HIV and Oral Sex

[ianmx]

I am newly diagnosed and was recently having a conversation with my advocate where the topic of oral sex came up. When I talk about oral sex I talk with the assumption that there is precum or full ejaculation in the mouth... he was adamant that oral sex was not without risk, however whenever i see the question in the forums here, mostly 'am i infected' the standard response is oral is a 0% risk factor. or at least played off as no reason to be tested, only anal and vaginal unprotected sex is a risk.

I googled and i cannot find any site, including the cdc, that says oral is a 0% risk factor but all agree the risks are greatly reduced. i see many sites refer to 'some studies' but i cannot find those studies. some say that because most sexual encounters would include other activities other than oral it is hard to determine the transmission. meaning at best oral is inconclusive but not risk free.

where is the thought process and policy of this site that oral is 0% risk taken from? of course anyone who feels they need to post in 'am i infected' should be encouraged to be tested 100% of the time, but that's another story.

i put this in prevention because knowledge is prevention and i wasn't sure where else the question would fit. 

ian

[Jeff G]

We do not comment on what other sites say about oral transmission and rely on the latest peer reviewed science instead . We always tell people to test risk or not .

There have been no fewer than three separate serodiscordant couples studies (where one person is HIV positive, the other negative.) These couples were tracked for three. five and ten years. The couples used condoms for penetrative vaginal and anal sex, but NO BARRIER at all for oral sex. Any kind of oral sex.

These studies yielded NO infections.

http://journals.lww.com/aidsonline/Fulltext/2002/06140/Evaluating_the_risk_of_HIV_transmission_through.17.aspx#P38

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.

[ianmx]

Thank you for the link

I have actually seen that study before. I found it interesting that they only tested heterosexuals and out of the infected 135 people, only 25 were male. The mix isn't even close to real life HIV statistics.

Even this study mentions other studies where M2M oral might have resulted in 'probable' infections.

"A recent work found eight cases of probable orogenital transmission among 102 recently infected men who had had sex with men"

The CDC isn't a website, it is the government policy on infectious diseases in which the medical community bases their own information, and they report that there is a low risk with oral sex and much of that risk depends on the oral care of participants.

The study linked to here mentions no oral care or if the people in the study had been examined by dentists for gingivitis, cavities, or sores in the mouth. All things that the CDC points to as being a risk factor. The CDC also recommends not having oral within 25 minutes of brushing your teeth.

This study linked to actually concludes that transmission through oral is a low probability when other risks are excluded... is one of those risks oral health? This study does not give a 0% risk factor, they don't even suggest that is their conclusion, they were dealing with a controlled group and maybe oral health was considered as part of the controlled group. That isn't real life experience, we don't 'hook up' and take a trip to the dentist first.

These tests are not done by saying 'hey, we think you might get HIV if you give this HIV guy a blow job, wanna try?'... They eliminate everything they consider to be a risk and reject people who might meet those risk factors, maybe people with a cold sore in their mouth? That isn't real world sex and we don't send our oral partners for an oral exam before hand. The goal of the test is to eliminate all risks first because they don't really want to infect someone, so they go in confident they have covered their bases.

I must admit there is a lot on contradicting information about HIV. I hear the reason HIV cannot be passed by oral is because the virus cannot live in the mouth, but yet we have oral HIV tests. We hear the virus cannot live outside the host body because just exposure to the air kills the virus, yet we accept shared needles as a means of transmission. Maybe we know less than we think we know.  ... or speaking for myself. hahah

Well, still an interesting read to say the least. Thanks for the link!

ian

[leatherman]

I hear the reason HIV cannot be passed by oral is because the virus cannot live in the mouth, but yet we have oral HIV tests.

When you seroconvert your immune system produces antibodies to fight off a virus. those tests looks for antibodies that have developed to HIV, not HIV itself. A viral load measures the actual HIV.

We hear the virus cannot live outside the host body because just exposure to the air kills the virus, yet we accept shared needles as a means of transmission.

shared injection needles can hold hiv-filled blood and literally inject it into the blood system of someone else. air doesn't have time to breakdown the hiv and the hiv is forced into another person (a wound bleeds outward and that's why hiv blood splattered onto the wound of another person is not enough to transmit hiv)

[ianmx]

When you seroconvert your immune system produces antibodies to fight off a virus. those tests looks for antibodies that have developed to HIV, not HIV itself.

Thanks Leatherman! that i did not know about the oral tests. Learn something new every day 

ian

[Andy Velez]

Ian, a couple of thoughts...

First of all I always say that only sex with your own hand is 100% safe, although there is a great deal of substantive support for minimizing the risk of oral sex.

Secondly and maybe most importantly, has your HIV test result been confirmed by a western blot test?

Just checking to be sure...

[tyranossaurusrex]

When you seroconvert your immune system produces antibodies to fight off a virus. those tests looks for antibodies that have developed to HIV, not HIV itself. A viral load measures the actual HIV.
shared injection needles can hold hiv-filled blood and literally inject it into the blood system of someone else. air doesn't have time to breakdown the hiv and the hiv is forced into another person (a wound bleeds outward and that's why hiv blood splattered onto the wound of another person is not enough to transmit hiv)

hi, leatherman

i have similar doubts, too. for example, why is it people consider sharing sex toys (a dildo, for example) a risk? after someone has used a dildo, if the person passes it to someone else, on the way between one person and the next isn't there a lot of expose to the air?

i understand, sharing needles, leftover blood stays inside the equipment. so there is not that much exposure to the air. but what about on the dildo example?

