[Question #2453] ORAL SEX HIV RISK

44 months ago
Hello Doctors,

Thank you for your time again and I believe that you are doing an amazing job. I am very impressed that some of you even answer on the weekends and late hours. I have already asked a question about 20 days ago about some exposures but I would like to add some details about that matter just to see if some information are correct or not because there is a lot of confusion. 

I encounter TS Escorts the only unprotected sex that I have is FELLATIO, I confronted all of them and said they were clean, check routinely and that they would never hurt someone or do something to someone that they don't want happen to them.

When it comes to ORAL SEX, FELLATIO, MOUTH TO PENIS without condoms & NO EJACULATION maybe some pre-cum. (these are my only potential exposures) Some say it is safe sex & some say it is safer sex

1) Is it true that our saliva contains enzymes & proteins that protect us from the virus?  (According to members of MedHelp, POZ.COM communities) 

2) Is it true that when HIV exposed to air or when it comes outside the body or outside the penis (pre cum, semen,blood) it becomes inactive and that HIV is fragile and it requires a precise environment ? (According to members of MedHelp, POZ.COM communities)

3) If someone is exposed only to pre-cum, would the pre-cum be highly infectious or would it be minimal compared to semen and blood? 

 4) Does the mouth to be infected with HIV require to have gaping wounds and be in a really bad shape of oral health (like meth mouth) to be infected or a little bit of bleeding gums is enough? 

5) Why FELLATIO is considered more risky than CUNNILINGUS, when the vagina is full of vaginal fluids? 

6) Is testing & P.E.P warranted after unprotected FELLATIOS?

7) Have you ever had a credible documented case or has a documented case elsewhere of HIV infection FELLATIO ever occurred? If yes how can we be sure of it's credibility.

44 months ago
There seems to be a technical problem with my question problem as I see some lines between the text and it says updated but I dont see an answer. :/ and on the mobile version I can see half my question did I do something wrong? 
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Welcome back to the Forum.  While I applaud your concern about your sexual health.  As Dr. Handsfield explained to you earlier, fellatio is a very low risk activity in terms of HIV risk and when combined with the fact that your sex partners (even transsexual women) are unlikely to have HIV, is close to a no risk event.  I hope that the replies I am about to provide will help you to move forward without further concern.  As for your specific questions:

1.  Yes, this is a true statement. Saliva contains an number of enzymes which would help to kill HIV if it were present.
2.  Correct.  When exposed to the environment, HIV becomes non-infectious
3. There is HIV present in pre-ejaculatory fluid.  Thus it is potentially infectious
4.  This is a reasonable question but there is no good scientific evidence that oral hygiene/bleeding gums or other oral hygiene problems are associated with increased risk for HIV acquisition.
5.  This is a mechanical issue.  There is more direct contact associated with fellatio than cunnilingus.
6. No!!!
7.  Yes, there are a few(very few compared to other possible routes of infection) cases of HIV which were acquired due to fellatio performed on an HIV infected partners. 

I hope these comments are helpful and add to the information you already have been provided by Dr. Handsfield.  EWH
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44 months ago
So it's a risk (still low) if FLUIDS come in direct contact with the bloodstream. But is it true that the HIV concentrations in pre-ejaculatory are much lower than semen and that HIV would be  much more fragile? (Is it a very fragile virus?)  And about the cases of HIV with oral sex are they documented well or based on what the patients say?  Also, what is your opinion of the three long term studies that have occured with HIV- & HIV+ couples performed multiple uprotected oral sex acts and not one infection occured. Are they good studies?  ( Example Del Romero study & Page-Shafer study) You really think I am getting too anxious about for no real reason? I probably am but I cant seem to relax about it. Thank you and Dr Handsfield again for your help and I really admire you for doing all this. For me this is the best Q & A website from professional experts and medical doctors. 

Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Perhaps you are confused.  Sexual activity does not introduce genital secretions into the blood stream.  Needles injecting material do.  This does not involve sex!

As I said, there are PROVEN cases of HIV which occurred as the result of performing oral sex on an infected man (i.e. fellatio).

I hope these replies, reinforcing my early replies will be helpful.  EWh
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44 months ago
Hello again Dr.

I just tested today with a Determine Rapid 4th Generation test Antigen/Antibody  (I also did it a month ago) Result was NEGATIVE today as well. 

EXPOSURES OF UNPROTECTED FELLATIO without ejaculation prior testing. 
 
89 days 
81 days 
52 days 
7 days 

I know that the 7 day one is no way near conclusive. But would it be anywhere near enough a good encouraging and hopeful indication? I plan going again next week and I will also go at MEPS soon (maybe in 2 weeks) for military processing.  Do you recommend an RNA early detection test?  Should I stop worrying that much now?


Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Following your recent HIV combination antibody/antigen test, your results for all exposures more than 6 weeks are completely conclusive.  Obviously while your exposure 7 days ago is not something that allows ruling out HIV infection from an exposure 8 days ago, the chances that you acquired infection form this exposure are low- far lower than your chance of getting struck by lightening. 

I see no reason for getting an HIV RNA test.  In fact, your risk of a falsely positive test with an RNA test is far higher than your risk for having acquired HIV.  I DO think you are worrying entirely too much and think you do not need further testing. 

EWH
Parenthetically, noting that you are about to under go military processing, on a personal level, let me than you for you commitment and service.  EWH
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Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
There have now been three replies to these questions.  As per Forum Guidelines, this thread will now be closed.  EWH
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