucking instead, the AIDS epidemic would eventually end all by itself.
Actually, I hate that quote. Why? Because it perpetuates the myth that only gay men become hiv positive and only gay men are victims of the AIDS epidemic. And that, if you'll pardon the pun, sucks.
Just my 2p.
Ann
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Point well taken. I was assuming that the quote came due to the interview in a magazine aimed towards gay men. But it applies to everyone, of course.
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Can you correct me if im understanding it correctly. In the 3study One is pos and the other is neg.
But how about in the ongoing study(gay)?
Is there any study if the person is at ARS stage? I think this is splitting hairs.
The ARS stage is said to be the most infectious stage but after seroconversion, is there a stage that can match-up the ARS stage?
If after serocoversion there is a stage that can match-up the ARS stage then receptive oral sex is a safer sex based on the 3 study.
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Question,
There isn't necessarily a set "stage", no. People who are not on antiretroviral therapy can have fluctuating viral loads. You can't tell by looking at someone how high their viral load is and neither can a person tell themselves how high their viral load is. (I'm just saying that to make it clear to all) A person can be going along quite nicely, without meds, and suddenly have a spike in their viral load and it is perfectly possible for someone to have such a spike yet feel fine.
My own viral load has fluctuated widely over the years I have been monitored. (I'm not on meds) It's been as low as 3,350 and as high as 90,000 something. It's currently in the 10,000s, but who knows what it will be next time I am checked.
I don't think there's been any specific study of the infectivity of people experiencing ARS but we do know that people in the first few months of infection can have viral loads as high as in the hundreds of thousands.
You have to remember too that serum (blood) viral load levels and the viral load levels of ejaculate are rarely the same.
The bottom line here is that all the current evidence points to oral carrying very, very low risk. You will have to decide where your own comfort level lies regarding what level of risk you are willing to take. That level can go from using condoms for any penile/oral contact, to not allowing anyone to cum in your mouth, to completely throwing caution to the wind and swallowing. It's up to you.
Ann
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Hi about using condoms. Is the purpose of using condoms in vaginal and anal sex is because of the "invisible cuts" on the mucuous membranes?
If there is no cut inside the vagina and anus would there still risk of transmission?
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Question,
Is the purpose of using condoms in vaginal and anal sex is because of the "invisible cuts" on the mucuous membranes?
"invisible cuts"? There is no such thing.
If there is no cut inside the vagina and anus would there still risk of transmission?
Yes. The risk of transmission comes not from cuts or abrasions alone, but also the type of cell hiv needs to bump into to infect a new host through are found in the anus and vagina - and also the urethra and foreskin of the penis.
This is why condoms MUST be used for anal or vaginal intercourse.
Ann
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Thank you very much.
I been reading here that in the state of mass, the window period is 6week? Because of the 4th Generation test.
So if I test using 4th Generation but not in mass, What window period will I follow?
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Question,
Officially, you fall into the three month window period. However, you'll have to look at the facts and decide for yourself what to do. All we can do here is recommend you stick to the official three month window.
Ann
(whose hands are tied on the window period thingy)
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Hi
Do Sore Throat means you have A Cough? Is the ARS Sore throat have dry cough?
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It does zero good to discuss symptoms. Seriously. If you deep throated, then a sore throat might be natural. Also, if you got gonnorrhea, strep, syphilis, have allergies, and about a hundred other pathogens, you could have a sore throat. For the record, HIV manifests itself systemically - so you would not have indications at the "point" of infection (meaning, if you get HIV through penetrative sex, you would not exhibit symptoms on your penis, etc).
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I didnt deep-throated. Its protected insertive vaginal sex. Im worried because the condom I used was from the woman. I didint know if it has a hole in it.
I Have a Scenario: If Someone got infected of hiv today and he got a fever the following day because his roommate has a fever. Would ARS come at the 2nd week mark or the Fever he got the following day would prolong?
Any Worried Well here from the philippines? Where did you test? Im planning to have a test and I want to know where I can avail the 4th generation test.
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Question,
Symptoms or the lack of symptoms mean nothing when it comes to hiv infection.
You had protected intercourse. You didn't have a risk of infection. You would have known if the condom had a hole because it would have broken. The woman provided the condom for HER protection, not yours. Do you seriously think she would use faulty condoms and put her own life at risk?
You did not have a risk of infection through protected intercourse. You don't need to test over this specific incident.
Ann
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I didnt deep-throated. Its protected insertive vaginal sex. Im worried because the condom I used was from the woman. I didint know if it has a hole in it.
I Have a Scenario: If Someone got infected of hiv today and he got a fever the following day because his roommate has a fever. Would ARS come at the 2nd week mark or the Fever he got the following day would prolong?
Any Worried Well here from the philippines? Where did you test? Im planning to have a test and I want to know where I can avail the 4th generation test.
i tested but only using a rapid test. i tested at Remedios Labs, beside the Remedios AIDS Foundation in Malate (www.remedios.com.ph). they're just a diagnostic clinic so they didnt have equipment for ELISA. they do WB though, to confirm. they use particle agglutination for HIV 1 and 2. this test is comparable to ELISA so it's very reliable.
as with a 4th gen test, i think they have it in San Lazaro hospital, not 100% on this though. try calling them :)
i'd still go for a 13 week conclusive test though, regardless of generation and type (rapid or ELISA) of test. :)
EDIT: i tested negative, btw, on the 13th week (in case you're wondering) :)
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Hi Cicatriz.
Thanks for the information you wrote on my thread. I think some hosptial have 4th generation testing but some hospital are asking for pictures. Why are they asking for pictures for hiv test?
By the way Why did you test? what was your risk?
pictures?! what the? i've no idea why they would ask pictures. heck, i didnt even give my name to the testing center i went to. i just gave them a code name and they gave me a number and a claim card.
as for the 4th gen test, aside from San Lazaro, im not sure where else to get it. Makati Med and Medical City have 3rd gen EIA/ELISA tests. But as widely recommended, regardless of generation and type, a 13th week test is considered conclusive.
you may want to have your test where i had mine. the atmosphere is more discreet and they have pre and post counseling. i dont think big hospitals do. well, they even ask for pictures -- this is unbelievable, btw. you can call them at 5240924 to ask for information. they even give back half of what you paid if you tested negative (refunding the supposed payment for the confimatory test) initial payment is 700, but they give back 300 or 400 if your test was non-reactive. so you see, they're not in it for the money (or pictures). :P
i tested because i had a few weird symptoms and prior to those i did it with what you may consider a "sex worker". protected, nonetheless, but you know how your mind can fuel your anxiety. some of which still linger now, but im banking on the negative result i got to erase all anxiety. :)
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About condoms.
IF a condom has a hole, it wouldnt be unnoticed? I tried for myself using a condom and needle prick the tip of the condom and I masturbated it didnt broke. But if I needle prick the body part of the condom and I masturbated it did broke.
So why if there is a hole in the tip it wont break?
Im just afraid if there is hole in the tip of the condom and use for vaginal sex and it wouldnt break.
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Sorry for posting in "Worried Scott" thread.
Do physical checkups like rectal examination part of casual contact that its not a risk?