cunnilingus

A simple question: why the cunnilingus is considered sure, and the insertive vaginal intercourse is considered at risk?
It is very frequent having small cuts in mouth (for example, after to have washed the teeth): why the active subject doesn't risk?
It seems more risky that, than a vaginal insertive with a skin-intact penis.
What do you think about it?

[robespierre]

In other terms: these vaginal secretion are really able to infect?
If the answer is yes, I think that licking vaginal secretions is like lickin blood.
And, if the answers is yes, who could make a cunnilingus without any fright?

[robespierre]

Thank you.
If, as we all know, "the risk for fellatio (oral sex performed on a man) has been documented to be 1/10,000 and surely cunninlingus is NOT higher than that", I desume that a contact with vaginal secretion (with tongue or with penis...) is a close-to zero risk.
And I desume also than 5/10000 risk for insertive vaginal sex is very overvalued.
Do you agree with me?

[WorriedUS]

RP,

Type in "insertive vaginal sex" in search bar, and you will get the following link to a past question asked by a forum user to Dr. H. It is titled "Condom use and hiv infection statistics on insertive vaginal sex".  Dr. H addresses insertive vaginal sex here.

But regarding your cuts on your penis and insertive vaginal sex (risk = 5/10,000), it is theoretically possible, but NOT likely.  (being struck by lightning is ALSO theoretical, but NOT likely). You should read another post on 11/06/06 (today) titled

"Once and for All, What would be necessary for transmission to occur. - Chrispus 11/05/2006 ".  

Granted this post has to do with insertive oral sex (risk 0.5/10,000), but Dr. H answers the penis would have to have like OPEN lesions such as those resulting from Herpes, the other person's viral lode would have to be HIGH, the blood (and he says a LOT of blood) would have to be massaged into the lesions. Even then, it would be highly unlikely.  Dr. H said the following "Manual contact with vaginal secretions isn't a high enough risk to worry about."  

Secondly, cunnilingus is VERY safe.  In the 20+ years that Dr. H has been assessing the risk of STDs in his clinics, he has NEVER documented a case by way of cunnilingus.  

See the link to the table I've posted below. The risk for cunnlingus is SO low perhaps (I am simply surmising) that it is not even documented as oral sex by AEGIS.  This table has been made by the Aids Education Global Information System, (extremely reputable, and well-reknowned organization).

http://ww2.aegis.org/pubs/mmwr/2005/r402a1t1.gif

The risk for fellatio (oral sex performed on a man) has been documented to be 1/10,000 and surely cunninlingus is NOT higher than that. If it is, it is not MUCH higher.

-----------------

Finally, RP, HIV just has to have HIGH risk probability factors for transfer, on some on a cumulative basis. Like Blood transfusions are 90% chance of infection with an HIV+ person, but receptive anal sex with a known HIV+ person would require more than a few exposures and instances for the risk to be enhanced.  It has to do with probability and that is not my field, but the way Dr. H explains it, I am sure he would say that is correct. So even though this is my conjecture, and perhaps you might be better off to study Dr. H's responses to other forum questions or posting your question in the HIV prevention forum once. Hope I answered your questions.

-WorriedUS

[robespierre]

Has anybody something to say about it?

[WorriedUS]

This is what the doc said in early 2005 regarding cunnilingus.

"STD transmission from female genitals to a person's mouth by cunnilingus has never been shown to occur, to my knowledge. Granted, this hasn't been studied much--but the reason it hasn't been studied is that it seems to be too low risk to make it worthwhile to do any research. It stands to reason there is a risk of herpes transmission, if the woman has genital HSV infection, and perhaps HPV (but HPV of the mouth never causes symptoms anyway). Syphilis also clearly is possible but rare. If there is some tiny risk of chlamydia, gonorrhea, syphilis, or HIV, the risk is too small to worry about (or for you to be tested). The symptoms you are experiencing almost surely are unrelated to the exposure you describe, except indirectly through anxiety.

As I have written many times in this forum, when a person suspects his or her own symptoms are due to anxiety, usually they are right. But since HIV is what you seem to be worried about, get tested; the negative result probably will be more reassuring than anything I can say. (Search the forum for "time to positive HIV test for many other threads about when to be tested.)

Best wishes-- HHH, MD"

This answer can be found in the STD forum and is entitled "what can be transmitte orally?" posted initially by forum user dsc1212 on 08/09/2005.  

You can also type in "time to test positive HIV" and look for the answer there.

Good luck!

-WorriedUS

[robespierre]

Dear friend,
I thank you for the links.
But the question remains: why vaginal secretion are zero-risk in cunnilingus, and at risk (even low) in vaginal insertive?

