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Had Oral Sex With HIV Positive Person With Condom. Risk Of HIV Infection?

Posted on Fri, 13 Sep 2013

Question: Two days ago I performed oral sex on my HIV + partner using a condom, unfortunately I didn't notice but the condom rolled back over itself and ended up covering only the pee hole, I am almost sure I touched pre ejaculatory fluid with my mouth because I felt something slippery (lubricant, saliva, pre ejaculate?), even though I realized that inmediately and put the condom back in its place. I wanna know what's my risk of getting infected?, how much HIV is in preejaculate?. I couldn't find any answer in the last topic, any links to read would be much appreciated. My partner viral load is undetectable (and it's been for several years), does it affect viral load in pre ejaculate?. He takes lamivoudine, zidovudine and nevirapine. In your opinion, should I take Post - Exposure Profilaxis?. Could I take this meds?. Finally if the question falls out of your field of expertise (with all respect), could you consult it with a HIV specialist?.

Answered by Dr. Sankaranantham Murugan (1 hour later)

Brief Answer:
HIV risk is negligible

Detailed Answer:
Hi,

Welcome to XXXXXXX

Thanks for choosing XXXXXXX

1. When the viral load of your partner is undetectable, the chance of HIV risk is very much reduced.
2. Pre-ejaculatory fluid is containing very low viral load and very rarely it can cause an infection and when your partner's viral load is undetectable precum becomes very much less risk.
3.As per CDC,Atlanta, Oral sex is having low risk.
So your chances of getting HIV is negligible.
If you have still doubt you can take Post Exposure Prophylaxis under the supervision of a HIV physician preferably within 24 hours after the risky contact.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (2 hours later)

Thanks for your advice. Lamivoudine, Zidovudine and Nevirapine are effective to reduce HIV in genital secretions and rectal secretions therefore reducing viral load to undetectable levels in those places?. I read some drugs work better for blood plasma but not in sexual fluids. It's important for me to know cause we practice safer sex all the times and this was an accident. What are my chances to adquire HIV if the condoms breaks inside me or my partner?. We used extra safe condoms.

Kind regards.

Answered by Dr. Sankaranantham Murugan (6 hours later)

Brief Answer:
HIV risk is still negligible.

Detailed Answer:
Hi,
Welcome back.

The combination of Zidovudine, Lamivudine and Nevirapine is still a good combination. When the HIV viral load is undetectable in blood, the viral load concentration in all other body fluids including genital and anal secretions. There is a possibility of reservoir sites like macrophages, glial cells, lymph nodes etc. where these virus could lie dormant in spite of undetectable viral load, but not in body fluids. Don't confuse the two situations.
The chances of getting HIV through breaking of condoms is very much less than that of an unprotected Anal penetration (6.5-50/ 0000 exposures), Vaginal (5-10/0000 exposures) and Oral sex (low) as per CDC, Atlanta.
So nothing to worry.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (12 hours later)

Thanks for you reassurance. I have a doubt. Five years ago I had anal warts they healed after treatment (cream). I am wondering if the skin is still susceptible or more susceptible to HIV. It worries me because I read HPV is for life but an outbreak depends of inmune system. So is somehow the effectiveness of condom reduced?. I don't have visible warts by now. I've only been the receptive partner once using an extrasafe condom. Excuseme if I am getting away from the initial question.

Answered by Dr. Sankaranantham Murugan (2 hours later)

Brief Answer:
Old HPV not increases the HIV risk,safe in condom

Detailed Answer:
Hi,
You are welcome to ask related queries.

After complete healing of HPV lesions, that too after five years, you need not to have worry about increased susceptibility of the skin for HIV. It is as similar to that of a normal healthy skin. HPV recurrence after 5 years also not common. Recurrence or relapse or new lesions usually occur within 3-6 months.
Condoms offer a high degree of protection against HPV and HIV.
So you are not at risk anyway.
Relax and have a nice day.
Dr S.Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sankaranantham Murugan (20 hours later)

Thank you. Last related question then I will close discussion. Do you know if there's any documented case of transmission of oral sex involving exclusively pre-ejaculatory fluid (no semen)?. I couldn't find any case related, but there are some cases of people getting infected when they took ejaculation in the mouth as their risk.

Answered by Dr. Sankaranantham Murugan (2 hours later)

Brief Answer:
No documented cases of HIV through Precum.

Detailed Answer:
Hi,
Welcome back.
There is no documented evidence for HIV transmission through pre-ejaculatory fluid by oral sex.
I had not come across any case report of getting HIV through pre-ejaculatory fluid even through vaginal or anal penetration in my carrier of 25 years in HIV practice.
Dr S.Murugan

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar