Prevention for Positives: HIV & STD Transmission Issues
or, "What About Diseases That Are Spread By Having Sex?"

HIV is just one of many sexually transmitted diseases (STDs).  While HIV is one of the most chronic and potentially deadly STDs, there are other STDs which can cause immediate death or cause disastrous chronic problems.  See Table 1.

All STDs can make it easier for someone with HIV to transmit HIV to someone else through sex.  STDs produce large or small open sores and inflammation (redness, warmth, swelling, drainage) that provide openings and "fuel" for HIV to attach to another person's skin or mucous membranes (mouth, vagina, rectum).

Persons with HIV infection may have forms of HIV that are different in how dangerous they are and how they respond to HIV medications.  If persons with HIV have sex with each other, those persons can trade strains back and forth that can make the other person more sick and harder to treat for the rest of their life.  For example, if a person with HIV is not taking medications consistently, that person's strain of HIV can become resistant to those medications.  If that person has unprotected sex with another person with HIV, then the resistant strain of HIV from the first person can be transferred over to the second person and the second person's strain of HIV can infect the first person.  This transfer can make that both persons' HIV infection more resistant to HIV medications and possibly much more difficult to treat. 

Different strains of HIV differ in how dangerous they are also ("virulence.")  Virulence refers to how dangerous that strain of HIV is: how fast it makes someone sick by dropping the immune system ("T cell count",) and how fast the amount of virus builds up in the body ("viral load").  There have been a few examples in the scientific literature of how one person can transfer a more virulent, more deadly, and more resistant strain of HIV to another person that is already infected.

It should be noted here that although there are "examples" of this transfer of HIV back and forth between HIV infected partners, this phenomena does not seem to be very common.  However, the discussion about other STDs is still very relevant.

Other STDs can also worsen HIV infection by putting more stress on the immune system.  Hopefully one can conclude from Table 1 that whether or not one already has HIV infection, one always needs to avoid the sexual transmission of any STDs including another strain of HIV to stay healthy.  When you have unprotected sex with someone, it is as if you are having sex with everyone they ever had sex with in terms of your risk for HIV and other STDs.  Many STDs are curable but diagnosis may be difficult and permanent damage to the body such as the inability to have children can result even with effective treatment.

All of the sexually transmitted diseases in Table 1 including HIV can be passed through oral, vaginal and rectal sexual intercourse whenever blood or secretions are exchanged.  Surprisingly herpes viruses can be transmitted from intact skin and mucosal surfaces (mouth, vagina, rectum) and there may be no visible spots or blisters.

Effective means for prevention of STDs as well as  HIV include the following:

1.  Condoms.  These should be used for all forms of intercourse (foreplay, oral, vaginal, and anal) even if ejaculation does not occur.  If breakage occurs, intercourse should be halted immediately at least temporarily, and the condom should be replaced.  Thin sheets of latex or dental dams may be alternatives for safe oral sex.  It is important to use latex rubber condoms and not condoms that are made from any other materials including sheep intestines.  Prior to and during sex, condoms need to be lubricated with a water-based lubricant like KY (there are many others.)  Never use anything besides water-based gels, or the condom may be damaged by the lubricant and suffer damage or leakage.  It is also important to find the type of condom which is best for the person wearing it in terms of fit, comfort and ease of application.  Just like anything else, you get what you pay for.  Purchase the best condoms that you can afford or seek out sources of free condoms from STD treatment centers, clinics, or Family Planning. Condoms should be stored in intact wrappers and removed from the wrapper only just prior to use.  The expiration date for condoms should not be exceeded.  Condoms should be stored where the room temperature is fairly steady and away from very cold or very hot temperatures.  Carrying a condom in one's wallet is not recommended as pressure and temperature may weaken the condom.  However, condoms may not be effective for all STDs including herpes, warts, hepatitis B as these STDs may be transmitted by skin to skin contact or kissing.

2.  Abstinence.  This refers to not having sexual intercourse.  While this method in theory is very effective, this philosophy is not as effective as one might think even among believers.  In fact many persons who practice abstinence without a backup plan such as condoms often get into trouble with unwanted pregnancies and STDs including HIV.

3.  Having sex in ways that does not result in exposure to body fluids.  For example, mutual masturbation.  Of all of the ways to prevent trading HIV and STDS, this might be the most effective and still be a lot of fun.

4.  If you use intravenous drugs, never share syringes or needles with another user.  If you must share, then rinse the syringe and needle several times with a weak solution of bleach and water to kill any virus or germs that might be in the syringe and needle from the last user.

See the HIV transmission page for more practical tips on prevention of STDS including HIV through sex or through intravenous drug use.

Methods of STD and HIV prevention that are not effective include the following:

1.  Oral contraceptive pills or birth control pills.  While these medications prevent pregnancy, they do nothing to prevent STDs.  In fact it could be argued that they increase STDs by encouraging sexual intercourse without the fear of pregnancy.

2.  Microbicidal or spermicidal gels or creams (for example, nonoxynol-9.)  Spermicidal gels are gels that are put in the vagina or rectum to kill sperm and prevent pregnancy.  Currently there is no approved vaginal or rectal preparation which prevents HIV or other STDs.  There is no evidence that douching or any other treatment of the vagina or rectum will protect from infections with HIV and other STDs.  In fact spermicidal gels and douching may actually irritate the vagina or rectum just slightly and in doing so make those areas more susceptible to STDS including HIV.

3.  Questioning your partner about STDs.  You cannot rely on someone who is not medically trained to know whether or not they have had or currently have a STD.  Many STDs (chlamydia, gonorrhea, herpes, HIV, syphilis) do not have symptoms in many individuals who are nevertheless infected and can infect others.

4.  Examining your partner for STDs.  Many STDs cannot be detected except with sophisticated medical tests.

Methods of STD and HIV prevention that are somewhat effective include the following:

1.  Having oral sex only.  The exact rate of transmission of STDs and HIV by oral sex is unknown.  However, some experts estimate that up to 8-10% of all HIV infections may be due to oral sex.  Although saliva tends to inhibit HIV, small crevices in the gums or around the teeth may allow entry for HIV.  Although HIV seems to less frequently transmitted via oral sex, other STDs find very fertile ground in the mouth and throat.  In plain language, it is very easy to get syphilis, gonorrhea, chlamydia, herpes, chancroid, and other STDS with unprotected oral sex.

2.  Having sex without ejaculation.  It is well established that the fluid that oozes from the penis prior to ejaculation (pre-cum) can transmit STDs including HIV.  Also vaginal fluid and rectal secretions harbor quite a bit of the HIV virus.  If there are any small (even microscopic) cuts on the genital organs, rectum, or in the gums, then there may be small amounts of blood present that can transmit the other partner with HIV.

3.  One or both partners are taking effective HIV medications.  This strategy may not be effective because HIV medications do not always get into the genital secretions as well as into the blood.  Therefore, someone may have a very low or undetectable HIV viral load in the blood, but they may have a lot of virus in their vagina or cum.  Also there are many other STDs that can be passed which can cause major problems for either or both parties.

If you believe you have been exposed to an STD or HIV, or you have symptoms of a STD or HIV, please consult your healthcare provider or local STD treatment resources for appropriate evaluation and treatment.  Never attempt to diagnose or treat yourself.  You can find a search engine based at the CDC HERE to search for resources in your area (e.g., enter your city or county and state).

5.21.11

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