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Trying to be real safe, not sure I am - risks? Freak out?
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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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Trying to be real safe, not sure I am - risks? Freak out?

Hi Doctor:

I am just looking for a little reassurance and help.  I am a gay man and am pretty freaked out about HIV.  I am a lot of anxiety about it so I just try to limit my sexual practices to things that would keep my risk low.  I don't "Hook Up" that much but when I do, I always ask my partners their status and if they have STDs - but I know you can't trust everyone as some people don't know or they are fine when they are really not.  If I practice anal sex (which is rarely do - maybe 2-3 times a year if that).  I am the top guy and I always wear a condom - to date, never had a condom break or fall off.  But what freaks me out is oral sex.  I do give guys oral sex but never to completion.  But I am sure I have been exposed to precum.  I have read giving oral sex is very low risk, but it still freaks me out.  Here are some questions I have for you.

1.  My doctor says condoms are only 65%-75% effective in intercourse - I thought it was a lot higher than that? My doctor is very conservative and very old school.  Like I said, never had one break or fall off. so that 25-35% factor freaks me out.
2.  Oral sex - some clinics say high risk some say minimal risk - especially without ejaculation in the mouth. I have even heard that it would rare to aquire HIV from giving oral sex without ejaculation.  Its such a gray area.  Do you always recommend condoms for oral sex - maybe I guess I should have my partners wear them.  But damn, how many gay men (or women) wear condoms for oral.  And if you ask them to wear one, they look at you like your a nut.  And its not like I let my partners ejaculate in my mouth - no one has ever done that.
3.  I get tested every year for stds - all of them.  It is such an anxious period for me.  I truly freak out, won't sleep for weeks before, and convince my self I am doomed.  I want to enjoy sex, but its like this little cloud hanging over my head.  Its not like I have ever had unprotected anal - but the oral thing just does a number on my anxiety.
4. Lastly, the testing center where I go does a risk assessment and tells me I should wear a condom always for anal/vaginal sex (which of course I do), ask my partners their status, don't have sex while under the influence (I don't drink) and thats it.  As they say everytime "It's a simple as that."  But yet, I get really anxious about HIV.  Their is such conflicing information out there about oral sex - you can call one HIV hotline and get one answer - call another and they tell you something completely different (California Aids Hotline says minimal risk, GMHC says a risk plain and simple).

I am sure anxiety plays a role in this.  But is it true that oral sex would be a pretty rare way to get HIV? And, on the very rare occassion I have anal sex and wear a condom (and its stays on and doesn't break) I shouldn't really freak out. I have now promised myself that I will now have my partner's wear condoms for oral sex.

Thanks for your time, Doctor.
Related Discussions
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Thanks to nsns for posting the thread from Dr. Bob's forum at thebody.com, which I saw a week or two ago.  I read his forum regularly.  Although Dr. Bob and I have different styles, in substance we agree virtually 100% about the risks of HIV transmission and prevention strategies for gay men and others.

It sounds like you are being very safe.  If you stick with your current program, you likely will go a lifetime without catching HIV.  The only thing you don't say is that you routinely ask your partners their HIV status and avoid sex with those who are positive or who are evasive about it.  As I have said many times, I consider that a central strateggy for gay men who are serious about avoiding HIV.

1) Condom efficacy can be defined several ways.  Correct and proper use is far closer to 99-100% effective against HIV for any particular exposure.  But "use effectiveness", in the population as a whole, always is lower. My guess is that your doc's 65-75% figure comes from contraception data:  probably about a quarter to a third of couples who rely on condoms as their only strategy to prevent pregnancy eventually conceive.

2) Almost nobody wears condoms consistently for fellatio.  Although there is a small risk to the receptive (giving) partner from unprotected oral (but virtually no risk for the insertive/receiving partner), health officials hesitate to even recommend condoms, because it doesn't pass the "laugh test".  The fear is that some people will react with "If I have to use condoms even for oral sex, I may as well not use them at all"--i.e., a negative effect on overall sexual safety.  So you're still quite safe, espeically without intra-oral ejaculation.  However, this is a circumstance in which I definitely think you need to know your partners' HIV status; and give no BJs (even without ejaculation) to the positives.  Or use a condom in those cases.

3) I don't think there is a question here.  Regardless of your anxiety, it remains wise for you to have HIV and STD testing on a regular basis.  Once a year sounds about right, given your risk level.

