How Dangerous Is It to Have Sex with Someone Who Has HIV?

The human immunodeficiency virus, or HIV, is still a public health problem affecting millions of people in the U.S. and around the world, and yet it is an issue we do not talk about - or when we do, it carries stigma and misinformation. Many people, especially young people who did not live during the 1980s epidemic, still do not understand where HIV came from or how it is transmitted. Dr. K gives us the facts about the history, prevention and treatment of HIV.

Additional resources for this episode:
Centers for Disease Control and Prevention: https://www.cdc.gov/hiv/basics/index.html
Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524
Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/4251-hiv-aids
Johns Hopkins: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hiv-and-aids

If you have a question for Dr. K, email QandAwithDrK@mpqhf.org. Your question will remain anonymous. 

Transcript

Beth Brown: 0:09

Welcome to Q and A with Dr. K., A podcast by Mountain Pacific Quality Health, where we sit down with Dr. Doug Kuntzweiler and get your health questions answered. Because on Q and A with Dr. K, the doctor is always in. Hello again, listeners. Thanks for being here. I'm Beth Brown, your host, and I'm here with Mountain Pacific chief medical officer Doug Kuntzweiler, as usual. Dr. K, good to see you.

Dr. Doug Kuntzweiler: 0:44

Good to see you as well. Thank you.

Beth Brown: 0:46

So today's question actually came to us from Facebook Messenger, which is just great. We'll take these questions however we can get them. Obviously, we have our email address, where folks can send in questions, but we're on Facebook, too, so find us there. This one, I think, was in response to a social media post we did to commemorate World AIDS Day, and HIV and AIDS don't get the platform they did three or four decades ago, when there was all the news and everyone was obsessed with it. And now it's really kind of quieted down. But it's still a huge public health issue here in the U.S. and around the world. And people still don't understand the facts, and especially how it can be transmitted. So that's the question and here it is; it's short: how dangerous is it to use your tongue on the private parts of a person infected with HIV? So as usual, I think we need to take a step back and make sure we just understand what we're talking about here. So because we haven't heard about HIV and AIDS for a while, maybe, a lot of people out there, let's do a quick refresher on what is HIV.

Dr. Doug Kuntzweiler: 1:50

Absolutely. And you're exactly correct that it does not get the platform it once had, yet worldwide, over a million people die of AIDS every year - still, despite effective therapy. So AIDS is caused by the Human Immunodeficiency Virus, HIV. And this is a virus that probably developed in ape and monkeys in Central Africa. And those are both food items in those countries. And it's thought that probably the virus mutated and was able to jump into human beings, probably when they were butchering a monkey for for sale, if they had a cut on their hands, and they were cutting up monkey meat, they would be exposed to the monkey's blood. And that's probably how it got started. People have gone back and looked at people who died of unknown illnesses in Central Africa as far back as the 1920s. Sometimes usually British doctors would see these patients, they would be puzzled by what killed them, and they would preserve tissue while people have been able to go back and look at that tissue and find evidence of the HIV virus in those tissues. And that goes back as far as the 1920s. In the United States, it was first recognized in 1981. There was a landmark paper that was published where an infectious disease specialist in Southern California reported five otherwise healthy young men who died of a very rare fungal pneumonia called pneumocystis. That was just sort of unheard of. I was a fourth year medical student at the time and our infectious disease professor said, you know, look at this paper and pay attention, this is going to turn out to be something big. And then in 1983, a French investigator and an American investigator identified the human immunodeficiency virus as the cause of those opportunistic infections. And an opportunistic infection is an infection that normally doesn't trouble the average human being. But if your immune system is weakened, either by a medication or by some illness, then these rare organisms, and there's a whole host of them funguses and bacteria and viruses can cause an infection and kill you now - and, and also, there are some rare cancers. There was a rare cancer called Kaposi sarcoma that was reported in some of these early cases, too, and that was almost unheard of. So it - HIV is a virus. It's spread through a variety of means most prominently through blood exposure to blood of somebody who has the HIV but also semen, vaginal fluid and breast milk, and a pregnant woman can pass it on to her fetus while they're still in the uterus. So any exposure to those fluids can give you HIV and it usually comes through what we call a mucous membrane. So the lining of your mouth is very different than the skin outside on on your cheek, the lining is, it's soft, it has a rich capillary blood flow. And that's called a mucous membrane. So you have that in your mouth, you have it in your - the lining of your eyelids, the lining of your nose, the lining of your upper airway, the vaginal lining, the lining of the rectum, those are all mucosal membranes, and they can be easily traumatized. You know, if you sometimes just blow your nose vigorously, you can get a tiny little tear in that lining, and you'll have a small bloody nose. If you're brushing your teeth vigorously, you can get a tiny little, maybe even microscopic scratch of your gums of the lining of your mouth. And that's all that the virus needs to gain access to your body. When it gets inside your body. It has a particular affinity for, what are called, T four white blood cells, or CD four cells, and they are part of your body's immune system. They are the cells that fight off cancers. And these kind of unusual infectious organisms. Usually they're funguses, or sometimes viruses like cytomegaloviruses, when that's common, or some bacteria that normally don't cause trouble. So the virus gets into these T four cells, and it forces them to make more virus. And then at some point, that cell explodes and releases the virus into your bloodstream. And at that point, you can pass it on to someone else. Initially, it was called the "gay plague," because it was initially recognized in men who had sex with men, but it didn't take very long to realize that nobody really was safe from this, because then we began seeing women who were infected, people who had gotten it while the mother was pregnant, even some got through blood transfusions until we realized how to recognize it.

