HIV risk escort services

[jw1978]

I'm a little anxious. Yesterday I spent 2 hours with a 25 year old Serbian escort girl while on vacation in Italy. She was very nice and seemed very healthy. We had vaginal sex twice (with 2 different condoms), and I went down on her. The condom was completely intact both times and I was careful to make sure it was on. She insisted on using condoms, which I take as a good sign. She did not give me oral sex and she did not have any lesions or bleeding anywhere. I do not have any cuts or sores either. She said it was only her second day on the job but had had several clients already in those 2 days. She stated that she had full STD testing prior to enrolling at her escort agency, but didn't have documentation with her. The escort agency (which is high end and quite expensive with a fancy website) also said she was clean when they signed her up (which was very recent). I think I believe her about the second day on the job thing as she really did seem very new to it and told me that even before I asked her about her health status. She is highlighted as a "new girl" on their site. She is a college girl and said she had been in a 2 year monogamous relationship in Serbia until recently.

I think I am low risk for HIV but would be grateful for assurances based on this information.

Thanks

John

[Justiin]

I saw on the news lately 2 lesbien girls infected eachother  recently in usa ! They have the same strain of the virus

[Life360_Dave]

Vance has gone to great length siting accuate information about the risk of oral hiv contraction. If you not convinced and you now think you have ARS then it would be best to have an HIV test to put your mind at ease.  You can take the duo at 28 days would be conclusive.
Do let us know your test results.

[jw1978]

Thank you for the citations. They are reassuring. One further follow-up question re ARS if you don't mind: have you even heard of an incubation period as short as 7-8 days?

[jw1978]

OK thanks. The citation above stated that "older studies" suggested no of extremely low risk but that has changed. It seems to be the case that in practice no cases have been convincingly acquired from oral sex (based on other threads I read). How can be be sure? Would you mind sending me those citations?

BTW, the escort girl is still "available" on their website, so presumably she isn't ill.

[Vance2335]

There is info from Dr's on this site, articles and studies done.

[Vance2335]

by Vance2335, Apr 14, 2011
"Oral sex. there is no evidence that HIV is spread through giving or receiving oral sex" Dr.Hook

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by Vance2335, Apr 19, 2011
"I'm not sure why you are considering further testing.  HIV is not spread through oral sex." Dr.Hook

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by Vance2335, Apr 26, 2011
http://health.columbia.edu/files/healthservices/pdf/GHAP_HIV_Aids_Handbook.pdf)


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by Vance2335, May 04, 2011
"Welcome to the Forum. In preparing to answer your question I reviewed your interactions last week on the HIV Community site as requested and am perplexed as why you have repeated it here.  Lizzie provide numerous quotes from Dr. Handsfield and me which summarize the facts- there are no credible reports of HIV being spread by oral sex- none, zero, never.  Repeating the question will not change the answer.  Does that mean that is might happen sometime for some bizarre reason, no- things happen but your risk of HIV is lower than your risk of being hit by a meteorite while reading my reply." Dr.Hook

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by Vance2335, May 05, 2011
The various symptoms you describe do not raise concerns about HIV and, in your case, following a no risk exposure (there is no risk from performing oral sex) there is just nothing to worry about. -Dr.Hook

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by Vance2335, May 11, 2011
"HIV is not spread through giving or receiving oral sex" Dr.Hook

Based on the math calculated risk of 1 in 50,000,000 chance And that is using a conservative number another estimate could be 1 in 500,000,000.

As for syphilis risk of .00006% of coming into contact with someone who had syphilis and most infections are not oral so even a conservative number would be .00001% So that is 1 in 1,000,000...which I am not sure my math is right. Same for gonorrhea.

