Oral sex and HIV transmission

Robinson, Eileen; Bg, Evans

doi:10.1097/00002030-199904160-00021

Cited by 48 publications

(34 citation statements)

References 5 publications

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“…Thus, in the prevention campaign, in addition to stressing the importance of condom use during anal sex, it is important to warn that STD/ HIV transmission can also occur with oral sex and the risk of oral transmission can be reduced by condom use. If a condom cannot be used, ejaculation outside of the mouth may lessen the risk of STD/HIV transmission 24 . In addition, factors associated with an increased risk of oral transmission such as oral trauma, sores, in¯amma-tion, allergy, concomitant STD, and systemic immune suppression should also be conveyed in the prevention campaign.…”

Section: Discussionmentioning

confidence: 99%

High rates of sexually transmitted diseases among male transvestites in Jakarta, Indonesia

Joesoef

Gultom²,

Irana³

et al. 2003

Int J STD AIDS

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Many male transvestites (waria) in Jakarta, Indonesia engage in unprotected receptive anal and oral intercourse with homosexual and bisexual men for pay. Although this behaviour clearly puts them at risk of sexually transmitted diseases (STDs), including HIV infection, little is known about the prevalence of STD among them. To learn the STD prevalence and its risk factors, we conducted an STD prevalence survey among waria in North Jakarta, Indonesia. From August to December 1999 we offered screening for rectal and pharyngeal infections with Neisseria gonorrhoeae (Ng), Chlamydia trachomatis (Ct) by DNA probe (GenProbe PACE 2) and for Treponema pallidum (Tp) by non-treponemal and treponemal serological tests. Of 296 participants (median age 28 years), 93% reported having been paid for sex. A total of 96% reported having had oral sex (median five times/week) and/or anal sex (median three times/week) in the last week. Ng was found in the rectum of 12.8% and the pharynx of 4.2%; Ct was found in 3.8% and 2.4%, respectively. A total of 43.6% had reactive non-treponemal and treponemal tests. Of the 129 with positive treponemal tests, 42.6% had non-treponemal test titres greater than 1:8. In the logistic regression model, waria who were younger (< or =25 years old) had a significantly 3.5 times risk of Ng and/or Ct infections than older waria (>25 years old). Because only 12% of waria stated that they consistently used condoms during any sex act, it is important to warn them that STD/HIV transmission can occur with either anal or oral sex and that the risk of either anal or oral transmission can be reduced by condom use. In addition, high rates of asymptomatic syphilis and rectal gonorrhoea warrant a periodic screening and treatment for these infections in this population. Because waria have the highest rates of HIV and their clients consist of homosexual and bisexual men, successful prevention efforts in waria could help curb the spread of the epidemic.

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Section: Discussionmentioning

confidence: 99%

High rates of sexually transmitted diseases among male transvestites in Jakarta, Indonesia

Joesoef

Gultom²,

Irana³

et al. 2003

Int J STD AIDS

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“…Innovative approaches to prevent HIV transmission include the use of antiretrovirals as preventive tools, known as preexposure prophylaxis (Prep), either as oral pills or topical microbicides containing an active antiviral agent (13). Recent studies have shown a partial reduction in HIV acquisition in women using a vaginal tenofovir gel (1) and in MSM taking a daily oral tenofovir disoproxil fumarate (TDF)-emtricitabine (FTC) combination pill (11), the favored combination for Prep.While it is agreed that oral sex carries a much lower HIV infection risk than vaginal and anal sex, studies have convincingly demonstrated that both insertive and receptive oral sex are independent risk factors for transmission of HIV (6,19,20). The risk increases with frequency of activity, the presence of oral ulcers, oropharyngeal inflammation, or sexually transmitted infections in the oropharynx.…”

mentioning

confidence: 99%

“…While it is agreed that oral sex carries a much lower HIV infection risk than vaginal and anal sex, studies have convincingly demonstrated that both insertive and receptive oral sex are independent risk factors for transmission of HIV (6,19,20). The risk increases with frequency of activity, the presence of oral ulcers, oropharyngeal inflammation, or sexually transmitted infections in the oropharynx.…”

mentioning

confidence: 99%

Concentrations of Tenofovir and Emtricitabine in Saliva: Implications for Preexposure Prophylaxis of Oral HIV Acquisition

