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Magnetic girl / girl couple
May 12, 2006

Hello DR Frascino,

Thank you for all the time you put into this website.

I am a lesbian who recently met a girl who is HIV positive. I am negative and would like to stay that way. (Like you and Steve) We are about to move towards a more sexual relationship. I am sorry if the following scenarios that I will describe are too graphic and / or offensive for you or some viewers of the forum but I am interested purely for my own information and piece of mind.

I would like to get your opinion on the risks of transmission in the following sexual scenarios.

1) Mutual kissing / rubbing / inserting fingers (into vagina)

2) Oral sex (both receptive and giving) - are 'dams' effective in prevention?

3) Using a double ended dildo obviously simultaneously? Is it best to just mark both ends and not to swap ends?

Thank you for your help.

Rhianna.

Response from Dr. Frascino

Hey Rhianna,

Cool name!

Scenarios too graphic and/or too offensive for me or this forum? Nah. I think that may be almost impossible. Just check the archives and you'll see what I mean!

To specifically address your questions:

1. No risk, assuming no open wounds on the skin of the fingers doing the walking through the love canal.

2. Latex dams are indeed protective. HIV cannot permeate intact latex. No way. No how. Unprotected cunnilingus carries a very low risk for HIV transmission. I'll repost a question from the archives that addresses this point. (I know it involves guy-gal action, but the risks are the same.)

3. No risk as long as you do not swap ends. I'll reprint a post form the archives that discusses sex toy safety as well. (Yeah, I know it's not a double-ender, but the same info still applies.)

Regarding general information about sex and sexuality as it relates to HIV, I suggest you read the "Sex and Sexuality" chapter at HIV InSite (http://hivinsite.ucsf.edu/InSite?page=md-daily-sex). Again, I apologize that this is hetero-orientated information, but I still think you'll find it helpful. I also suggest you read through the archives of this forum pertaining to "magnetic couples."

Good luck.

Dr. Bob

Woman risks--Please help! I need some sex! Mar 29, 2006

Hi.

I am a woman and my potential partner is a - man. I read in a magazine at my doctors office that the risk of infection for a neg man from a pos woman is ridiculously low with both vaginal intercourse and oral sex, assuming no sores, rough play, etc.. I was diagnosed about 6 months ago w/ AIDS (not just HIV) but I am now healthy my viral load in undetectable.

Specifically, how safe is oral sex without protection--me giving it to him, him giving it to me, assuming, again, no sores, cuts, vampire action going on?

Also, I realize the infection risks are very low for sex if we are careful w/ condoms, and I have already read the other responses and can see that oral risk is low too, but can you reccommend a place I can get actual statistics? Or can you just tell me? Because although this question may have already been answered, I have not been able to find it in this forum or the mixed couples forums or any other on this website. I have already searched. And searched. And searched. I have found conflicting info on this website--yes I have--and whenever I almost find what I'm looking for, in the end you guys say "search blah blah blah forum". Which, again, I already have. I have spend hours, days, months searching and I am about to have a breakdown! Your advise seems closest to what I need. Besides sex.

Please help!

Response from Dr. Frascino

Hello,

I would not agree with what you read in that magazine pertaining to the risk of an HIV-negative guy contracting HIV from an HIV-positive woman through (unprotected) vaginal sex. "Ridiculously low???" What???

As for your searching and searching and not finding information about estimated HIV-transmission risk, I can't believe you were searching all that hard. I just did a quick search and located about a gazillion posts with the information clearly spelled out. But, nonetheless, here it is once again:

1. Latex condoms are protective for all types of sex if used properly and they don't fail. HIV cannot penetrate, permeate or cha-cha-cha through intact latex. No way. No how.

2. The estimated per-act risk for acquisition of HIV from unprotected insertive penile-vaginal sex with a partner confirmed to be HIV positive is 5 per 10,000 exposures. (This is not "ridiculously low" by any standard!)

3. The estimated per-act risk for the acquisition of HIV from unprotected insertive oral sex (i.e. HIV person performing oral sex on HIV- man) is 0.5 per 10,000 exposures.

4. There are no published estimated-risk statistics for cunnilingus. The risk is extremely small. You can read my comments about that in the post from the archives (below).