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by Vance2335, Jun 01, 2011
http://www.medhelp.org/posts/HIV-Prevention/Hiv-risk/show/1527984

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by Vance2335, Jun 22, 2011
But you really don't need to worry about HIV transmission from oral sex (with or without condoms), hand-genital contact, frottage (body rubbing), kissing, etc. HIV is not transmitted by these activities --..." Dr.HHH

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by Vance2335, Aug 23, 2011
As far as HIV is concerned, there is no known risk of getting HIV from performing oral sex on an infected partner, even if that person's genital secretions get into your eyes or if you swallow. Dr.Hook

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by Vance2335, Sep 01, 2011
We do not recommend HIV testing following oral sex because we consider it a no risk act. EWH

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by Vance2335, Nov 15, 2011
Dr.Hook
Welcome back to our Forum. As you know from other posts about oral sex, our stance is that giving or receiving oral sex is not a risk for HIV.  Some others suggest that there is an appreciable risk of HIV from oral sex however, there are no convincing scientific reports which support these statements.  The presence of a burn in your mouth, or a sore, or ingestion of blood does not change this.  Still no risk an no reason for testing.

[Vance2335]

There was an additional interview based study from Austrailia that followed up on this http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102251988.html
It found that a few men who were HIV+ (4) stated that they got it more than likely from oral sex. Once again, this poses the question how accurate can interviews be? There is a good possibility that the patients didn't want to admit to unsafe sex practices and were lying.

Another Wales study suggest 2.6% of infection is due to oral sex http://www.aidsmap.com/en/news/8C50587D-7487-4440-BCFD-3AF7C9EE92C3.asp But once again, the study seems flawed in many ways. First off, it is once again an interview based study. The problem once again lies (and is seen a lot in the study) of interviewers changing thier answer and admitting to risky sexual practices. the result was that 2.6% stated that oral sex is how they believe they got infected, but once again, how many (if not all) were mistaken or lying?

There was an addition Spain based study that studied oral sex HIV transmission. It looked at unprotected oral sex between a known HIV+ and a known HIV- couple/partners. It's results stated that in over 20000 acts of unprotected oral sex NOT ONE SINGLE HIV- seroconverted.

In addition, a San Fran study looked at over 250 Gay/Bisexual couples only engaging in unprotected oral sex. Over the course of the study. 1/3 said their partner was confirmed HIV+, another 1/3 stated that their partner ejaculated in thier mouth, once again not ONE person seroconverted.

A study in 2002 at UCSF found NOT one case of exclusive male to male unprotected oral sex resulting in
seroconversion. The stated that "IV infection via oral sex is a very rare event" and that statistically the risk showed a probability of zero.

Recent studies have also found that saliva inhibits HIV infection in the mouth.

Overall, there are studies on both sides of the fence. Some say it is a negligible risk, some say there is NO risk, some say there is a VERY low, but real risk of infection.

Other things to consider:
The CDC states a point estimate that 1:10000 of oral HIV transmission. Many (including the experts on this site) state that that number is probably too high.
The experts on this site have said that they have NEVER seen clinically, or in the literature, a convincing case of oral transmission of HIV.

My thoughts? I think that anything is medically possible, but how possible, I'm not sure. I feel that the risk could be anywhere from zero to exceedingly rare. Logically, if oral sex posed even a low risk of transmission, the HIV infection rates would be a lot higher. I think the difference between theoretical risk and real risk need to be separated as well. Theoretically, I think oral infection is potentially possible, and I don't doubt that it does happen, but probably only in extenuating circumstances. The difficulty with reported cases is that we are going on the patients word. With a touchy subject like HIV transmission, many will be reluctant to reveal that they in fact had engaged in unprotected vaginal or anal sex, or IV drug use. certainly, oral sex would be the more "socially acceptable" way to have contracted the virus, so I feel it's VERY likely that a large proportion (if not most) or reported cases are unreliable. In addition, with the experts on this site stating that they have never read a convincing case of oral sex transmission despite over 30 years of experience says volumes for the extreme rarity of HIV oral sex transmission.
Saying that, I think it is always good to err on the side of caution and recommend protected oral sex. Saying that, I also feel that many health care advice resources are VERY reluctant to reveal how apparently exceedingly rare oral sex HIV transmission is for the very sake of erring on the side of caution. There simply has not been enough information out there or research done to come to a conclusive decision on oral sex transmission. But from everything I've read and heard here, it ranged from (virtually/significantly) ZERO risk to an "exceedingly low" risk.