[WorriedUS]

Check this thread in the HIV prevention forum entitled "Oral - a couple of new questions" dated 09/26/2006, initiated by forum user idiotic999.  Dr. H. answers the following.  But DO read that thread. Dr. H has some good answers on "little" or "no" risk.:

----------------
" [there] aren't a lot of STDs, including HIV, that infect or are transmitted from the external genital organs of women; and in general STDs are most efficiently transmitted by sex that involves penetration. And in HIV infected people, saliva generally does not contain HIV in amounts high enough to transmit the infection."

----------------

Doc doesn't clearly talk about vaginal secretions, but my guess would be the same as his assertions on saliva, that the vaginal secretions do not have enough of the virus for an efficient transmission (although definitely more than in saliva).  And coupled with the fact that the route to the penis is also inefficient (urethra), vaginal sex is really inefficient.  

There is a new study done that shows that uncircumsized men might be more at risk for vaginal sex, but that test is yet to be duplicated and confirmed.  

But I would NOT spilt hairs.  if you're worrying. just get tested once at the 6-8 week mark.

Good luck!

-WorriedUS

[Worried_in_the_MW]

Here is your answer. I cannot take credit for all this research.  
Let me know if you have any questions after reading this.

Cunnilingus does not pose a significant risk for HIV for two main reasons.

The first is the multiple HIV inhibiting properties in human saliva:
Human oral epithelial beta-defensins block HIV-1 infection

Last Updated: 2003-11-04 16:31:12 -0400 (Reuters Health)

By Megan Rauscher

NEW YORK (Reuters Health) - Researchers report that HIV-1 induces human beta-defensin (hBD) expression in normal human oral epithelial cells and blocks HIV-1 infectivity.

This may explain why transmission of HIV through oral secretions is uncommon and lead to ways to prevent HIV infection at more susceptible mucosal sites such as the colorectal and vaginal lining, said Dr. Aaron Weinberg from Case Western Reserve University. Dr. Weinberg led a Cleveland, Ohio-based team who reports their discovery in a "Fast Track" paper in the November 7th issue of the journal AIDS.

Natural antimicrobial hBDs are ubiquitous to mucosal linings, including the oral cavity, tracheal lining, the skin, the urogenital lining, and the gastrointestinal lining.

At mucosal sites other than the mouth, hBDs are induced only when the mucosa is injured. "In the mouth, they are induced above baseline levels always and we've discovered that there are certain organisms unique to our oral cavity that have the ability to induce these beta defensins," Dr. Weinberg told Reuters Health.

In their experiments, HIV-1 induced expression of hBD-2 and hBD-3 mRNA 4- to 78-fold, respectively, above baseline in normal oral epithelial cells. "These beta defensins, once induced, have antiretroviral activity," Dr. Weinberg said. "HIV-1 failed to infect these cells, even after 5 days of exposure," he and colleagues note in their report.

hBD-2 and hBD-3 appear to block HIV-1 replication by interacting directly with infectious virions and down-modulating the CXCR4 coreceptor.

"We have a hunch that the oral cavity is uniquely inherently resistant to HIV infectivity," Dr. Weinberg told Reuters Health. "And what we can learn biologically from the oral cavity may help us understand why other sites such as the colorectal and vaginal lining are so susceptible to HIV infection, comparatively speaking."

Ideally, he said, "if we can isolate the organisms from the oral cavity that induce beta-defensins, generate them recombinantly, and apply it to the susceptible sites, we can artificially and locally induce these beta-defensins under normal conditions to prevent prophylactically HIV infectivity." M o r e l i n k s a n d a b s t r a c t s :


STUDY SHOWS COMPONENT OF SALIVA IS VERY EFFECTIVE IN BLOCKING AIDS VIRUS

Potential for Use In Preventing Sexual Transmission of HIV

New York, NY (January 7, 1998) -- Research conducted at The New York Hospital-Cornell University Medical College has found that a natural component of human saliva has a very powerful effect in blocking the growth of laboratory strains of HIV as well as AIDS viruses taken directly from patients. This finding could lead to the development of natural inhibitors to HIV transmission. In a study published in the January 5 issue of the Journal of Experimental Medicine, Dr. Jeffrey Laurence, Director of the Laboratory for AIDS Virus Research; Dr. Ralph Nachman, Chairman of the Department of Medicine; Dr. Roy L. Silverstein, Chief of the Division of Hematology-Oncology; and a team of biomedical scientists describe how they have identified a natural sugar-protein, concentrated in saliva, known as TSP (thrombospondin), and discovered its remarkable ability to block the growth of the AIDS virus. Recognizing that over the past years several labs have found a variety of substances in human saliva that partially inhibit the growth of HIV, Dr. Laurence and his research team delved further into this phenomenon.