Finally, regarding "actual statistics," please note what we are quoting are estimates based on epidemiological studies. The best way to think about HIV risk is to first decide if there is a risk and if so, then to decide if the risk is high (unprotected receptive anal), medium (unprotected vaginal) or low (oral sex). To get more detailed than that isn't really all that helpful.

However, if you insist on fact and figures, I'd suggest you review the HIV InSite Knowledge Base chapter on safer sex. It has over 124 references and lots of statistics for you to ponder. The site can be accessed at http://hivinsite.ucsf.edu/InSite?page=kb-07-02-02. If that doesn't satisfy your info quest, I suggest you "search blah, blah, blah forum," OK?

Dr. Bob

Oral Sex and HIV Feb 18, 2006

i have just stumbled on this site, and would like your opinion, on jan 1st 2006 i had protected vaginal sex with a prostitute, but i performed unprotected oral sex on her, before i performed she whiped her virgina and when performing oral sex i could taste no secretion or menstural blood, immediately afterwards i realised what a rediculous thing i had done and became increasingly paranoid about the possibility of HIV infection, on the 3rd of Jan i started on 28 PEP course, what do you think my chances of having HIV are, alot of other sites i have been on say Cunnilingus is Low risk, some say no risk, quantatively what is this risk? i am due to go for an HIV test at the end of march and am petrified of the result, many thanks

Ben C

Response from Dr. Frascino

Hello Ben,

She "whiped her virgina?" Would that be "whiped" as in whipped or "whiped" as in wiped? And would that be "virgina" as in Virginia or "virgina" as in vagina? I would assume "whipped" and "Virginia" are out, because nothing kinky ever happens in that state. The risk of HIV transmission from cunnilingus is extremely low. I'll post a question from the recent archives that addresses this problem. (See below.)

I do not believe PEP was warranted for your potential exposure. There is no reason to be "petrified" of your HIV test results. I see nothing but good news heading in your direction. I suggest you begin practicing your WOO-HOOs!

Good luck.

Dr. Bob

Cunnilingus - no blood, good oral healt Jan 12, 2006

Dear Dr. Bob,

Just sent a donation of 200 dollares - thanks fo you help - people need it and now i feel i need too You had answered a number of questions related to the risk of cunnilingus. I was engaged in one 2 months ago but no blood was involved and my oral helth is ok. The experience was with the mistress and when i asked her afterwards she told me she is DD free .What concerns me that you mentioned once that the probability of getting HIV in this case 0.5 per 10000 cases. doest it mean that there is 1 possible transmission in 20000 cases. a number of cunnilinguses given is much more then that and there are no documented cases so far. How do these 2 things reconcile? I am still concerned although i understand i should not be....you know... How is it possible generally to get HIV via giving cunnilingus in case when there is no blood and my oral health seems to be in order. Appreciate your reply. I have another general question re the symptoms... It seems that in case there are symptoms there are ususally more then one should be present based on the statistics you posted earlier. Appreciate your reply Thanks for the help

Response from Dr. Frascino

Hello,

The estimated statistical per-episode risk of 0.5 per 10,000 exposures for unprotected oral intercourse refers to fellatio (oral sex performed on a man), not cunnilingus. The cunnilingus figure would be much less. In fact, it's so small it's difficult to quantitate. There are only very few cases of HIV transmission resulting from performing oral sex on a woman that have been reported to the CDC. Considering we've been monitoring this epidemic for over two decades, that alone is excellent evidence that the HIV-transmission risk through cunnilingus is extremely low. There are a number of scientific hypotheses as to why this is true, but the bottom line remains the same: it's an extremely low-risk activity. (Note: the risk increases if the woman is menstruating and/or the person performing cunnilingus has oral mucous membrane sores, abrasions or inflammation.)

Regarding your second question, ARS can be quite variable in scope, number and severity of symptoms. However, yes, generally more than a single symptom is present.

Thanks for your generous donation!

Stay well.