Given the CDC's point estimate, some quick mathematical estimations can support such claims:
odds of a person being HIV+ (this varies, for my town) 1:1000. (keep in mind this number will easily change depending on the risk factors of the person you slept with. here, most HIV patients are prisoners, IV drug users, or sex workers statistically). =0.001% chance your partner has HIV

Chance point estimate of per case of oral sex (unprotected) via CDC of a confimed HIV+ partner 1: 10000 (taking into consideration mouth ulcers, cuts, etc). = 0.0001%

chances not including any information on ARS symptoms/ partner history etc =
=0.000001% per episode,
or a  1 in 10 000 000 chance of getting HIV from one count of Oral sex (unprotected receptive) with a partner of unknown HIV status.

That number is certainly very low and potentially statistically insignificant. It is stated that it doesnt happen, so most will say the risk is not zero, but ANY activity in life typically carries zero risk. A one in ten million estimate per episode suggests that HIV transmission via oral sex that is receptive unprotected probably only occurs in very rare, potentially atypical situations.

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by Vance2335, Apr 12, 2011
HIV is not spread by masturbation, through oral sex, through kissing or other casual contact.  -Dr.Hook

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by Vance2335, Apr 13, 2011
"There is no credible evidence that HIV is spread through oral sex, with or without the presence of cuts or blood in the persons mouth."-Dr.Hook

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[Vance2335]

http://www.medhelp.org/posts/HIV---International/Worried/show/1231068?personal_page_id=861869#post_5663711

http://hivinsite.ucsf.edu/InSite?page=pr-rr-05&doc=pr-rr-05-05

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by Vance2335, Apr 04, 2011
No incident HIV infections among MSM who practice exclusively oral sex.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WePpC2072)??Balls JE, Evans JL, Dilley J, Osmond D, Shiboski S, Shiboski C, Klausner J, McFarland W, Greenspan D, Page-Shafer K?University of California, San Francisco, San Francisco, United States

Oral transmission of HIV, reality or fiction? An update
J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

AIDS: Volume 16(17) 22 November 2002 pp 2350-2352
Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan
Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:

Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117
Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.

There is no debate (among experts) about the HIV risks associated with oral sex. The risk is so low that almost nobody who cares for HIV infected patients has ever had a patient believed to have been infected that way. Among experts, it's a semantic issue about using terms like "no risk" and "very low risk". There is no difference between my or Dr. Hook's use of "low risk" and other experts' "no risk".
DR. HANSFIELD

"And oral sex is basically safe sex -- completely safe with respect to HIV and although not zero risk for other STDs, the chance of infection is far lower than for unprotected vaginal or anal sex. Please educate yourself about the real risks. If you stick with oral sex and condom-protected vaginal or anal sex, you have no HIV worries and very little worry about other STDs. " DR HANSFIELD

"I am sure you can find lots of people who belive that HIV is transmitted by oral sex, but you will not find scientific data to support this unrealistic concern..." DR HOOK

"HIV is not spread by touching, masturbation, oral sex or condom protected sex."- DR. HOOK

in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?
I TOTALLY AGREE / DR GARCIA



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by Vance2335, Apr 05, 2011
I posted a few days ago and was extremely anxious and nervous about a single episode of unprotected oral sex (receptive and insertive) with no ejaculation. Since I have a great interest in health care, etc. I immediately started reading anything that I could find about HIV and oral sex. I then came here, in which many well educated members helped to calm my fears. Mnay of the members here know A LOT about the risks involving oral sex, so I thought it would be good to share what I have read and been told so far. I will try to source everything as good as I can. What I'm looking for here is everyone's opinions on the topic and if you agree/disagree with what i am posting. I am starting medical school in a few months and really want to have an educated opinion on the topic.

