HIV Risk Without Ejaculation During Sex

Determining your risk of getting human immunodeficiency virus (HIV) from different sexual behaviors is always a tricky subject. In evaluating your risk, you tend to weigh pros and cons as to which activities might be safer than others.

A stack of multi-colored condoms
Getty Images / Rafe Swan / Cultura

At times, this can put you at higher rather than lower-risk simply because "common sense" assumptions are not often right. One such assumption is that a person can largely avoid ​HIV if their partner does not ejaculate. While it may seem reasonable to assume that less semen means less HIV, the facts don't always support the belief.

HIV in Pre-Seminal Fluid

The simple fact is that HIV is present in both semen and pre-seminal fluid (also known as pre-ejaculatory fluid or "pre-cum"). While the volume of HIV in pre-seminal fluids is inherently lower, that number can change significantly in people living with HIV who are not treated.

By and large, a person with untreated HIV will have more active virus circulating in the blood and other body fluids (as measured by the HIV viral load). The same applies to a man who may not be taking his HIV medications correctly and is unable to achieve an undetectable viral load.

Moreover, the presence of a coexisting sexually transmitted disease and even some urinary tract infections can increase a process called HIV shedding, where the infection draws more HIV to the male genital tract and, by default, to the man's semen.

Similarly, the amount of pre-seminal fluid can vary from person to person, as can the sperm content of the fluid. Pre-seminal fluid is released from a male's urethra (the opening in a male's penis) during sexual arousal and before ejaculation.

A man can release up to 4 milliliters (mL) of pre-seminal fluid (a little less than one teaspoon). The longer the sexual activity, the more pre-ejaculate a man is likely to produce.

Weighing the Facts

The belief that pre-seminal fluid is not infectious assumes that there is a certain volume of seminal fluid by which HIV transmission is unlikely. While semen is known to be a dominant carrier of HIV, there has long been a debate as to whether sperm carries HIV or whether the virus is just freely circulating in the seminal fluid.

Most research today suggests that it's both. In addition to freely circulating virus, sperm interacts with elements on HIV's outer shell, called heparan sulfate and mannose receptors, effectively sticking the two together like Velcro.

In this capacity, sperm is a viral carrier and is more easily able to pass the virus to vulnerable white blood cells, called dendritic cells, that are found around abrasions in the vaginal or anal lining.

While this may suggest that sperm plays a bigger part in HIV infection that the fluid itself, there is one spoiler—men with vasectomies can pass HIV to their partners.

It leaves the question as to whether the volume of seminal fluid is key to infection. And while it certainly seems a fair argument, there is really no effective way to know how little is "safe" and how much is "unsafe."

A Word From Verywell

If you are concerned that you may have HIV, see a doctor about an HIV test. If you don't have HIV, protect yourself by using the most effective tools of prevention, including condoms and pre-exposure prophylaxis (PrEP).

If you are living with HIV, the most important thing you can do is prevent transmission and stay healthy. You can do this by taking your HIV drugs every day as prescribed. Doing so can help you maintain an undetectable viral load, thereby reducing your risk of passing the virus to others.

An undetectable viral load doesn't mean you can toss out the condoms, but it does mean you can have sex with far less concern about transmission.

Frequently Asked Questions

  • How do you help prevent HIV transmission?

    There are several key ways to prevent yourself and others from contracting HIV, including limiting your number of sexual partners, using condoms every time you have sex, and avoiding sharing needles. If you are HIV-positive, it is important to take medication correctly to keep your viral load undetectable, and if your partner is HIV-positive, it is important to take PrEP daily.

  • How is HIV treated?

    HIV is primarily treated with antiretroviral drugs. In addition, lifestyle behaviors can help maintain overall health, including avoiding smoking, proper diet and exercise, limiting alcohol, and keeping up with regular checkups.

  • What are the symptoms of HIV?

    Symptoms of HIV depend on the stage. In stage 1, symptoms may include fever, chills, headache, night sweats, sore throat, aches, fatigue, swollen lymph nodes, and mouth ulcers whereas in stage 2, these symptoms mostly resolve except for swollen lymph nodes. In stage 3, common symptoms include lymph node swelling, thrush, skin problems, severe night sweats, and extreme weight loss.

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Article Sources
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