Dr. Laurence said, "We began by exploring why there is so little HIV virus in saliva, while large amounts of the virus are found in other body fluids; and why human saliva is so effective at blocking the growth of the AIDS virus in the test tube. This led us to the discovery of TSP." According to Dr. Laurence, "We made the observation that thrombospondin type 1 (TSP-1) can block HIV-1 infection of primary human cells and transform human cell lines of T lymphocyte and monocyte lineages. TSP is effective against both laboratory-adapted strains of HIV-1 and HIV-1 patient isolates. It is active at physiologic concentrations. Saliva experiments indicate that TSP-1 is a major component of the natural HIV inhibitory capacity of saliva." TSP is of particular interest as a natural inhibitor, as others have shown that it may promote wound healing, and suppression of some bacterial infections. Higher levels of TSP in the saliva of some male, as opposed to female, animals may relate to the more frequent wounding of male animals. Wound licking, with application of saliva molecules that could inhibit infection, would then be very beneficial. Speaking of the application of this research, Dr. Nachman said, "This is an exciting finding that is another step forward in our research efforts aimed at preventing AIDS transmission. TSP derivatives could potentially be used vaginally, rectally and orally in condoms, foams, suppositories, mouthwashes and toothpastes to inhibit transmission of the AIDS virus."

While TSP is a very large molecule that would be unwieldy to use directly in patients, the Cornell research team also investigated the mechanism of action of TSP. They found that peptides -- small pieces of the larger TSP -- could block binding of the AIDS virus to its receptor on immune cells. This offers the potential for direct use of these smaller molecules to prevent sexual transmission of HIV. Funding for this work was provided by the Dental, Heart/Lung/Blood, and Allergy/Immunology Institutes of the NIH.

Salivary HIV-1 Inhibitors
P.I.: Murray R. Robinovitch, Professor and Chairman, Department of Oral Biology, School of Dentistry, University of Washington

The specific aims of this study are to identify, isolate and characterize those non-immunoglobulin components of saliva that inhibit HIV-l infectivity and to elucidate their mechanisms of action. We found that adapted the multinuclear activation of a galactosidase indicator assay (MAGI) and the secretory leukocyte protease inhibitor assay (SLPI) for use in the studies. Of seven chromatographically separated components of saliva, those containing non-glycosylated basic proine-rich proteins inhibited HIV-l from 20 to 80% at protein concentrations within physiologic range. The fractions were inhibitory using both assays. The site of action appears to be prior to or at the site of viral entry into the cell rather than later in the infection process.

The modes of transmission of human acquired immunodeficiency syndrome (AIDS) are still not completely understood even though bodily fluids such as blood and semen of infected subjects are regarded as extremely hazardous. Other human secretions such as milk and saliva have been reported to contain inhibitors of HIV-1 infectivity and it is now known that saliva may contain non-immunoglobulin inhibitors as well as secretory immunoglobulins if the subject is infected with HIV. The degree to which a non-infected person_s saliva may be protective against HIV-1 infection via the oral route, and the degree to which the non-immunoglobulin factors and antibodies in an infected subject_s saliva may lessen the biohazard of this secretion is not known. Such information is vital from a public health point of view, and is also extremely important to the practice of dentistry. With such information, better advice can be offered to the public on how to contain AIDS, and to the profession of dentistry on how to design office practices and procedures.


Saliva neutralizes HIV-1 infection by displacing envelope gp120 from the virion.

Int Conf AIDS 1998 Jun 28-Jul 3; 12:267 (abstract no. 21143)

Malamud D, Nagashunmugan T, Friedman HM, Davis CA, Abrams WR
Dept. Biochemistry Univ. Penn Dental Med., Phila 19104-6003, USA.

BACKGROUND: Incubation of HIV-1 with human saliva decreases infectivity. This inhibition is specific for HIV-1, with no effect on adenovirus, HIV-2 or SIV and appears to work at the level of the virus rather than the host cell. We have now identified an active protein fraction and provide evidence that the mechanism of action involves stripping of gp120 from the virus.