4) There always will be conflicting advice, especially when the data are uncertain.  In general, the most objective advice comes from disinterested parties, without a social (or joint medical/social) agenda.

I hope this helps.  Best wishes.  Stay safe--   HHH, MD
9 Comments
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Thought you might find this informative? I found this on the net

http://www.thebody.com/Forums/AIDS/SafeSex/Current/Q174878.html

Hi Doctor:

You are cute. Ok, on to my question. so many guys (gay) and woman (straight) give oral sex - thousands of times a day. Hardly anyone, ANYONE wears a condom or dental dam. I have givin oral a lot in my young life (27) but never to completion - i.e. no ejaculation in my mouth and probably a bit of precum. I have always, always, always (can I say always again) had protected insertive and receptive anal sex. No condoms breaking, ripping, slipping and always put in on right before going in (pretty close to zero risk? right?). Ok, now I decided I would take the very low risk of oral sex and make it lower - oral with a condom - to bring the very low risk to zero. Well, low and behold - no one will let me suck their ****! No one. I bet **** Cheney wouldn't let me go down on him (though I would rather suck Tony Soprano's **** than his). I tried a lot to have oral with a condom but so many guys say Forgetaboutit. Is oral sex without ejaculation really a minimal risk? can I not Freak out about it? I always check my partners dicks for sores, etc...I never take ejaculation in my mouth - but I worry - what if this person just got HIV and he is extremely infectious and a drop of his precum in my mouth will transmit the virus, would if he has an STD and some of the STD discharge gets in my mouth - I want to sleep at night and not worry, but try getting a guy to wear a condom for oral - never going to happen, never ever ever. So what is an oral boy to do?

Thanks for your time -stay cute, Doctor Steve is a hottie, too. Yum!




  Response from Dr. Frascino

Hello,

"Doctor Hottie???" Ah, I bet you say that to all the Sex-experts you want to butter up (lube up?) to answer your questions, now don'cha???

Oral sex on Cheney??? Gosh, you almost made me upchuck my lunch just with the thought of that unsettling image. Yuk!

I believe your independent research into the use of condoms for random blowjobs is probably fairly accurate. Most dudes just don't bother with them. I also believe your assessment of the risk of oral sex is also accurate "very low." It is not completely nonexistent, but it is indeed very low and if a latex condom was used, the very low risk could be reduced essentially to nonexistent. So why don't dudes do that? I actually asked a group of sexually active gay men that exact question in a support group. The vast majority did not use condoms for oral sex. Most said they knew or thought that the risk was so small as to not really matter. Others felt if they pulled out a condom it would scare off their trick, because there were so many other guys willing to suck them off without the raincoat in place. Some guys felt that if the guy wanting to do them tried to use a condom they would think the guy sucking them off "had something," rather than thinking the guy was just trying to be "extra safe." Of note was the fact that several very handsome guys in the group did say they preferred to use condoms with partners they had oral sex with on a regular basis. Some magnetic couples in the group also said they preferred to use condoms for everything they did, even though other magnetic couples said they used condoms only for anal sex, not for oral. One guy said he's conducted his own personal experiment by being a frequent visitor to a sex club that "specialized" in oral sex called Blow Buddies where he "eats at least a yard of ****" every weekend. He found most guys did not want him to use condoms, so he stopped trying several years ago. He's HIV negative and gets tested every month. He's had a few STDs in the interim, but continues to be HIV negative. He said he now considers spunk to be one of his four major food groups. I report all this merely to show you the reality of what's happening at least in a microcosm of the oral sex world. So, regarding the risk of HIV from oral sex, should you just "fuhgeddaboutit???" No, I would not suggest that. I believe there is indeed some degree of risk, especially if there are extenuating circumstances. Everyone needs to set their own safer-sex rituals to a level of comfort that allows them to enjoy sex. After all, sex is a wonderful invention, right? If you feel better reducing a very low risk to an even lower level of risk by using a condom for oral sex, you may have to search a bit harder for partners, but they do exist. The several guys in the support group who liked to use condoms happened to be total spunks!! Definitely the hottest guys in a room full of gym bunnies. No, I can't give you their names and numbers, so don't ask.

My ultimate advice is:

1. Stick to what you feel is safe or "safe enough" for your comfort level. Nothing kills the wonder of a post-sex afterglow quicker than worry!

2. Never, ever, ever, ever (you can continue adding lots of evers here) go down on **** Cheney's ****. We all know the man is more toxic than kryptonite.

