[Question #5648] HIV Risks - Non-insertive sex

73 months ago

Dear Doctors:

Yet another anxiety driven question but your reassurances are always worth hearing. I'm a heterosexual male living in the Midwest US. I have recently started limiting my encounters with new partners to mutual masturbation until both persons can complete STD testing for more long term relationships. This has generally served me well and kept me from going overboard with anxiety when I don't know a partner's status.

About a week ago, however, I was with a new partner. We engaged in mutual masturbation and I also sucked her nipples. She does have a younger child and I'm not sure if she might still have been lactating a bit. I did suck on her nipples pretty vigorously. I just can't recall noticing any secretions. I've read other threads where you have stated there is no risk to adults from ingesting a partner's breast milk - even if that partner is infected with HIV.

I guess what would be helpful for me is a more scientific explanation as to why that's the case. In some sense, I'd also like to know why performing oral sex on a woman is such low risk for HIV. In both instances, it seems you are potentially ingesting infected fluids. Why is there little or no risk biologically speaking?

The scientific explanations actually do quite a bit to lessen my anxiety. Thank you again for all the great work you do through this site.

Edward W. Hook M.D.

73 months ago

Welcome back to the Forum. Your plan of limiting interactions to mutual masturbation and non-penetrative activities until you are confident of partners' infection status will keep you safe. Unless it was obvious that your partner was still lactating it is unlikely that she was. I see no scientific reason for testing related to the events that you describe. Going on to your question regarding why ingestion of fluids does not lead to infection:

The oral cavity resists infection for a variety of reasons. The human oral cavity has the greatest amount of bacteria of any site in the human body. Infections do not occur because of the intact epithelial surfaces of the mouth which may be less susceptible to infection than the epithelium of the genital tract. In addition, the presence on antibodies and other antibacterial substances in saliva also inhibit the growth of bacteria. Finally when infected genital secretions are ingested, they quickly go into the stomach where acids and additional antibacterial substances tend to render microorganisms non-infectious. Finally, all of these contributors are validated by the FACT that oral infections following oral sex (including cunnilingus) are less common in exposed persons that follow genital or recto-genital contact. EWH

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73 months ago

Thank you for your quick reply Doctor. I guess my concern about this whole lactation idea stems from the few cases where HIV has been passed onto to a partner performing fellatio. I can kind of understand how cunnilingus would be inefficient due to the amount of secretions ingested, exposure to air, etc. How is it that HIV was actually passed in those cases of fellatio? Would not ingesting breast milk be a similar direct pathway? I know these are anxiety driven but I do appreciate your advice.

Edward W. Hook M.D.

73 months ago

You are over interpreting things. In those rare cases in which fellatio has led to HIV, the assumption if that the direct contact of the penis/ejaculate with tonsillar cells at the back of the throat contribute to infection. neither ingestion of breast milk nor cunnilingus results in this sort of direct inoculation. EWG---

73 months ago

Doctor - my partner recently tested negative on an Oraquick and tells me that it’s been more than 6 months since she’s had sex with anyone. I used to have complete confidence in Oraquick but have been confused lately by some of the reliability reports. The insert references about a 91% accuracy for those actually infected with HIV. Journal articles studying the test in the field seem to demonstrate much higher sensitivity and specificity, often >95%. I know lab tests are more reliable overall but can I trust Oraquick results when performed more than 3 months after an exposure? Thanks again for all your help.

Edward W. Hook M.D.

73 months ago

OraQuick is a fine, highly reliable test for HIV antibodies however it tests only for antibodies and the is a slight sensitivity cost in looking for antibodies in oral fluids. As a result, while the OraQuick is a very good test, it is slightly less sensitive than tests performed of serum and plasma, particularly when tests are performed in the 8-12 week range following exposure. I would be confident that OraQuick results related to events 6 months in the past but, as I said particularly for recent exposures, it is slightly less sensitive.

I hope this information has been helpful. As this is my 3rd response this thread will now be closed without further responses. Take care. EWH

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