Rectal intercourse while the threat of HIV transmission

Key points

  • The estimated risk of infection is zero for unprotected anal intercourse with an HIV-positive partner with a fully suppressed viral load.
  • If HIV is certainly not completely suppressed by effective therapy, rectal intercourse without condoms is just a high-risk path of intimate HIV transmission for both the insertive and receptive partner.
  • Intimately sent infections while the partner that is HIV-positive recently contaminated boost the danger of transmission.

In the event that partner that is HIV-positive using antiretroviral therapy and contains a completely suppressed viral load (‘undetectable’), the possibility of HIV transmission through rectal intercourse is zero.

The PARTNER-2 study accompanied 783 male partners where the HIV-positive partner had an invisible viral load with no condoms were utilized in rectal intercourse. After 1596 couple-years of follow-up and 77,000 acts of unprotected rectal intercourse, no HIV transmission from HIV-positive lovers happened additionally the scientists find ghana brides figured the possibility of HIV transmission during these circumstances had been efficiently zero (Rodger).

If viral load is detectable, condomless rectal intercourse is a extremely efficient method of transmitting HIV, which is considered a high-risk task both for lovers, even though precise level of danger can rely on numerous factors.

For every condomless work having an untreated HIV-positive partner, the possibility of illness happens to be approximated at 1.38percent (one out of 72 opportunity) and 0.11per cent (one out of 909 opportunity) for the receptive and insertive lovers correspondingly.

Nonetheless, it could be 10 to 25 times greater in the event that partner that is positive recently contaminated. Research reports have identified some other factors that further raise the threat of transmission.

Dangers to insertive and partners that are receptive

There is certainly a extensive belief among homosexual guys that the insertive partner (‘top’) are at suprisingly low chance of HIV illness. It is a fact that HIV disease happens less often in males whom entirely simply take the role that is insertive in males whom practice both functions, or males who practise receptive anal sex only (Jin).

Nonetheless, being the insertive partner in condomless intercourse continues to be a high-risk task. The per-act danger for the insertive partner in rectal intercourse is related to the per-act danger for a man (insertive) partner in genital sex.

The receptive partner (‘bottom’) are at threat of illness from HIV when you look at the semen and pre-seminal liquids (‘pre-cum’) for the partner that is infected. Rectal muscle is delicate and simply damaged, that could provide the virus immediate access to the bloodstream. Nevertheless, such damaged tissues just isn’t needed for illness that occurs: the rectal muscle itself is full of cells which are straight at risk of illness.

The insertive partner (‘top’) can be vulnerable to illness, as you can find high amounts of HIV in rectal secretions, along with bloodstream through the rectal tissues (Zuckerman). This produces a danger of transmission to your insertive partner through the muscle into the urethra as well as on the top associated with the penis – particularly underneath the foreskin.

A few systematic reviews of research reports have determined that condomless receptive anal sex posed more or less ten to twelve times greater danger of disease than insertive intercourse that is anal.

Insertive anal sex refers to your work of penetration during anal sex. The partner that is insertive the ‘top’.

The very last area of the big intestine simply over the rectum.

viral load

Dimension of this number of virus in a bloodstream test, reported as range HIV RNA copies per milliliter of blood plasma. The VL is an indicator that is important of progression as well as how good therapy is working.

intimately sent infections (STIs)

Although HIV may be intimately sent, the word is frequently utilized to chlamydia, gonorrhoea, syphilis, herpes, scabies, trichomonas vaginalis, etc.

Receptive rectal intercourse relates into the work to be penetrated during anal sex. The partner that is receptive the ‘bottom’.

The newest report about the proof estimated that for every single condomless work with an HIV-positive partner, the possibility of disease ended up being 1.38percent ( one out of 72 possibility) for the receptive partner and 0.11% ( one out of 909 possibility) when it comes to insertive partner (Patel).

However, lots of the studies had been completed before antiretroviral therapy after diagnosis became the norm and are also prone to over-estimate the possibility of illness.

Rectal intercourse between both women and men

Rectal intercourse between women and men has generally maybe maybe not gotten the maximum amount of attention as anal sex between males. Nevertheless, there was proof that rectal intercourse is practised by more and more sexually active grownups. This year, 11percent of females and 13% of males in britain report having anal sex in days gone by 12 months, with more youthful generations being prone to report it (Mercer).

Unprotected heterosexual rectal intercourse probably plays a crucial role in HIV transmission among heterosexuals, although dependable quotes miss (Baggaley).

Present illness

The very first couple of weeks or months after HIV has entered a body that is person’s their viral load is generally very high plus they are really infectious.

