HIV Oral and Rimming

[paul82_uk]

Hi,

I suffer from crohns and take the immunosuppression azathioprine.

I engaged in oral sex and rimming (received and gave) on sunday morning (3am)  male-to-male. I do not know the hiv status of the other male. There was no ejaculation form him or me was I at risk and what level? Also should I get PEPSE for this exposure it is less then 72 hours.

In addition dose being on an immunosuppression such as azathioprine increase your risk of HIV or other STD?

Any advice or guidance would be appreciated.

Thanks in advance
Paul

[H. Hunter Handsfield, M.D.]

Thanks.  I'm not sure of BASHH's sources, but most such data are dependent on infected persons' beliefs about when and where they were infected, which often are wrong.  Most people with HIV have multiple potential exposures, and being certain about which one was the source can be difficult.  In any case, you summarize the conflicting information very well. Dr. Hook and I are among those who have never seen (or personally heard of) any patient with confirmed HIV acquisition through oral sex.

But there really isn't much conflict.  There no important difference between "it never occurs" and "it happens but extremely rarely".

That should end this thread.  Take care.

[paul82_uk]

The figures of 0.04% and 0.09% came from the BASHH guidlines. There's a lot of confusing information for various sources.
Some say there is a risk of HIV transmission through oral sex. Where some say the is zero risk or that the chance is so low it may aswell be zero. This is all with regards to the person performing the fellatio. Also a number of medical professionals have stated that they have never seen HIV positive result from the the act of oral sex (Dr Sean & Dr Jose from freedom health and med help)

[H. Hunter Handsfield, M.D.]

Your partner's geographic and ethnic origins don't make any obvious difference, but meeting a partner in a bar and having sex the same night is certainly a high risk behavior.  

The data show that even with the assumption that a partner is HIV positive if no information is exchanged, asking and knowing about HIV status is associated with reduced risk of HIV transmission over time.

I cannot vouch for the transmission risks you quote.  If 0.04 and 0.09 mean 4% risk and 9% risk, respectively, they are obviously wrong.  0.04% and 0.09% are more plausible but still are too high according to most analyses.  Where did you get those figures?

[paul82_uk]

The oral sex took place at his apartment, and we met in a local mai stream gay bar which was the first time of meeting

[paul82_uk]

apologies, the other male was white from northern ireland had lived in mainland uk for 8 years.

HIV was not discussed he did mention use of condoms for intercourse.  But the night went no further then the oral sex and rimming, and was no ejaculation from either party.

There was a packet on the side that contained condoms and lube which is from a well established HIV outreach prevention service for the gay and bisexual community.

I understand that if HIV is not discuss always go on the side of caution that they are more likley to be positive more so then negative.

i understand for oral sex the risk of transmission is 0 to 0.04 and 0 to 0.09 for mucous membrane exposure.

I shall however speak to a health advisor and have a HIV test within 1 month followed by a 3 month one for confirmation.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

It would be helpful to know more about your partner, i.e. where and how you met and where you had sex.  But anonymous sex between men, without exchange of HIV testing information beforehand, suggests a pretty good chance he had HIV.

However, oral sex is safe sex.  Not zero risk, but one analysis by CDC, the US federal public health agency, suggests that if one parter has HIV, transmission occurs once for every 10,000-20,000 penile-oral exposures. That's equivalent to giving or receiving oral sex with an infected partner every day for 27-55 years and maybe never getting infected.  Oral-anal exposure is not known to transmit HIV; if it happens, it is probably just as rare as for oral sex.

Some STDs (but not all) can be transmitted by oral sex or rimming, and the risk is higher than for HIV.  But still the risk is low -- much lower than for anal or vaginal sex, for example.  The highest risks here probably are for gastrointestinal infections and hepatitis A, from the oral-anal exposure.

Your azathioprine treatment or your Crohn's disease will have no effect risk of catching HIV or other STDs, or on reliability of HIV test results.

My "advice and guidance" are:

First, please get in the habit of asking your partners about their HIV status, and sharing your own, before you have sex.  Although you had safe sex with respect to HIV, intentions for safety sometimes go by the wayside in the heat of the moment.  No man should ever have sex with another man without first discussing and sharing HIV status, and either avoiding sex entirely with partners who are positive, don't know, or give evasive answers -- or at least being extra certain about safe sex with them.

Second, you definitely don't need PEP after an exposure of this sort.

Third, all people sexually active outside mutually monogamous relationships should have routine STD/HIV testing from time to time, like once a year.  On that basis, if you haven't been tested recently, this would be a good time.  But as far as this particular sexual encounter is concerned, testing is optional.

Finally, the UK GUM clinics are among the world's best sources for expert HIV/STD care and prevention services.  Your nearest GUM clinic would an ideal resource for HIV/STD testing.  In addition to HIV and garden variety STDs, ask about vaccination against hepatitis A and B, if you haven't been immunized.

I hope this helps.  Best wishes--  HHH, MD