Dr. Bob

Vancouver question (Dildos)

Apr 24, 2006

Dr bob, your forum is excellent. I wish to support it on a regular basis. Question first. On Feb 28, I had shared a anal toy with a male bi-sexual sex worker.it was used on him first then taken out for about 1 min then inserted into me for the next 20 mins or so. I had 2 hiv test done so far but all negative. VDRL was negative too. Hep C is negative too. I am having some symptoms like small sores in mouth and tongue. Ocassional chills, some occassional headaches, a few episodes of drichea, increased pinkishness on my face or cheek areas. Fatigues as well. I am going to get my test done right when i reach the 3 months anniveasry of the exposure. Dr bob can u please let me know the risk involved here of getting hiv.I am dead worried,,,once i am negative,,i will scream yahhooo and send u a big big donation. Thanks a million.

Response from Dr. Frascino

Hello,

Although I don't know what "a few episodes of drichea . . ." are, I would say your two negative HIV tests to date are encouraging, but not conclusive. I agree you should have a three-month test to get a definitive result.

Sex toys should not be shared without proper cleaning between uses. I also recommend using a condom on sex toys that are shared. I'll repost below a question from the archives that addresses safe sex toy use.

Thanks for your willingness to make a donation (www.concertedeffort.org). I'll send my good-luck karma that your three-month HIV test remains negative.

Good luck!

Dr. Bob

Dr. Bob, Help set the record straight on Sex Toys Sep 21, 2004

Dr. Bob,

I recently bought some anal sex toys (2 rubber plugs and 1 set of jelly beads) and got a little freaked out that maybe they had been used before (although I don't know nor do I have any proof they ever were used). The packaging was a little messed up and I thought I saw a hair on one of the plugs (perhaps it was one of mine from the initial handling). I did a pretty thorough visual exam of each toy and they didn't appear to have any fluids or wetness to them, However, to be safe, I did not use any of the toys for an initial 30 hours and during this 30 hour period I thoroughly washed each toy 4 separate times: twice with antibacterial soap (Triclosan) and twice with regular Irish Spring Bar Soap and let them air dry after each of the 4 washings. I also used fairly hot water (about 50 C to 60 C) for at least one of the rinses. I then used the toys but got freaked out when many of the sex toy sites said that rubber and jelly are porous and can't be sterlized. If the toys had been used before, and given my initial cleansing methods, did I just engage in a potentially "High", "Low", "Extremely Low", or "No Risk" event? Should I be tested for HIV?

J. J.

Response from Dr. Frascino

Hello JJ,

Wow, if you are that rigorous about cleansing a brand new sex toy, I can only imagine what you must do to a brand new boyfriend before having nookie with him. Is it true you sent your last boyfriend through a carwash three times strapped butt naked to the hood of a Hummer before you let him give you a hummer? And the boyfriend before that was stuffed into an industrial-strength front-loading washer with an extra dose of chlorine (water temp. 60-75C and) and then tumbled dried before you let him stuff and tumble you in bed??? OK, enough about making "dirty" boys squeaky clean. Let's talk about sex toys. Sex toys would pose an HIV risk only if the person using the toy before you was HIV positive and got some of their blood, pre-cum, semen, post-cum, or vaginal secretions on the toy, and the toy was used almost immediately after the infected person used it, and the infected person's body fluids had direct access to your mucosal surfaces or bloodstream. As you can see, your story does not meet these criteria.

It's surprising that some folks are fearful of contracting HIV from sex toys purchased new from adult stores. Do you really think it's likely someone else would have previously used that exact item??? Even Nordstrom wouldn't accept butt plug returns! And remember, the toy would have had to be used immediately before you. In essence, there is no risk of contracting HIV from new toys just purchased from a store. OK?

Now, just to be complete, I'll mention that to prevent HIV transmission when toying around with sex toys, simply wash the toy with soap and water immediately after you use it (and before anyone else uses it). You can, of course, also wash the toy immediately before you play with it. I would definitely consider the four washing cycles lasting 30 hours that you had with your new jelly and rubber friends to be excessive foreplay.

So, was your risk "high, low, extremely low, or no???" Hopefully by now, you know it's no! No? Yes, it's no!

Should you be tested for HIV? No. No risk means no reason to test. By the way, just how much money do you spend on cleaning products in an average month at your house?

Stay well J.J.

Dr. Bob



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