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Terrified!
Dec 16, 2009

About 4 weeks ago, I had sex with someone who is HIV+. I was pretty intoxicated so I dont remember all the details and just going from what the guy told me. The first thing I remember is waking up and the guy is giving me oral. I let him continue and after a few minutes he sat on top of my penis without a condom. I then told him to stop and put a condom on. I think I was in him for about 1 minute unprotected. We continued to have sex with a condom for about 3-5 minutes at which time I asked him if he was safe and that is when he told me he was positive. I immedietly freaked out and stopped having sex.

I questioned him on everything he remembers from the night (we were both pretty intoxicated). He said that at night we made out and gave each other oral sex, rimming, and he put his head inside me and I immedietly took it out since it hurt too much. In the day when we woke up, is when he performed oral sex on me, inserted my penis inside of him for about 1 minute without a condom, and then we had sex with a condom for about 5 minutes. He also said neither one of us came at any point. I remeber there was traces of feces on the condom when we stopped.

Since I got back, I spoke to my doctor and he considered the exposure to be minimal so he put me on a PEP of Truvada alone. I have been taking it for 29 days and tomorrow is my last pill.

Obviously I am VERY scared about contracting HIV. I have since started to see a therapist to deal with the horrible anxiety I have as well as the guilt that I am experiencing for putting myself in a compromising situation where I did not have any control.

Since then, I have had a knot in my throat, which the doctor says can be due to anxiety or the fact that the day of I got violently sick from all the alcohol and scare and threw up for about 2 hours. I dont think any of my lymph nodes are swollen, they dont hurt when I touch them. I woke up the day after in a night sweat, but he also said it was probably due to anxiety. About 1 week later, I broke out with a few red dots on my penis, which he said could be herpes. I have had these before, so he thinks the stress might have brought on the outbreak. I did check my penis and mouth the morning of and I had no open soars on either.

Based on this information, what do you think are the risks? Will the PEP help reduce if I was infected? Is Truvada alone ok (I know it is too late)? Are the symptoms I am experiencing due to the anxiety and nerves?

Doctor is testing me in a couple of days, then again in 1 month, then again in 3 months.

Thank you so much for any advise you can offer. As you can tell I am so anxious, scared, and depressed about this whole situation.

Thank you!

Response from Dr. Frascino

Hello,

What is the true risk from oral sex? This is a somewhat difficult question to respond to, as there can be confounding variables. See below for some recent information from the archives. (By the way, we have an entire chapter in the archives devoted to oral sex. Check it out! My opinion that oral sex carries only a low risk for HIV transmission/acquisition hasn't changed.)

The medications you listed do not increase the HIV risk associated with oral sex.

Should you be obsessed with worry? No.

Dr. Bob

Oral sex/Magnetic Couple (TRANSMISSION VIA ORAL SEX) Jun 15, 2009

Dear Robert,

First of all, thank you very much for providing such great advice and information on this site. I am HIV-negative and have just recently started to date a guy who is HIV-positive. I am 29 years old and have only ever slept with one person, who was also negative. So as you can imagine, this has been a really emotional journey for me. I have not had sex with my current HIV positive boyfriend yet. I am waiting till I am informed on all of the risks involved, before preceding. I have been doing a ton of research online, and keep getting conflicting results. I really love him, and want to try to make this work. I also want to feel comfortable having sex with him. My question I had was regarding oral sex. How safe is oral sex without a condom and without the guy ejaculating in your mouth? I am trying to keep an open mind, but I cannot imagine not being able to have unprotected oral sex with my boyfriend. Using a condom for everything else is fine by me. Please shed some light on this situation for me. I am just trying to make good choices and have the knowledge before we start having sex. Thank you so much for your time.

Response from Dr. Frascino

Hi,

The HIV risk associated with oral sex is definitely a QTND (question that never dies). What we can say is that overall risk of HIV acquisition/transmission via oral sex is very low. An insertive partner has less risk than a receptive partner. Review the information in the archives. We have entire chapters devoted to oral sex, magnetic couples, HIV-sexual transmission, etc. Also, I'll post below a summary of recent information presented at medical conferences discussing the latest information on the HIV transmission risk related to oral sex. Many magnetic couples have decided the risks associated with oral sex are acceptably low and forego using condoms. Others try to adhere to an absolutely no-avoidable-risk policy and hence cover their penis popsicles before all oral action. Ultimately only you and your partner can decide how much risk is acceptable. Some risk-adverse folks never drive above the posted speed limit even if there isn't another car in sight for miles and miles. Others never wear their seatbelt and text while speeding on the freeway during rush hour. We all make calculated decisions about acceptable risk everyday. You need to do the same thing with HIV and oral sex.

Dr. Bob

TRANSMISSION VIA ORAL SEX

The risk of HIV transmission through oral sex has been a subject of debate since the early years of the epidemic. But the issue is difficult to resolve based on epidemiological studies, since most people do not limit themselves to a single sexual practice. As described in the December 2008 issue of the International Journal of Epidemiology, researchers from Imperial College in London undertook a systematic review to assess the risk of HIV transmission via "orogenital intercourse," both fellatio (on a man) and cunnilingus (on a woman).

The authors searched the PubMed database and bibliographies of relevant articles through July 2007. Out of the 56,214 titles searched, they identified ten potentially appropriate studies. Two additional studies were identified through bibliographies, and one was found through discussions with experts. Ten studies, all from North America or Europe, provided estimates of HIV transmission probabilities per partner, incidence per partner, incidence per study participant, and incidence per sex act. Only three were conducted after the advent of HAART, which suppresses viral load and therefore reduces transmission risk. Given the small number of studies, they did not consider a meta-analysis (in which data from all studies are pooled) appropriate.

Six studies reported no instances of transmission via oral sex. The four studies that reported non-zero estimates included per-partner estimates of 20% (in a small study with only ten participants) and 1%, one per-study-participant estimate of 0.37%, and one per-act estimate of 0.04%. "There are currently insufficient data to estimate precisely the risk from orogenital intercourse exposure," the investigators concluded. "The low risk of transmission evident from identified studies means that more and larger studies would be required to provide sufficient evidence to derive more precise estimates."

In a related study reported in the January 28, 2009, issue of AIDS, Swedish researchers sought to determine whether exposure to HIV via oral sex results in HIV-neutralizing antibody activity in the saliva. Saliva samples were collected from 25 HIV negative gay/bisexual men with positive male partners and from 22 low-risk HIV negative healthy male control subjects; 21 of the 25 HIV-exposed but uninfected individuals reported unprotected receptive oral sex and three reported unprotected receptive anal intercourse.

Saliva from both exposed uninfected individuals and low-risk control subjects exhibited HIV-neutralizing activity. However, a significant difference was seen for immunoglobulin A1 (IgA1), with 13 of 25 exposed uninfected individualsbut none of the 22 presumably unexposed control subjectsexhibiting HIV neutralization. Based on these findings, the researchers concluded, "Unprotected oral sex evokes a salivary IgA1-mediated HIV-neutralizing response that persists over time during continuous exposure in uninfected male partners of infected men."



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