METHODS: HIV-1 (laboratory strains and primary isolates) was grown in PBMCs and purified by centrifugation and chromatography on Sephacryl 1000. Submandibular saliva from seronegative donors, or fractions obtained after anion exchange chromatography, were incubated with HIV-1, and then tested for infectivity with HeLa CD4 cells or PBMCs as compared to virus incubated with media only. To test for effects of salivary proteins on gp120-CD4 binding, gp120 binding to immobilized CD4 (NEN-drugquest) was utilized. To detect gp120 stripping, virus treated with media or salivary proteins was analyzed after sucrose gradient centrifugation (10-60% sucrose) or centrifugation at 145,000 x g on a 5% sucrose cushion. Supernatant and pellet were analyzed by ELISA and Western blotting using antibodies to p24 and gp120.

RESULTS: Submandibular saliva did not block the binding of gp120 to immobilized CD4. Incubation of saliva with laboratory strains or primary isolates of HIV-1 resulted in a shift of approximately 50% of the gp120 from the viral pellet to the supernatant. After anion exchange chromatography of submandibular saliva we identified a fraction which inhibited HIV-1 infectivity. This fraction contained two high molecular weight sialyated glycoproteins, and several lower molecular weight proteins. This active fraction also stripped gp120 from the virus.

CONCLUSION: The specific inhibition of HIV-1 infectivity by human submandibular saliva is associated with removal of gp120 from the virus. The active fraction contains several proteins, including two high molecular weight glycoproteins.

Mechanisms of anti-HIV-1 activity of human submandibular saliva.

Conf Retroviruses Opportunistic Infect 1997 Jan 22-26; 4th:140 (abstract no. 412)

Nagashunmugam T, Malamud D, Davis C, Friedman HM; University of Pennsylvania, Philadelphia, PA.

Human submandibular saliva contains factors that reduces HIV-1 infectivity in vitro. The mechanism of action of these salivary proteins is unknown. We asked if salivary proteins act at the level of the virus or, instead, on the host cell. Monoclonal antibodies were used to detect cell surface receptors (CD3, CD4, CD7, HLA-DR, LFA-1, and LFA2) on peripheral blood derived mononuclear cells (PBMCs) treated with media or saliva. Our results show that saliva did not block these receptors nor lower the intensity of detection. PBMCs pretreated with saliva showed no inhibition when subsequently infected with HIV-1HxB2. These results suggest that saliva does not exhibit anti-viral activity by modifying the host cell. Saliva did not block binding of gp120 to CD4 nor did it lyse the virus. Incubation of HIV with submandibular saliva did lead to viral aggregation. Virus-saliva aggregates were subjected to centrifugation on a 10-60% sucrose gradient, fractionated and assayed for p24 antigen. The HIV-saliva complex sediments at a higher density compared with virus alone. Analysis of the gradient fractions for gp120 shows that the env protein is displaced from the virion. These results suggest that one mechanism of salivary anti-HIV activity involves removal of gp120 thereby decreasing HIV infectivity. This work was supported by NIH grants DE09569 and RR00040.

The second is the fact that the vaginal secretions released during cunnilingus are relatively uninfectious. Scientific research regarding women

[anotherdummy]

Vaginal fluid, I have read, is lower concentration than semen and blood, and in some places I have read it is lower than breast milk.  Low in general.  You need lots of virus to become infected.  If you have insertive vaginal the risk is low for HIV transmisison if you have no open sores or other std's present, and because the only other potential entry point is the urethra, a small surface, and alot of work for the fragile virus to "get through".....hence the reason hiv transmission through vaginal sex is much lower than receptive anal.

The doctor has said many many times to people concerned about fingering a vagina with cuts on their fingers that it is not a risk....does it not make sense then that an intact penis that goes into a vagina is also very low risk?  Cunnilingus is low risk because saliva seems to kill the virus, and with the fluids being exposed to the atmosphere it would also stand to reason that hiv just will not survive in enough quantity to infect by this method.

[robespierre]

Thank you all.
So, in according with Dumbo, "The doctor has said many many times to people concerned about fingering a vagina with cuts on their fingers that it is not a risk....does it not make sense then that an intact penis that goes into a vagina is also very low risk?"
But, looking at the abstract about cervice fluids, I think that inserting a finger, with cuts, deep into vagina is risky.
And further, I'm asking to myself if the cervical fluids don't go out from vagina, or remain inside (that seems very strange!)
Bottom line: it's better to stay at home and masturbating!

[robespierre]

Another thought: if "saliva may be protective against HIV-1 infection via the oral route", you would trust to lick a bleeding cut?

[monkeyflower]

Jesus. Are you this worried about whether a meteor is going to strike your house?

I think counseling is in order. Staying home and masturbating is all well and good, but a satisfying and fulfilling life generally involves other people.

[anotherdummy]

nothing is definitive here.

[anotherdummy]

Your "joke" was not obvious.  This is the net and it it understandably hard to "hear" and see how speech is presented.  I took it the same way monkeyflower did.

