More in-depth questions

[manfromthene]

Hi,

Thanks for answering my previous question - and you were right to tell me off for asking about risks from oral etc. However, I've thought about this a bit more, and just wanted to get some answers/opinions from you:

Last time, you said nobody has ever got HIV from cunnilingus, but CDC says "2 or 3" people have done. How did they get it?

I have also read that the mouth is very good at protecting against viruses, because saliva can break down infections, and even if swallowed the stomach acids will clear it - is that correct?

Would you say that there is only really a risk if there are cuts/bleeding/ulcers in the mouth?

Some people say that it's impossible to tell the real risk as very few people engage in just fingering/oral. If there was a risk, then mixed-status couples (one +ve, the other not), lesbians (who really just do this), and people who protect for other things (but not oral), would see a large volumes of HIV infection. Do you agree?

Thanks for answering

[manfromthene]

Hi Dr Hook,

Sorry to post again, but my email says that you have replied to this, but I can't see your reply on here. Please re-post your reply.

Thank you.

[Edward W Hook, MD]

Straight to your questions:

1. No risk from golden showers.
2.  Obvously there is no way to study the effect of how much vaginal secretion enters ones' mouth and its effect on HIV risk.  To repeat what has been said before, the risk from cunnilingus is very, very low, no matter what the quantity of secretions.
3.  Licking someone's fingers which have vaginal secretions - close to zero risk
4.  Fingering - zero
5.  Anal sex is, on a per exposure basis, higher risk in terms of getting HIV if one is having sex with an infected partner.  In the situation you describe however, the risk is zero, irrespective of what kind of sex she has practiced in the past because a condom was used.  Condoms work.
EWH

[manfromthene]

Thanks for your reply.

I really appreciate yours and Dr HHH's advice on this forum. It really has put things in to context. I know I could have saved myself some money, but I wasn't sure you could do that. And anyway, it's $15/£7.50 well spend.

Anyway, I'll ask some questions that are more specific to my situation:

Is there any risk from urine (golden showers)?

For cunnilingus, if you don't get any in the mouth, does that decrease the risk?

There was one woman who fingered herself, and then after taking her fingers out I licked them. There would have been a minimum of 10 seconds between leaving her vagina and entering my mouth. What is the risk from this? (I'm assuming very low as HIV doesn't last long outside the body, and the amount of liquid was very low - her fingers were bairly moist.)

As for fingering, the only cut I've ever had was where the skin had rubbed away, but there NEVER had been any bleeding. Obviously, I wouldn't finger someone with that, but if I did, what would be the risk? (I'm assuming very low, as there is no opening for blood.)

I read somewhere that (female) escorts who do anal sex are at a greater risk of having HIV (probably an urban myth). I did end up with one, but the only sex we did was straight vaginal intercourse with a condom. There was was no oral or fingering (except I touched one part of her outer lips). The condom stayed on at all time, and never broke. Am I right to assume that whether she does anal or not, the risk to me would be the same i.e, virtually non-existent as condoms are safe?

Really appreciate you taking the time to answer my questions.

p.s. just for the record about being in the west, I live in the UK (and only had sex with British women), if that makes any difference to any of the answers, but I suspect it doesn't.

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me this time.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

Also, you did not have to post a new question, you could have continued it along the lines of your prior thread.  Having said that, perhaps I can help to allay what I suspect are unnecessary concerns.  I do so in the hopes that you get the wish you express in the last sentence of your 2nd part to this thread and relax.  

Rather than deal with your litany of questions one by one, I will address your concerns here. For starters, you can find just about anything you want on different web sites. You need to figure out which ones you wish to believe. As for the CDC, please remember that it is their job to provide general advice to anyone who looks at their site.  In contrast, on this site you get advice tailored to your situation.  If one or two or even three out of the millions of people who have HIV got it from oral sex, I would suggest that those are the exceptions that "prove the rule".   Particularly when put in the context of the billions of exposures which have occurred since the epidemic began.

There is debate as to whether or not HIV can be transmitted through oral sex. some people say it cannot.  On this site we often use the figure "less than 1 in 10,000 exposures".  For any one person, those answers are essentially the same particularly when you factor in that most who ask such questions such as yourself don't even know if their partners have HIV;  in fact, in most such settings, the answer is no.

Viral load does matter but in the context of oral sex, not enough to be considered.

Finally, other STDs, particularly gonorrhea can be spread through oral sex. Lesion diseases like herpes and syphilis can on rare occasions as well but, as you point out, that is off topic.

Bottom line, maybe someone, somewhere got HIV through cunnilingus. You can let that worry you or not. If so, since the risk is of the same magnitude, I would suggest that you never go out in the rain - you could get hit by lightening (actually, your risk  of being struck by lighteningis higher than your risk of HIV form the exposure you describe.  EWH

[manfromthene]

What I should have said above is that I have had those questions and thought them through. I hope other people would read them, and be comforted by the answers. Therefore, please don't see these as just "need to know" questions. However, I did forget these questions:

On the subject of fingering, am I right in saying that there is no way HIV can get through unbroken skin?

Also, do viral loads matter. I think that if there is no way in, then whatever the loads it doesn't matter - do you agree?

I know this is slightly off-topic, but do fingering and cunnilingus have a risk for other STDs? If so, what would be their relative risk vs. HIV?

Sorry for so many questions, I hope that by getting it off my chest, I and others can relax.