Beth Brown: 4:20

That is a wealth of information. And I had no idea it went back as far as it does go back. If someone does get infected with HIV are their symptoms? Can people tell that they're sick?

Dr. Doug Kuntzweiler: 7:08

Well, that's interesting. This is part also of why HIV is pretty dangerous. You can be totally asymptomatic, or after your exposure, typically, in about two to four weeks, you may get kind of a viral syndrome, where you have a sore throat, maybe some fever, some achy muscles and joints and a rash, you might have some diarrhea. And those symptoms usually don't last very long, about a week to 10 days, like most viral syndromes, and then they simply go away, you're still infected, and the virus is slowly reproducing itself inside your T four cells. But those initial symptoms go away. So a lot of people, they feel like, well, I've got mono, or I've got a cold or you know, I ran into a bug somewhere, but I'm fine. And that's part of why it was so dangerous and was so easily spread.

Beth Brown: 7:57

And then HIV can progress as it recreates, and is growing in your body. At what point does it turn into AIDS?

Dr. Doug Kuntzweiler: 8:06

So we call it sort of just semantic thing, but we call it AIDS, when you show evidence of an opportunistic infection, one of these weird infections that someone with a healthy immune system doesn't get. You can be HIV positive, meaning the virus is in your body, not have an infection, and you don't have AIDS at the first point where you get, let's say, Pneumocystis pneumonia, then you've got AIDS, people would say, well, he's got full blown AIDS, because he's got cytomegalovirus, or he's got some weird protozoan infection.

Beth Brown: 8:38

How, when and how should somebody get tested for HIV, then, if they're not necessarily having symptoms, or it progresses to the point that they're really sick? When do you get tested?

Dr. Doug Kuntzweiler: 8:49

There are a variety of reasons why you would need to get tested. If you are in a higher risk group, if you are a male who has sex with other males, you should get tested. And you should do that periodically. If you are a woman who has a lot of sexual partners, you should get tested. If you are someone who is an IV drug user, and you have shared needles, haven't always used sterile needles, or maybe you're not sure, then you should get tested. And you should do that periodically. Because as I said, this is a disease that sometimes is completely asymptomatic, and you don't know. So those are some of the reasons why you should get tested. If you know that your partner is positive, and you have some sort of sexual encounter where you're you could be exposed to any of those body fluids I mentioned, then you should get tested.