First off, there was a study done in San Francisco that stated that up to 8% of HIV cases could be attributable to oral sex.
           -First off, this study is one of the ones that sent me into a panicking frenzy of mild panic attacks and anxiety. I feel this number is so unrealistically high due to the statistics elsewhere.
            -Indeed, I have read via a 4 MD round table that this study not only had a low sample size, that many of the patients who stated that they only had oral sex later on admitted to having more high risk exposure behaviour such as unprotected anal sex. In addition, it was used as an example that three of the main cases were atypical oral sex cases (one had major oral ulcers, etc / one had been with a HIV+ partner for years (and pot. more risky behaviours) / and one had had over 1100 counts of unprotected oral from over 42 partners (and once again more risky behaviours potentially).  I believe the study only looked at 122 men where 8 were said to be seroconverted via oral sex. It seems this study is one which freaked out the world on oral sex and launched studies as those seen below. IMHO, evidence suggests that this study not only shows how powerful weak research methods can be, but begs the question of how many needless cases of HIV anxiety it has caused. I know I am one of the people who saw this article first (it seems to have the most coverage).

[jw1978]

If there is no-one available to privide detailed guidance on this, are Dr Hook or Dr Handsfield accessible on any of the forums? Most of the expert forums redirect to the medical community forums.

[Vance2335]

My answer of no risk is not going to change. Studies have shown no risk.

[jw1978]

Thanks Vance. I just found this article on oral transmission which states that it clearly is possible, and has been demonstrated in primates. Something else I raed suggested that for MSM, 2-5% of new HIV infections in the UK were transmitted orally. Risk is definitely low though and I can't find any specific data on cunnilingus.

Immunol Rev. 2013 Jul;254(1):34-53. doi: 10.1111/imr.12078.
The oral mucosa immune environment and oral transmission of HIV/SIV.
Wood LF1, Chahroudi A, Chen HL, Jaspan HB, Sodora DL.

What is concerning me now are my symptoms. I possibly have some adenopathy now in my groin, low-grade fevers, myalgia, and right sided lower abdominal pain. No rash. I am not convinced by the "zero risk" line and would be grateful if you could expand on that. I would also like to hear from the other regular posters if they're available. Is the risk so low that I need not even get tested or abstain from penetrative sex until a definitive test at 28 days? As ever, your thoughts would be appreciated...

John

[Vance2335]

I did...NO RISK

[jw1978]

Thanks Vance - would you mind addressing my 3 questions above? I have R sided abdominal pain now also.

John

[Vance2335]

No HIV risk

[jw1978]

Could somebody help?

[jw1978]

It is now 8 days post exposure. I have diffuse myalgias and low-grade fever which started yesterday. No rash, no lymphadenopathy. I'm worried because as described we did unprotected cunnilingus. I'm not worried about whether the condom was intact; it was.

Two questions (for Teak, Vance, LindaLou, Sherwin, or anyone else with detailed knowledge in this subject):

1. How risky is the cunnilingus? It wasn't deeply penetrative, just labia/clitoris only.
2. What is the typical timing of the non-specific seroconversion illness following the exposure? Some sources say "days-weeks"; some say 2-6 weeks?
3. Should I be concerned enough to pursue testing?

I would be grateful for the collective feedback from the forum.

John

[jw1978]

Thank you Sherwin. I have no reason to doubt you. The condoms were a good  brand and they were intact when they removed. What about the fact that I performed oral sex on her though? Can you quantify that risk in any useful terms? Is it risky enough to get tested and/or abstain from unprotected sex with others?  

[SherwinHanz]

If u used a condom you didnt have a risk. It is a zero risk activity.

[jw1978]

I forgot to mention that this was a one-off encounter and have no other history of using escort services or other higher risk behaviors. I was in a monogamous relationship for 8 years until a few weeks ago.