Lastours

Fonsart

Burlacu

et al. 2011

Antimicrob Agents Chemother

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To prevent acquisition of HIV through oral sex, drugs used for preexposure prophylaxis (Prep) need to diffuse in saliva. We measured tenofovir (TFV) and emtricitabine (FTC) concentrations simultaneously in the plasma and saliva of 41 HIV-infected patients under stable antiretroviral treatment. Mean ratios of saliva/ plasma concentration were 3% (؎4%) and 86.9% (؎124%) for TFV and FTC, respectively. Tenofovir disoproxil fumarate (TDF) should be used in combination with FTC to prevent oral acquisition of HIV.Thirty years into the HIV pandemic, a high incidence of new HIV infections persists, particularly in the subgroup of men having sex with men (MSM), where HIV transmission is sustained (16). Innovative approaches to prevent HIV transmission include the use of antiretrovirals as preventive tools, known as preexposure prophylaxis (Prep), either as oral pills or topical microbicides containing an active antiviral agent (13). Recent studies have shown a partial reduction in HIV acquisition in women using a vaginal tenofovir gel (1) and in MSM taking a daily oral tenofovir disoproxil fumarate (TDF)-emtricitabine (FTC) combination pill (11), the favored combination for Prep.While it is agreed that oral sex carries a much lower HIV infection risk than vaginal and anal sex, studies have convincingly demonstrated that both insertive and receptive oral sex are independent risk factors for transmission of HIV (6,19,20). The risk increases with frequency of activity, the presence of oral ulcers, oropharyngeal inflammation, or sexually transmitted infections in the oropharynx. This route of transmission should not be underestimated, in particular in MSM, where oral sex is rarely protected (8). In order for Prep to prevent HIV transmission through oral sex also, antiviral drugs should be taken orally, and their saliva concentrations should be sufficient to inhibit viral replication. Yet, no data are available on the penetration of tenofovir (TFV) and FTC in saliva. The aim of this work is to measure TFV and FTC saliva concentrations and saliva-to-plasma ratios in HIV-infected patients receiving either a TDF-or a TDF-FTC-based treatment.HIV-infected patients regularly followed in our HIV clinic were included if they were receiving a stable antiretroviral regimen, including 245 mg TDF daily and/or 200 mg FTC daily for at least 3 months, and gave informed consent. The study was approved by the Paris Saint-Louis Institutional Review Board. Blood and saliva samples were collected simultaneously during a routine follow-up evaluation of their HIV infection. Saliva samples were obtained by having participants spit 10 ml saliva in a sterile pot. To confirm that saliva had been sampled, samples were tested by validated colorimetric assays for total proteins (Biuret test) and saliva ␣-amylase (S type, enzymatic method) levels, using a Roche Modular analyzer (Roche Diagnostics France, Meylan, France). Both plasma and saliva TFV and FTC levels were measured by a validated high-performance liquid chromatography with tandem mass spectromet...

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“…HIV-1 infection can be acquired through the oral cavity during breast-feeding (19,31), oral-genital sex (26), and direct deposition in macaques (27), despite the low transmission risk associated with saliva (35). Viral loads exceeding those in matched plasma by up to 10 2 copies/ml in saliva (33,34), 10 3 copies/ml in the tonsils (13), and 10 7 copies/ml in lymphoepithelial parotid cyst aspirates (38) have been recently reported.…”

mentioning

confidence: 99%

Characterization of Human Immunodeficiency Virus Type 1 in Saliva and Blood Plasma by V3-Specific Heteroduplex Tracking Assay and Genotype Analyses

Freel¹,

Williams²,

Nelson³

et al. 2001

J Virol

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The gp120 V3-encoding region of human immunodeficiency virus type 1 (HIV-1) RNA derived from the saliva and blood plasma of 11 individuals was characterized by heteroduplex tracking assay and sequence analyses. R5-like viral variants were identified in both fluids of all subjects. X4-like variants were detected in the plasma and/or saliva of three subjects, indicating that X4-like variants are not excluded from the saliva compartment. Viral subpopulations were similar in both fluids of most subjects, suggesting that HIV-1 in oral fluids and blood may stem from a common source. These findings raise the possibility of using saliva as a noninvasive fluid for evaluating and monitoring viral evolution in infected persons.

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Oral sex and HIV transmission

Cited by 48 publications

References 5 publications

High rates of sexually transmitted diseases among male transvestites in Jakarta, Indonesia

High rates of sexually transmitted diseases among male transvestites in Jakarta, Indonesia

Concentrations of Tenofovir and Emtricitabine in Saliva: Implications for Preexposure Prophylaxis of Oral HIV Acquisition

Characterization of Human Immunodeficiency Virus Type 1 in Saliva and Blood Plasma by V3-Specific Heteroduplex Tracking Assay and Genotype Analyses

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