[leatherman]

hi, leatherman

i have similar doubts, too. for example, why is it people consider sharing sex toys (a dildo, for example) a risk? after someone has used a dildo, if the person passes it to someone else, on the way between one person and the next isn't there a lot of expose to the air?

i understand, sharing needles, leftover blood stays inside the equipment. so there is not that much exposure to the air. but what about on the dildo example?

who are these "people" of whom you speak? and what's with all the "what if" scenarios?

Because HIV is a fragile virus (quickly dying with exposure to air, varying temperatures, etc) it is much less likely to transfer than the much more viable STIs - which are the real risks in your scenario. However, as it often is with medical advice, medical professionals are going to err on the side of caution. There have been almost zero cases of HIV infection transferred during oral sex and there has been zero cases of PLWH with undetectable HIV viral loads transferring HIV and yet oral sex is classified as a risk and two PLWH (both undetectable) are always counseled to use condoms - all because professionals are loathe to guarantee 100% safety for anything because anything "could" be possible.

So let's think about this dildo scenario for a minute. HIV is first transferred from the HIV positive person to the dildo. ANY exposure to air or temperature changes is going to kill off any HIV. Even if the HIV had not all died off by the time the second person used the toy, the chances of HIV transferring a second time (from the dildo to this 2nd person) approaches zero. Of course, like with pregnancy how every exposure to semen does not guarantee the creation of a child, every exposure to HIV does not guarantee infection. So in this scenario not only do we have a greatly decreased (perhaps to zero) chance of HIV transference via the dildo but the amount transferred is probably so little that the chance of infection approaches zero. The fact that no one has ever been documented as having been infected via dildo clearly shows that the chance of infection has not only approached zero but was zero.

[wardpoz]

poz guy here from NYC

[tyranossaurusrex]

who are these "people" of whom you speak? and what's with all the "what if" scenarios?

Because HIV is a fragile virus (quickly dying with exposure to air, varying temperatures, etc) it is much less likely to transfer than the much more viable STIs - which are the real risks in your scenario. However, as it often is with medical advice, medical professionals are going to err on the side of caution. There have been almost zero cases of HIV infection transferred during oral sex and there has been zero cases of PLWH with undetectable HIV viral loads transferring HIV and yet oral sex is classified as a risk and two PLWH (both undetectable) are always counseled to use condoms - all because professionals are loathe to guarantee 100% safety for anything because anything "could" be possible.

So let's think about this dildo scenario for a minute. HIV is first transferred from the HIV positive person to the dildo. ANY exposure to air or temperature changes is going to kill off any HIV. Even if the HIV had not all died off by the time the second person used the toy, the chances of HIV transferring a second time (from the dildo to this 2nd person) approaches zero. Of course, like with pregnancy how every exposure to semen does not guarantee the creation of a child, every exposure to HIV does not guarantee infection. So in this scenario not only do we have a greatly decreased (perhaps to zero) chance of HIV transference via the dildo but the amount transferred is probably so little that the chance of infection approaches zero. The fact that no one has ever been documented as having been infected via dildo clearly shows that the chance of infection has not only approached zero but was zero.

hi, leatherman.

thanks for your answer, again.

when i say "these people", i refer to this article at aidsmap: http://www.aidsmap.com/Sex-toys/page/1323537/ (which i find to be the best website i have found about the topic, so far). and on the article they mention it, the risk of transmission through sharing a sex toy, even stating it as "high risk". they also mention case reports of transmission through mutual masturbation, and rimming.

and on this pdf, from mayo clinic, where they even mention one documented case of hiv transmission through "french kissing": http://www.mayo.edu/pmts/mc8100-mc8199/mc8100-55.pdf

all of that to say, one who is trying to become educated about the topic can get very confused and lost reading all the different information.

[leatherman]

all of that to say, one who is trying to become educated about the topic can get very confused and lost reading all the different information.

stick with good sources, like the Lessons section here, or the CDC HIV section. While the CDC is overly cautious about some of their information, their data is what is used in preventing and treating HIV in America.

http://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html

Sharing Sex Toys   Negligible^
^ HIV transmission through these exposure routes is technically possible but unlikely and not well documented.

and on the article they mention it, the risk of transmission through sharing a sex toy, even stating it as "high risk". they also mention case reports of transmission through mutual masturbation, and rimming.

You may have given me the wrong link because that link does not say a lot of that. It mentions only one probable case in S. Africa about masturbation and it actually says the risk in rimming is negligible. It seems you were reading for worse-case scenarios and didn't see that all the "risks" in those activities was incredibly low. One or two cases is not proof of anything but outlier data. patient reporting is not always accurate (and almost all data collected about people's sexual activities is based on patient reporting), so oftentimes data collection is left with a few cases that are not easily proven as to the transmission risk (the gum disease of one patient was the actual risk and not the rimming per se) and these account for scientists not stating, especially when there is no other confirmatory data, that anything is 100% safe.

Rimming (oral-anal contact) is considered a negligible-risk activity for HIV transmission. There is a theoretical risk that the presence of blood in the rectum (for instance as a result of fingering, fisting, having intercourse with or use of sex toys) may present a risk of infection for the person doing the rimming.....

There are no other reported cases of infection or likely infection through rimming.

of course, all this is a moot point if the HIV positive partner is undetectable. It has been shown by the long term PARTNERS study (with both homo- and hetero-sexual couples) that being undetectable (for a period of time which has not yet been determined but probably in the 6-12 mo. range) results in a "risk" that "approaches zero". That's pretty amazing news, not only because it means treating people will result in ending transmissions; but scientists saying "approaching zero" is pretty rare.

[zach]

T-rex

you've hit information overload. slow down and give the research a rest... just gonna worry yourself over nothing