Anyway, ya, stay home and masturbate, you'll probably feel better for doing so.

[robespierre]

I only try to de-dramatize.
If I posted my question, it was not for "love of science", or for "joke" but to clarifying a real problem: haw is risky vaginal intercourse.
From all I read from this topic (thanks to Worried_in_MW for his interesting excursus), I think that the problem of vaginal secretion is not definitively clarified by the doctors.
Best wishes to all.

[robespierre]

Obviously, it was a joke!

[robespierre]

I widely agree with you, nothing is definitive.
But, if a Tab. says that "insertive vaginal" is 5/10000, and says nothing about cunnilingus, I think it's natural  to wonder about it.
My personal opinion is thath blood (even not visible) is always necessary for infection.
I hope not to make a mistake!

[WorriedUS]

You're right!  there aint no guarantees in life.  Everyone thinks that they might be the 1/2000 chance.  but that number is based on you having the same risky act on a repeated number of occurences.  If this was your ONLY time, you would be OK!!

But, conversely do you know what the meaning of 'splitting hairs means?'  The Doc would surely say you are doing just that!  It means that you are actively looking for reasons that are in your favor to make them reasons against you!  

Look at what the Doc said about cunnilingus and why it is NOT in the table..
------------------------------
"Granted, this hasn't been studied much--but the reason it hasn't been studied is that it seems to be too low risk to make it worthwhile to do any research."
------------------------------

I don't think he's just guessing.  He's a MEDICAL doctor, a world reknowned RESEARCH expert on the RISK AND probability of STD transmission, including HIV!!. Now, if you don't believe him, then GO GET TESTED!!!  at 4 weeks then between 6-8 weeks.  Then you will need mental health counseling for sure even if you cannot believe in your negative results.

You will be NEGATIVE at ALL..and it won't be a waste of money, since you will be satisfied, mentally, hopefully.  We understand your anxiety.. We've ALL been through it and are going through it to some degree.  It's understandable, since we all have varying (most of us have very little) knowledge and understanding on the relevant risk factors and probability of HIV and STD transmission.  Just try to listen to the logic side of your brain, and NOT the emotional RP, and take each day at a time, and try to convince yourself you DO NOT have HIV.  Good luck!

-WorriedUS

[robespierre]

Thanks a lot.
But I must specify that my anxiety comes from a vaginal intercourse (20-30 seconds) with a suspect condom breakage with a sex worker (there is a question of mine to the Doc one month ago).
That's the why I try to calm myself thinking about the low (o close to zero) risk of such a contact.
Thank you all.

[WorriedUS]

Regardless, doesn't change anything. You're splitting hairs.  Let it go.  If worried, get ONE test at between 6-8 weeks.  For sure it will be negative. And stop reading other websites except this one.  

-WorriedUS

[robespierre]

Thanks a lot.
I will follow your advice.
In effect, this is the only one webside where I have found a very good Doctor who speake clearly, and very good forumists!
On ather sites, especially here in Italy, there is only terrorism.
God bless you, sincerely yours.  
Fabio

[WorriedUS]

RP,

Go to the prevention forum, and scroll down to this thread,
"Oral - scar21: 10/29/2006" and see the comment posted by this person (JD_UK).  If you can't find it, I've repasted it here for you and everyone else:

------------------------------
"For the past seven years, I probably have performed and received oral sex about 70 times at massage parlours and tested conclusively negative for HIV yesterday. I always, ALWAYS used a condom for penetrative sex but none for oral sex. I have stopped visiting these places about year ago as its not worth taking the risk. I hope that puts your situation in perspective and that oral sex is a very, very, very low lisk for HIV infection.

Hope that helps.

Good luck
------------------------------

Robespierre, read it again, he said he received AND performed oral sex.  

hope this makes you feel a little better.

Ciao.

-WorriedUS

[robespierre]

But my problem - as I said - is a (suspect) condom breakage during a brief vaginal intercourse, not oral sex.

[monkeyflower]

Okay, I have to ask. How can you have a "suspect" condom breakage? It's *obvious* when a condom breaks.

But either way, very low risk. Very low.

[robespierre]

Suspect because, after a brief insertive vaginal, about 20-30 seconds, with an escort, I have noticed that condom was not very adherent, and sperm was not in the upper part of it, even the penis was enterely covered; then, I filled it up with water, and appeared a little hole, from about 5 cm by the upper size; now, I don

[ballocks]

errr i sort of have a question. i have had oral sex lately. i am male. i received fellatio and given cunnilingus to a female. and i have only done this once in my life. is there anything for me to worry about? everyone says im being paranoid for nothing