Beth Brown: 9:38

And you said women who have a lot of partners, which can be a very relative term. Are there - is there a certain range that women should be aware of?

Dr. Doug Kuntzweiler: 9:45

No, I think anytime you're you're not in a mutually exclusive relationship, you probably should think about it. And somebody may tell you, I've been tested and I'm negative, but you know, how do you know? I think the prudent thing is is to get yourself tested. We shouldn't forget that there are other sexually transmitted diseases that can go right along with HIV- syphilis, for instance, the human papilloma virus (HPV), which causes cervical cancer - that's an important one - gonorrhea, chlamydia. So if you are having any kind of sexual encounter or exchanging blood products, by injecting IV drugs, you should be very careful and go talk to your primary care provider or go to an infectious disease clinic or public health clinic and talk to them, you know, explain what your risk factors are. And they can give you advice about whether or not you should be tested.

Beth Brown: 10:37

So we've talked about how HIV is transmitted, I think it's important to talk to you about how it is not transmitted. Because there was a lot of misinformation out there. People were so scared, and there's probably still misinformation out there. So how is HIV not transmitted? What are some of those misconceptions we can do away with right now?

Dr. Doug Kuntzweiler: 10:58

There were lots of misconceptions. Part of that was because of the prejudice against people who are gay. And part of it was because, early in the epidemic, we just didn't know as much as we eventually knew. And that's true of any new [virus] - that you can say the same thing about COVID, there was a lot of misinformation. There were a lot of changes in advice, because early in an epidemic, you just don't know exactly what you're dealing with. You're right there, there was a lot of misinformation especially initially about how it was transmitted, but it's not transmitted through human touch, giving somebody a hug, shaking hands, you can't get it that way. It's not transmitted through saliva. So it's not a kissing disease, you can't get it through kissing, it's not transmitted through tears. So there's no problem with that, unless you are exchanging those body fluids I talked about, blood, semen vaginal fluid, you don't have to worry about getting it. So you can have someone living in your household who's HIV positive, and as long as you aren't exposed to those fluids, you don't have anything to worry about.

Beth Brown: 12:03

So I think that takes us back to our Facebook friend's question, which I think we've sort of answered in a roundabout way. But let's just be clear: the Facebook friend specifically questioned using your tongue on private parts. So we're talking about oral sex here. Can HIV be transmitted through oral sex?

Dr. Doug Kuntzweiler: 12:20

Yes, it absolutely can, whether it's male on female, male on male, female on female, if you're exposed to semen, or you are exposed to vaginal fluid, and that gets in your mouth or on your tongue. You may have microscopic little openings on your tongue or around your gums, as we talked about, and the virus can gain entrance that way, and yes, you can get it through oral sex.

Beth Brown: 12:44

Okay, so we have sort of let HIV and AIDS go on to the backburner, so to speak, and I'm sure that's because of treatment and what we've learned about HIV. But can you talk about how HIV is treated and is it something that really has gone by the wayside because the treatments have gotten so effective?

Dr. Doug Kuntzweiler: 13:06

Yeah, I think that's quite true. So early on, as soon as it was realized that this was a virus, people started working - all around the world - started working on treatment therapies. And initially, they came up with a couple of medications that seemed to help on these were labeled anti retroviral therapies, or ART. And all around the world, people kept working on them, because the initial ones were not terribly effective. They helped, but they certainly weren't a cure-all. Over the course of time, many different drugs were developed. And it was realized that if you use them in combinations, you could interfere with the virus's ability to reproduce to the point where today, if you develop an infection with HIV, or if you develop an exposure, and you have HIV in your cells, you can take a combination of medications, and it will suppress the virus. Now, it doesn't get rid of it completely. These are medicines that you have to stay on. But it will suppress it to the point where you are at very low risk of opportunistic infections. And you can pretty much live a normal lifespan. A great example would be Magic Johnson that people know. He was exposed a few years after the development of the initial drugs, and he's been on therapy ever since and is doing quite well, as are many people. The downside of that is then people got very cavalier about it. And I've spoken with young people in their 20s now who really don't know the history of AIDS. They don't realize how horrible it was in the 1980s and early 90s. Before these effective drugs were developed, that there were people dying horrible deaths all around the country and all around the world. And you need to remember that history, because this is still a very dangerous virus, and if you don't get effective therapy and stay on that therapy, you're at great risk of dying of one of these infections. And as I mentioned, over a million people annually around the world still die of AIDS.

Beth Brown: 15:10

That's why I'm really thankful for this question, because I do think when it is talked about, and maybe it's one of those topics that people avoid, because it is so related to sex, we get squeamish about that topic. And so we just don't talk about it. And then when we do it has that stigma still, because it makes people uncomfortable.

Dr. Doug Kuntzweiler: 15:31

Better to be squeamish than dead. That's what I say.

Beth Brown: 15:34

That's a very good point. What should we remember about HIV and AIDS, so we don't fall into spreading misinformation or fall into that stigma or discrimination. But I think maybe you just summed it up in a few words there.

Dr. Doug Kuntzweiler: 15:49

I want to put in a word for condoms. Condoms do protect you, not only from HIV, but also from these other infectious diseases that we talked about. So cheap, cheap protection, don't forget that.

Beth Brown: 16:03

Yeah, well, it's definitely much more affordable than the alternative if you do have to go through.

Dr. Doug Kuntzweiler: 16:09

Yes, these drugs, as you might have - might imagine are not particularly cheap. They're life saving, but they're not cheap.

Beth Brown: 16:16

And not to mention the toll that having to manage a virus that doesn't ever go away takes on all aspects of your life.

Dr. Doug Kuntzweiler: 16:24

If people, especially young people who aren't aware of, of you know, the history of AIDS, watching the movie Philadelphia with Tom Hanks gives you a pretty good idea of what went on. So I put in a plug for that movie, if if you didn't live through the epidemic, or you haven't read about it, and, and you're wondering what it was like, that's a great movie to watch. But I didn't get kickback either.

Beth Brown: 16:51

I do think it was nominated for a lot of awards, too, so not only - it's not just educational, it's entertainment. And it's good information to have. And it's very well done. It was an excellent movie. So in addition to watching Philadelphia, where else can our Facebook friend and anyone else who might be interested about some of the facts around HIV and AIDS, where should they go?

Dr. Doug Kuntzweiler: 17:11

Well, the CDC is still a great source of information. And I would guide people to that. And then the other sources that we often talk about the Mayo Clinic website, the Cleveland Clinic website, Johns Hopkins, any of the reputable, big medical centers will have a lot of information. But CDC has a lot of concise, good information. Another point I want to talk about is that if you get treated, if you get on treatment, you're much - even though you still have the virus in your T four cells - you're much less likely to transmit it to somebody. So that's another good reason to get treated. I would still say practice safe sex, use condoms, etc., but if you get treatment, you're much less likely to give it to someone else. And that's important. There also is pre-exposure prophylaxis, if you know you're going to have sex with somebody who is positive, you can take medication, and that will lower your risk. And there's also post-exposure prophylaxis, if you have sex with someone, you're exposed to any of those fluids we talked about. And then that person discloses to you that they're HIV positive, then you can take medication to reduce your risk of the virus getting established in your body. And yeah, it is a subject that is sometimes uncomfortable to talk about. But it it's incredibly important because there's so much suffering and, and death that goes along with this. And you know, you really don't want to be part of that. And you don't want to spread that if you can, and there is effective therapy now.

Beth Brown: 18:41

Thank you, Dr. K. Lots of good information. And thank you for listening. We'll put a few of the sources that Dr. K mentioned with this episode, and again, we just want to remind you that if you have a question for Dr. K, you can message us on Facebook if you'd like, or you can email us at the email address we have which is QandAwithDrK@mpqhf.org. And we'll have that email address attached with this episode as well. We hope that you got a lot of information, and if you need the information, we'll have those resources for you. Thanks, everybody. Have a great day.