HIV - Prevention Expert Forum
Needing help for a confused situation
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Needing help for a confused situation

I am a gay male. My quesiton involves a  few recent sexual episodes I had. I previously was in a year long relationship which ended around Dec 2012 and then resumed this week. In the span of that time, I had a "rebound" and started a short term relationship with another man. This relationship involved significant amounts of kissing, mutual masturbation and on a couple of occasions oral sex (both of us gave each other oral). No penetrative sex.

First, I  tend to have a history of canker sores in my mouth, not herpetic as far as I can tell.  I remember that I had one towards the mid-back of my mouth one of the times I gave this partner of mine oral sex. I did not take his ejaculate in my mouth, but I do remember tasting a small amount of pre-ejaculate. Given that I had a canker sore in my mouth that may have been actively bleeding and then contact of his seminal fluids with my sore, whats likelihood of any possible HIV transmission? A important detail is that he swore by his not having had any previous sexual encounter (men or women), and that he gladly agreed to test for an HIV reflex which came back negative.

The second question involves mutual masturbation. We did this on a couple of occasions as well and I do remember that our mutual seminal fluids were in contact with each others' genitalia at some point or another throughout the masturbating. One example is, after he had ejaculated, some of his fluids were partially on his hand and then used this hand to masturbate me. How likely is HIV transmitted in this scenario?

I'm only writing about this because I have resumed the year long relationship before this all happened and I would like to move foward in that relationship without worrying I am exposing my partner to any possible STIs. Since resuming, he has already performed oral sex on me. I will most likely re-test for everything at 3 mo., but I would like to hear form an expert if any of the above requires extra caution w/ regard to HIV or STIs.


239123_tn?1267651214
Welcome back to the forum.

Oral sex is considered safe sex with respect to HIV and other STDs; although not totally risk free, the chance of infection in either direction (oral to penis, penis to oral) is much lower than for unprotected vaginal or anal sex.  Experts remain divided on whether there is any risk at all from oral-penile sex, but all agree that if there is any risk, it is very low.  One calculation (by CDC) is that if one partner has HIV, the risk of transmission from an infected penile to oral partner is 1 in 10,000; and 1 in 20,000 in the opposite direction.  These numbers are equivalent to giving or receiving oral sex by infected partners once daily for 27 years or 55 years, respectively, before the transmission risk might be substantial.

Do open sores in the mouth, like canker sores, make any difference?  Maybe; nobody really knows.  But if they do, the increased risk if obviously small. Canker sores, wounds from cheek bites, inflamed gums, etc are exceedingly common, so there must have been millions and millions of HIV exposures in their presence -- and still no proved transmissions.

And of course getting semen or other secretions on the genitals, without penetration, also is exceedingly common -- yet no know transmission.  In any case, that kind of contact was explicitly addressed in my reply to your question almost exaclty 2 years ago (1/24/10), which included this:

"Safe sex means not putting a bare penis (i.e., without a condom) into someone's vagina, rectum, or mouth.  That's all.  Kissing, hand-genital contact, or exposure to genital secretions -- semen, pre-ejaculate fluid, blood, etc -- on the skin carries no known risk of HIV, even if healing cuts or skin lesions are presen."

All men who have sex with other men should have routine HIV/STD testing from time to time, e.g. once a year, even if there have been no apparent unsafe exposures.   And also before starting 9or resuming) a new committed sexual relationship.  So if you haven't been tested recently, this might be a good time.  But not because of the exposures you have described here.

Regards--  HHH, MD
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