Dr. Bob

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Dr. Bob is pretty informative and keeps things lighthearted.

The original poster asked a question regarding if the sex worker recently was infected with HIV. Is it true that if the woman (sex worker massuer) just recently acquired it could she become HIGHLY contagious and make it easier for the next customer to become infected with the virus? For example if her newly infected vaginal fluids came into contact with a cut on a finger or irritation on the penis shaft skin that was exposed? Thanks Dr.
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Doctor, just to clarify, I always ask my partner's (limited partners at that!), their status and their STD status.  However, what concerns me is they may not actually know or lie and say they are "ok."  God forbid someday if I ever gave oral to someone who was positive and they said they were negative but didn't know (keep in mind I don't allow ejaculate in my mouth) without a condom, would be risk be extremely high?  I read a roundtable dicussion online (USCF) and the doctors and experts their stated that it would be rare for someone to aquire HIV from giving oral sex without ejaculation.  I can assure you from this day forward I am using condoms for oral sex.  But, I will probably never get a chance to do since no one likes oral with a condom!  But who cares, I want to have as close to zero risk as possible.
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Good; I'm glad you're asking partners about their HIV status.  Of course some people will lie when asked directly, but most don't.  There's always the chance someone was infected since his last test, but most people who say they are HIV negative really are.

I didn't advise that you always use condoms for oral sex.  It's fine with me if you do, but probably not necessary.

To my knowledge, there are no data on risk of acquiring HIV from performing fellatio with or without intraoral ejaculation.  The UCSF round table participants probably were expressing opinion based on reasonable likelihoods, but probably not firm knowledge.

HHH, MD

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Dr. K from the SF Health Clinic says giving oral sex is very, very, very low risk.  And even oral sex with ejaculation is extremely low risk.  Dr. Bob also says its extremely low risk.  If its so rare to get hiv from giving oral - why do so many guys claim to have gotten that way?  I just throw that out there because I have read and heard many stories that guys have performed oral on another guy and the gay say's "well, sorry I am actually pos and was afraid to say anything."  I wish sex wasn't so scary.  One bj with no ejaculation can do you in I guess.
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Yes, there is a possibility of acquiring hiv or any other std by unprotected oral but of course the risks are minimal but not 100% safe. Nothing ever is. Thats why you see antibacterial soap commercials claiming they kill 99.9% of bacteria. You never see them claim it kills 100% because there are never any guarantees in life.

Your risk of catching hiv by giving oral (fellatio, cunnilingus) to an hiv infected person is higher if you have an open cut or sore in your mouth and the infected fluid (seminal pre-***, full ejaculate, vaginal fluids) comes into contact and enters through your open sore, cut, etc. in your mouth. You can also acquire a number of other STD's that are more common and easier to get than HIV. But going down the list of possible ways you can get HIV through sexual contact, oral sex is on the bottom of that list with unprotected anal sex at the top. And the rule goes that the one giving oral is more at risk than the one receiving.
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"If its so rare to get hiv from giving oral - why do so many guys claim to have gotten that way?"

Personal testimony from infected persons about the source of infection is often unreliable, especially in people with multiple possible exposures (ie, most HIV infected gay men).  Their assumptions about the source of infection are simply wrong.  Others often are uncomfortable acknowledging overtly unsafe behavior; for example, it can be hard to admit to unprotected anal sex with unknown partners if you have been told repeatedly how dumb it is, or if you have spoken out against barebacking while still doing it from time to time.  People may give misinformation to protect someone else--not wanting to out the guy they really caught it from.  And of course, a few really did catch HIV by oral sex.  But don't you think it's interesting that few if any women claim they were infected by performing oral sex on guys?

Anyway, systematic epidemiologic studies are much more reliable indicators than personal testimony by word of mouth, from websites, etc.  And such studies consistently demonstrate that infection by performing fellatio is uncommon.  But the risk isn't zero--and although most people don't like the notion of condoms for oral sex, it does maximize safety.  At a minimum, nobody should ever suck someone without being confident he is HIV negative.

HHH, MD
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I had unprotected receptive fellatio with a gay guy of unknown status three months ago (no ejaculation). I got tested 9 weeks after the incident, and everything was neg. I am concerned about the state of my gums at the time, but am trying to think rationally in accordance with Dr. HHH's testing period reccemondations.  Am I correct in saying that as my exposure was low risk (1 in 10,000), I do not need another test post the 9 week neagatve?
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