kissing and hiv

[Diego2010]

Hi doc,

I engaged in deep kissing with a girl of unknown status. At that time i had esophagitis A. I'm affraid i've put my self at risk if she had some blood in her mouth at the time we deep kissed. And if she had high viral load? How much blood would be needed for the infection occurs?

After 12/13 days i've developed a sore throat that lasted for 4 days and a small herpes simplex on my lips. I didn't measured it but i think i didn't have fever. No rash. Do you think only sore throat and a small herpes simplex on the lips could be ARS symptoms?

Do i need testing?

I know you say kissing is no risk and i believe you but i would like to understand why it is no risk. I'm confused because:

a) If blood gets in contact with the mucous membrane inside the mouth doesn't it poses a risk?

b) Why there is some risk (even low) for the person that performs oral sex and there is no risk for deep kissing? What is the difference? Shouldn't the risk be the same if there is blood present in the mouth of the infected person?

c)Why we say there is no risk if there are no studies just to rule out the risk of deep kissing? Isn't true that in serodiscordant couples in treatment the risk of transmission is low because of low viral load? So how can we take conclusions from studying those couples? And isn't true that is difficult to isolate deep kissing as the only possible risky activity performed by a couple?

Sorry to post a question that never dies. I just want to understand why kissing is zero risk. I know saliva have properties that inactivates hiv but is this the only reason? Does saliva inactivates all virus present in blood?

I've read that a certain amount of blood is needed for transmission to occur. But how much blood?

Thank you!

[Dr Sean Cummings]

Hi Diego,

I'm going to ork my way through the points beneath - I'm going to place my reply in CAPITALS so that it is clear where your question begins and my answer begins.

Do i need testing?

NOT FOR HIV

I know you say kissing is no risk and i believe you but i would like to understand why it is no risk. I'm confused because:

a) If blood gets in contact with the mucous membrane inside the mouth doesn't it poses a risk?

WELL YES, THEORETICALLY, BUT IT SEEMS THAT A) SALIVA IS HIV INHIBITORY SO SALIVA FOR BOTH PARTIES WOULD REDUCE THE EFFECT OF THE HIV B) TINY AMOUNTS OF BLOOD WOULD BE LIKELY SECRETED THIS WAY AND WOULD BE UNLIKELY TO BE SIGNIFICANT.

SO WHILST THINGS ARE THEORETICALLY POSSIBLE, THEY DO NOT ACTUALLY OCCUR - I COULD FOR EXAMPLE BE GEORGE W BUSH'S LOVE CHILD WITH A WELSH WOMAN - WHILST THEORETICALLY POSSIBLE IT IS MOST UNLIKELY.

b) Why there is some risk (even low) for the person that performs oral sex and there is no risk for deep kissing? What is the difference? Shouldn't the risk be the same if there is blood present in the mouth of the infected person?

THERE APPEARS TO BE NO RISK AT ALL FOR THE PERSON BEING SUCKED. THE PERSON SUCKING - THE SUCKER - IS AT SLIGHT RISK IF THERE IS BLEEDING AND OR EJACULATION OF HIV POSITIVE SEMEN

c)Why we say there is no risk if there are no studies just to rule out the risk of deep kissing?

INTERESTING POINT BUT ITS ONE OF THOSE "NO BRAINER" QUESTIONS - WE KNOW THE ANSWER ALREADY. CERTAIN TYPES OF SEXUAL ACTIVITY HAVE AN ESCALATING RISK - KISSING IS NOT ONE OF THEM.

Isn't true that in serodiscordant couples in treatment the risk of transmission is low because of low viral load?

NO. IN TREATED COUPLES WE THINK THAT THE REASON FOR LOW TRANSMISSION FROM AN HIV POSITIVE TO AN HIV NEGATIVE WHERE UNPROTECTED SEX OCCURS IS BECAUSE OF 1) LOW VIRAL LOAD INDUCED BY THE MEDICATIONS AND 2) OTHER FACTORS SUCH AS THE LOW RATE OF OTHER STD'S OR STI'S WITHIN THESE GROUPS. FOR THE MAJORITY OF MY HIV POSITIVE PATIENTS IN SERODISCORDANT RELATIONSHIPS, CONDOMS PREVENT TRANSFER.


So how can we take conclusions from studying those couples?

ANSWERED ABOVE

And isn't true that is difficult to isolate deep kissing as the only possible risky activity performed by a couple?

YES BUT WE HAVE BEEN ABLE TO ISOLATE ACTIVITY IN OTHER AREAS AND TO ASCRIBE A NUMERICAL RISK TO THEM. KISSING, DESPITE YOUR ENTHUSIASM TO PERSUADE ME OTHERWISE, IS NOT A RISK

Sorry to post a question that never dies. I just want to understand why kissing is zero risk. I know saliva have properties that inactivates hiv but is this the only reason? Does saliva inactivates all virus present in blood?

I've read that a certain amount of blood is needed for transmission to occur. But how much blood?

A LOT - UNSATISAFCTORY ANSWER I KNOW BUT C'EST LA VIE.

[Vance2335]

Read what hs been written to you.

"WELL YES, THEORETICALLY, BUT IT SEEMS THAT A) SALIVA IS HIV INHIBITORY SO SALIVA FOR BOTH PARTIES WOULD REDUCE THE EFFECT OF THE HIV B) TINY AMOUNTS OF BLOOD WOULD BE LIKELY SECRETED THIS WAY AND WOULD BE UNLIKELY TO BE SIGNIFICANT.

SO WHILST THINGS ARE THEORETICALLY POSSIBLE, THEY DO NOT ACTUALLY OCCUR - I COULD FOR EXAMPLE BE GEORGE W BUSH'S LOVE CHILD WITH A WELSH WOMAN - WHILST THEORETICALLY POSSIBLE IT IS MOST UNLIKELY."-Dr.Sean

[Diego2010]

Sorry Doctor,

Now i'm scared to death. You said that a sore throat alone may be a manifestation of hiv seroconversion and i had it at 12/13 days after deep kissing the girl.

Don't you think i sould test?

[Dr Sean Cummings]

Hi Diego

I'm sorry matey but I can't answer the first of these questions - its too bizarre.

With respect to the sore throat, yes, of course a sore throat alone MAY be a manifestation of HIV seroconversion - but it is unlikely to be on its own.

best wishes, Sean

[Diego2010]

Can I say that if enough blood needed for transmission to occur had passed to my mouth i would have noticed? Even if i was aroused during the kiss?

And regarding sore throat. If it appears without other symptoms can not be considered an ARS symptom?

Thanks.