Viral load could be the term used to explain the quantity of HIV circulating in the torso. As viral load rises, therefore does infectiousness. Having said that, whenever load that is viral therefore low as become invisible, there isn’t any danger after every one of HIV transmission.

For instance, a report of heterosexual partners in Rakai, Uganda, where one partner was HIV good in addition to other HIV negative in the beginning of the research, indicated that the probability of HIV transmission is greatest in the 1st two . 5 months after infection that is initial HIV, and that this correlated with greater viral load amounts during the early HIV infection. The researchers estimated that in accordance with chronic illness, infectiousness during main illness ended up being improved 26-fold (Hollingsworth).

As folks are frequently unacquainted with their illness at this time, they’re not using therapy and may accidentally expose sexual lovers to HIV. Individuals who have HIV without realising it are a lot very likely to be concerned in HIV transmission than individuals who understand they will have HIV, since the latter can get therapy.

Intimately sent infections

Many infections that are sexually transmitted specially people who result ulceration, including herpes simplex 2 (HSV-2), syphilis, gonorrhoea, and chlamydia, increase HIV-negative partners’ danger of acquiring HIV during genital sex. HIV-negative individuals with recurrent STIs might be at increased ongoing chance of HIV disease.

In individuals coping with HIV that are perhaps not using HIV therapy, STIs additionally cause increased vaginal shedding of HIV, which advances the chance of transmitting HIV to other people. However, STIs try not to raise the threat of HIV transmission from people that are using effective HIV therapy and have now an invisible viral load. Within the PARTNER research, there was clearly perhaps not just a solitary hiv transmission even though numerous research individuals had STIs.

There are two primary significant reasons for the effect of STIs on HIV transmission. Firstly, numerous (while not all) STIs could cause ulcers, sores or lesions. They offer an immediate real path of entry for HIV in a uninfected individual. Next, resistant cells which can be, on their own, prone to HIV infection – such as activated T-cells and dendritic cells – are vulnerable to show up in greater numbers during the web web site of a illness.

“Being the insertive partner in condomless intercourse stays a high-risk activity.”

The strongest proof is for herpes virus kind 2 (HSV-2). A meta-analysis unearthed that having HSV-2 ended up being connected with an elevated danger of acquiring HIV both in the population that is generala rise of 270%) plus in greater risk teams such as for instance intercourse employees and males who’ve intercourse with males (170%). Having a present hsv-2 disease had been connected with a nearly fivefold (470%) increased threat of acquiring HIV, most likely because vaginal ulceration, viral shedding and infection within the vaginal tract are undesirable in brand new HSV-2 infections and have a tendency to decrease with time (Looker).

Individual papillomavirus (HPV), the explanation for genital warts, is connected with a heightened risk of HIV illness in females whether or not it really is an HPV kind that triggers vaginal warts or a kind related to cervical cancer tumors (Houlihan). The clear presence of HPV in cells when you look at the penis additionally escalates the threat of purchase in males (Rositch).


Poppers are nitrite-based inhalants, trusted as being a leisure drug by homosexual males in a lot of nations. Specially popular to be used during receptive anal sex, sniffing poppers relaxes the rectal sphincter muscle tissue, making sexual intercourse easier and intensifying pleasure.

Nevertheless, utilizing poppers during unprotected, receptive anal sex more than doubles the possibility of HIV infection (Macdonald). This can be because poppers enhance blood circulation into the rectal cells, heightening their susceptibility to disease. Poppers usually do not impact the insertive partner’s danger of illness.

Rectal douching

Rectal douching could be the insertion of a fluid, such as for instance plain tap water or soapsuds, in to the anus via an instrument, to clean the anus before or after rectal intercourse and it is an activity that is common homosexual and bisexual guys. But, it would likely harm the rectal liner and remove protective naturally occurring germs. If the douching that is same, showerhead or other device is employed by each person, infections is also transmitted like that.

A synthesis of 24 studies indicated that rectal douching ended up being connected with an almost threefold increased likelihood of illness with HIV and a far more than twofold rise in the possibility of a sexually transmitted illness other than HIV (Li).

Even though it is feasible that this outcome could merely be due to behavioural distinctions, all the studies done multiple analyses take into consideration possible confounders such as for instance regularity of intercourse and partner figures.

Rectal blood

Rectal blood additionally raises the possibility of illness, and might be due to haemorrhoids, specific STIs such as for instance anal warts, herpes lesions, the use that is prior of toys, or by fingering and fisting.

Male circumcision

There are many data from low and middle-income nations to declare that circumcision might be protective, but only for males who solely use the role that is insertiveYuan).