Q-A 1 to Q-A 2

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Q-A 3

Q (t) I read in various website that the mouth mucosa is permeable, independently of the presence of lesions. May the HIV penetrate a mucosa without lesion ?
If yes, is it capable to reach a blood vessel ?

You also said that the HIV is fragile in the air : for instance a guy that comes in the evening, if he doesn't wash himself, often observes white traces at the base of the glans. Are these trace contaminating, in case of fellatio for instance ?

A (t) Concerning fellatio, the risk of HIV transmission is possible in case of a bleeding lesion, like gingivitis, or even just after a teeth brushing. But the lesion may be microscopic, giving a non visible bleeding. To our knowledge, the HIV cannot penetrate a mucosa without lesion.

Taking about mucosa permeability, or skin permeability, means that, indeed, these surfaces are not continuous, and exchanges from one side to the other are possible. Indeed, the majority of the skin surface is not continued by skin, but by empty spaces, wich are the scene of important exchanges with the outer.
Concerning the fragility of the HIV in the air, this notion is based on the fact that it is much more fragile than other viruses, like HBV or HCV (this is why it is much more probable to be infected by this two viruses, when stung by a needle on a beach, than with the HIV).
Until now, the contaminating power of the HIV was evaluated by measuring the reverse transcriptase activity : it has been shown that a solution containing 100,000 times more virus than in the blood of contaminated person, after a 56°C heating of 30 minutes, keeps an infecting power during three hours.
Concerning the risk of contamination from dried sperm containing HIV, its infecting power is certainly diminued; but only biological measurements could tell us in wich proportion (we could no find any publication on this particular subject); a fellatio made in these conditions could present a risk, if there is a bleeding lesion in the mouth, even invisible. (9711)

Q-A 4

Q (t) Is a mouth rinsing after a fellation sufficient to protect from a risk of HIV transmission ?

A (t) Concerning fellatio, the risk of HIV transmission is possible in case of a bleeding lesion, like gingivitis, or even just after a teeth brushing. But the lesion may be microscopic, causing a non visible bleeding. So, a rapid rinsing of the mouth is not sufficient to avoid the risk of transmission : indeed, if there is a bleeding lesion, the virus may be instantaneously penetrate in this opening. (9711)

Q-A 5

Q (t) If there is risk of contamination during a fellation without ejaculation, does it mean that the penis skin may transmit the virus ? How can the virus propagate, without ejaculation ?
Could you also tell me if there is a site in France gathering the places where the anonymous test may be done ?

A (t) Concerning fellatio, the risk of HIV transmission is possible in case of a bleeding lesion, like gingivitis, or even just after a teeth brushing. But the lesion may be microscopic, causing a non visible bleeding. The risk of contamination from a male sex without ejaculation exists. It is possible because of "internal micro-ejaculations".
It mustn't be forgotten that even during a very short penetration, the risk of HIV transmission exists, because of the presence of seminal liquid just at the extremity of the urethra. Furthemore, an early ejaculation may always occur, as it is difficult to always control the state of excitation.

Concerning the site indicating the places where to make an anonymous test, you should contact the Centre Régional d'Information et de Prévention du SIDA (CRIPS) : <http://www.lecrips.net> (9801)

Q-A 6

Q (t) I am seventeen, homosexual and I had a sexual relation with a man. He came in my mouth, and I swallowed. I wonder there is a risk to have a sexually transmitted disease. I have no lesion in my mouth, but I plan to make the p24 analysis.

A (t) Indeed, the risk of being contaminated by an ejaculation during a fellatio is possible provided there is a bleeding lesion in the mouth (even invisible) for instance in case of gingivitis, particularly after an energic teeth brushing just before a sexual contact.

If you wish to have more precisions on this subject, we recommend you to visit our Internet website <http://www.positifs.org/>, particularly the C.3. (Information on AIDS and prevention) and F. (Medical aspects of AIDS) headings. You could also have a look to the website of "Info Sida Suisse", with who we closely collaborate, in the framework of their FAQ (<http://village.cyberbrain.com/mirax/sidafaq.htm>).

In case of doubt, one should make a serology (antibodies measurement) two or three months after the sexual intercourse. It is also recommended to make a p24 antigen test in the two weeks; some advise to make a viral load. It is indeed a much more expensive analysis, but it seems that a treatment at the time of the contamination, for a few months, would tremendously slow down the evolution risk of the infection (5th conference on Retroviruses and opportunistic infections, Chicago, February 1998); it is now important to detect as early as possible a contamination by te HIV, and to use all the available means.

Concerning the major risk of being contaminated by others sexually transmitted diseases after ejaculation or during a fellatio, an univocal answer is not easy to give. Actually, few studies have been carried out on this risk of transmission, HIV expected (the epidemy of AIDS had to appear to make the medicine get on with the taboo subject of fellatio).

What we know is that for instance a Chlamydia infection may be localised in the pharynx. Pyogenic germs (like streptococcus or staphylococcus) are know to give mouth infections, but also genital infections. Some germs can also be transmitted by oral contact (for instance the Epstein-Barr virus, responsible for the infectious mononucleosis). (9802)

Q-A 7

Q (t) Just one question : I had an homosexual relation with a man, and afterwards I felt remorse. We used condoms for sodomy. It is really reliable ? I mean that at the basis of the penis, the preservative leaves a little space. Is there any risk of transmission at the level of the anus, in case of deep sodomy ? We made a quick fellatio (3 mn) without ejaculation, but without condom. Is it risky ? We masturbated and I went on caressing him, for 5 minutes after his ejaculation. I had his sperm on the hands, is there a risk ? I had no appearent lesion on the hands. Is the hands-sex contact risky ? Did I risk anything when he masturbated me (I came in his hand) ? I already read the FAQ, but I need a confirmation for my particular case, as I don't feel very well...

A (t)  When appropriately used, a preservative assures a good prevention of the HIV transmission during any sexual intercourse. If the size of the condom is convenient (adapted to the erected penis), there is no possibility of sperm back-flow at the basis of the penis.
Concerning fellation without ejaculation, there is always a risk, provided there is a bleeding lesion in the mouth (even invisible). Even without ejaculation, some virus may be present at the meatus, at the extremity of the penis.
Concerning the contact of the hand with sperm or sex, there is no risk without a cutaneous lesion. (9802)