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Risk of hiv transmission from precum during oral sex
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Risk of hiv transmission from precum during oral sex

Hi , during July 2013 I had flu like symptoms which lasted about 2weeks. I was tested for HIV at the beginning of August and the result was positive, viral load 90,000 but a cd4 count of 760. I started treatment on 15 august , taking truvada and stocrin.

I have two questions ,

1)Assuming the drugs work how long does it usually take to reduce the viral load significantly ? My next blood test is mid October.

2) what is the risk of passing on HIV, at this stage of my infection, if my partner (hiv negative) gives me oral sex and gets small amounts of my precum in his mouth, and I don't ejaculate and I am not not even close to ejaculating.
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

I'm sorry to hear of your HIV infection.  But I'm also very glad to see you are under care and on treatment with top-of-the-line antiretroviral drugs.  It is also good news that your initial viral load was modest (many people start out in the millions) and you started treatment before your CD4 count declined significantly.  The prognosis is excellent for very effective control of your infection.

Assuming your doctor is an infectious diseases specialist or otherwise highly experienced in HIV/AIDS management, his or her knowledge probably is as good or better than mine.  Of course you should ask him or her the same questions, if you haven't yet done so.  But here are my comments:

1) The initial response typically is quite rapid, and you can expect your October test to show a substantially lower viral load -- perhaps even undetectable.

2) Transmission of HIV by oral sex is rare.  Even without treatment, the average risk has been calculated, in a publication a few years ago by the US Centers for Disease Control and Prevention (CDC), at 1 transmission for every 10,000 events -- equivalent to daily exposures for 27 years before transmission might be likely.

That said, the CDC data did not take into account whether the infected partner had acquired HIV recently, viral load, or ARV treatment.  There also are no data on whether or not ejaculation in the mouth makes any difference.  Since it is likely your viral load has already declined significantly, my guess is that in the cirumstances you describe, your partner would be at very low risk, but I cannot venture a guess at the numerical probability.

As you may know, even with the highest risk sexual practices -- unprotected anal sex -- the risk of transmission is near zero in people on ARV therapy who have undetectable viral loads.  Undoubtedly the already low risk of transmission by oral sex would also be zero or close to it.  Anyway, my advice is that you and your partner use condoms, even for oral sex (and certainly for anal) until you know for sure your viral load has responded well to treatment.  It's probably only a month or so -- I'm sure you can stand the wait!

I hope these comments are helpful.  Best wishes for successful treatment--

HHH, MD
9 Comments
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Avatar_m_tn
Thank you for the helpful information.

Is it true that saliva in the mouth inhibits the transmission of HIV?
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239123_tn?1267651214
Yes.  This is believed to be one of the reasons that oral sex and kissing are very low risk for HIV transmission.
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Avatar_m_tn
Thank you once again

This may sound like a strange question , but is HIV that easy to contract in reality ?
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239123_tn?1267651214
This depends on how you define "easy".  If all the stars are aligned the wrong way (e.g., the infected person recently acquired HIV, is not on treatment, has a high viral load, the exposed person has HSV-2 and is uncircumcised, and you're speaking of unprotected anal sex) the transmission risk may be as high as 1%, i.e. one transmission for every 100 exposures.  That's high enough to sustain high transmission rates in men who have frequent anonymous sex with other men in bath houses, for example.  And there have been a few cases in which a single person transmitted HIV to 10 or more partners.  On the other hand, all these stars don't usually align in such a malignant way, and the average sexual encounter infrequently transmits HIV, even among persons in high risk groups, such as gay men with multiple partners.  Still, even a relatively low risk on a per-contact basis can translate into very high risk over time, with many anal sex contacts with many partners.
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Avatar_m_tn
My viral load is now confirmed as <20 and my cd4 count is 775. I am taking truvada and stocrin meds.
I have no stds .

I have met a guy who is negative, who I have become close to, he is a pure top (only wants to receive oral and to **** me) . I realise that I have to face up to telling him that I am HIV positive, but at this stage (we haven't had sex) haven't felt it appropriate or found the right moment to tell him.

He wants to have sex with me and I have told him that I will only have penetrative sex if he uses a condom which he is fine with.

Under these circumstances do I really need to tell him about my HIV status at this stage? I know that in a perfect world I should tell him , but if it just turns out to be a one night stand , so to speak, And we have had safe sex, is it really necessary to say given the very small risk of transmission.
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239123_tn?1267651214
Congratulations on a superb response to treatment.

With your very low viral load, the chance of transmission of HIV to your new partner is extremely low, probably zero. That would be the case even with unprotected anal sex, and for sure for oral sex.

However, you definitely need to tell him (all sex partners the rest of your life) about your HIV status.  Even if the the risk is zero now, you can't guarantee that your treatment might stop being effective.  Anyway, if your relationship continues, you can assume he will know someday.  How will he feel then?  And how will you feel about not having told him?  How would you feel if your situation and his were reversed?
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Avatar_m_tn
Thank you for your reply. It is of course my intention to tell my new partner, because for any longer term relationship to be successful it has to be based on openness and honesty ........but it is finding the right moment to do so and the fear of rejection that is daunting
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239123_tn?1267651214
Understood.  You might benefit from speaking with others about their experiences discussing HIV status with partners.  There are support groups for HIV positive persons in many communities, and probably online.  Try thebody.com, for example.
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