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HELP! New Serodiscordant Relationship
Jun 16, 2004

I recently met a great guy that I'm falling head over heels for. He was negative on 4/22 when we met, but a few weeks later tested positive (while applying to participate in a research study). We don't know how he became poz, but suspect it had to do with oral sex (he likes to swallow) with a previous positive partner. He has not had unprotected anal sex.

We've only had "safer" sex... but I'm seriously concerned. (I recently tested negative less than 30 days ago).

I really like this guy. A LOT. But I'm concerned and confused for both his safety and mine. Condom use is a given for us, so I'm not too worried about transmission that way. But I would like to get information on the risks associated with oral sex (no condoms, but also no swallowing) from both top and bottom positions. Also kissing, rimming, etc... where do I draw the line? Does an undetectable viral load (once the meds kick in) mitigate the risk of him transmitting the virus to me?

Also, I have chronic Hep B, so I want to be really careful not to complicate my own condition.

He is such a great guy and I really want to make this work, but need to understand the risks so we can negotiate appropriate levels of intimacy that we are both comfortable, and satisfied with. ...and can live with for the long haul in a monogamous relationship

Thanks

Response from Dr. Remien

Let me start by saying that it is good to hear that you and your partner are confronting these issues. And you have it right - it is important to understand the risks and then discuss and negotiate levels of physical intimacy that you can both be comfortable and satisfied with. Sex is not comfortable nor fun when there is anxiety and confusion.

If you read my responses to inquiries similar to yours you will note that I refuse to try and give people percentage of risk for specific behaviors. This is mainly because there is another Forum on this website (Safe Sex, Prevention and Transmission) that deals with these type of questions. Also, my concern is that couples figure out for themselves what level of risk they are comfortable with based on the uncertainty in the information that is available. Percent risk for specific behaviors is useful information at the population level. However, at the individual level, if transmission occurs in a couple as a result of a low risk activity, for example, for that couple the transmission was 100% - it happened! So while kissing or oral sex, especially without ejaculation is considered to be low risk, there is not zero risk and couples need to decide if they are okay with that. Similarly, while lower viral load is associated with lower transmission risk, transmission can still occur. Also, remember that a plasma viral load (blood test) is not the same as the viral load of genital secretions (e.g., semen), which can be different.

It is good that you are also concerned about your own chronic HEP B condition. Your partner should also be concerned about HEP B and other STDs which can further complicate his health status.

Please spend some time on the Safe Sex Forum on this website, keep on talking with your boyfriend, and have fun with each other.


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