Sex without ejaculation may reduce the overall risk of HIV transmission, but it doesn’t necessarily prevent it. That’s because HIV inprecum(pre-seminal fluid) can still put you at risk.
Most people know that HIV is mainly transmitted through sex, however, the risk is not the same for all types of sex. Each type of sexual contact carries its own risk of HIV transmission. Receptive anal sex, for instance, carries a higher risk of infection than receptive vaginal sex. Oral sex has the lowest risk of transmission.
This article aims to explore the factors that contribute to HIV transmission and whether “pulling out” is an effective strategy to prevent HIV. In addition, the article will examine ways to reduce the risk of HIV if external (or “male” condoms) and internal (or “female” condoms) are not used consistently.
How Is HIV Transmitted?
HIV in Pre-seminal Fluid
Although pulling out before ejaculation decreases the overall risk of transmission, it doesn’t prevent it altogether. Why? Because pre-seminal fluid can contain the virus too.
In people with HIV, pre-seminal fluid is just as potentially infectious as semen, containing roughly the same concentration of HIV.This means that even if the insertive partner pulls out before ejaculation, the receptive partner can still be exposed to HIV through pre-seminal fluids.
RecapPre-seminal fluid (“pre-cum”) contains roughly the same high concentration of HIV as semen. During unprotected (also referred to as “condomless”) sex, pre-seminal fluid can potentially cause an infection.
Recap
Pre-seminal fluid (“pre-cum”) contains roughly the same high concentration of HIV as semen. During unprotected (also referred to as “condomless”) sex, pre-seminal fluid can potentially cause an infection.
Can You Get HIV From One Exposure?
It’s possible for a person to become infected with HIV after one exposure.However, the risk level varies depending on the type of exposure or behavior.
Risk Factors
People often consider pre-seminal fluid to be less of a risk with respect to HIV because the volume of fluid released is generally lower than semen. However, there are numerous factors that can increase that risk.
Pre-seminal Fluid Volume
It’s normal for males to produce anywhere from a few drops to more than 5 mL of pre-cum.However, an older study found that some men can produce high amounts of pre-cum,especially after a prolonged period of abstinence.
HIV Viral Load
An untreated HIV infection can lead to a highviral load. The HIV viral load is a measure of the number of viruses in a sample of blood, ranging from undetectable to well over a million. A higher viral load in the blood corresponds to a higher concentration of viruses in pre-cum.
Anal Sex
Therisk of HIV from anal sexis high because rectal tissues are delicate and easily broken. This allows the virus to pass directly into the bloodstream.
At the same time, the rectum has only a single layer of cells overlying tissues that are rich in immune cells calledCD4 T cells. These are the very cells that HIV targets and infects. Because of this, even a small volume of fluid may establish an infection.
Sexually Transmitted Infections (STIs)
Syphilis, gonorrhea, and herpes can increase your risk of getting HIV in the future.Some STDs likesyphiliscause ulcers that provide HIV easy access into the body. Others likegonorrheacause inflammation that draws immune cells, including CD4 T-cells, to the site of infection, giving HIV more targets to infect. These factors can raise the risk of infection.
HIV Shedding
Even people with an undetectable viral load in the blood can have detectable HIV in semen and pre-seminal fluid as a result of shedding.
RecapEven though the concentration of HIV in the pre-seminal fluid is lower than in semen, certain factors can increase the risk of HIV, including having a high viral load, having an STI, or engaging in anal sex.
Even though the concentration of HIV in the pre-seminal fluid is lower than in semen, certain factors can increase the risk of HIV, including having a high viral load, having an STI, or engaging in anal sex.
Weighing the Risks
In the end, there is no hard and fast rule as to “how much” or “how little” pre-seminal fluid is needed to cause an HIV infection. There are many variables that play a role in determining a person’s risk.
While pulling out before ejaculation may reduce the chances of transmission, it does not eliminate it. For example, an older study showed that condomless receptive anal sex with ejaculation was found to be approximately twice as risky as condomless receptive unprotected anal intercourse with withdrawal.While the risk of contracting HIV is lower with withdrawal, there is definitely a risk.
If you don’t use external or internal condoms consistently, there are ways to reduce the risk of getting HIV or passing it to others:
RecapThe current evidence suggests that pre-seminal fluid can transmit HIV. To reduce the risk of infection, you can take theHIV prevention pill (PrEP)if you don’t have HIV, or start antiretroviral therapy and maintain an undetectable viral load if you do.
The current evidence suggests that pre-seminal fluid can transmit HIV. To reduce the risk of infection, you can take theHIV prevention pill (PrEP)if you don’t have HIV, or start antiretroviral therapy and maintain an undetectable viral load if you do.
Can I Stop Using Condoms If I’m on PrEP?
Summary
Pulling out before ejaculation does not prevent the transmission of HIV. Pre-seminal fluid contains roughly as much HIV as semen. And, even though fluid volumes tend to be smaller, there may be enough to cause an infection. Factors like a high viral load, having an STI, or engaging in anal sex can increase the risk.
If you don’t use external or internal condoms consistently, consider starting pre-exposure (PrEP) to reduce your risk of acquiring the virus.
If you are concerned that you’ve been exposed to HIV, don’t wait to get tested. Instead, head to your nearest clinic to requestpost-exposure prophylaxis (PEP). This is a strategy in which antiretroviral drugs are taken for 28 days after exposure to avoid an HIV infection.
PEP needs to be started no later than 72 hours after possible exposure, ideally within 48 hours. Arapid HIV testis given beforehand to ensure you don’t have HIV. AnotherHIV testis given afterward to confirm whether the infection has been prevented.
Frequently Asked Questions
There are several key ways to avoid HIV, including limiting your number of sex partners, using external or internal condoms every time you have sex, and avoiding sharing needles. If you are HIV-positive, it is important to take your medications correctly to keep your viral load undetectable. Your partner can also take PrEP to reduce their risk of getting HIV.
HIV is treated with antiretroviral drugs. Lifestyle changes can also keep you strong and help you avoid infection. This includes quitting cigarettes, eating a healthy diet, exercising regularly, and keeping up with routine HIV checkups.Learn MoreHow HIV Is Treated
HIV is treated with antiretroviral drugs. Lifestyle changes can also keep you strong and help you avoid infection. This includes quitting cigarettes, eating a healthy diet, exercising regularly, and keeping up with routine HIV checkups.
Learn MoreHow HIV Is Treated
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J.Estimating per-act HIV transmission risk: a systematic review.AIDS. 2014;28(10):1509-1519. doi:10.1097/QAD.0000000000000298Centers for Disease Control and Prevention.How HIV spreads.Politch JA, Mayer KH, Anderson DJ.HIV-1 is undetectable in preejaculatory secretions from HIV-1-infected men on suppressive HAART.AIDS.2016;30(12):1899-1903. doi:10.1097/QAD.0000000000001130Stanford Medicine Health Care.Risk of exposure to HIV/AIDS.Centers for Disease Control and Prevention.HIV risk behaviors.Lampiao F.Coitus Interruptus: Are there spermatozoa in the pre-ejaculate?Int J Med Biomed Res. 2014;3(1):1-4. doi:10.14194/ijmbr.3.1.1Chudnovsky A, Niederberger CS.Copious pre-ejaculation: small glands–major headaches.J Androl. 2006;28(3):374-375. doi:10.2164/jandrol.107.002576Kariuki SM, Selhorst P, Norman J, et al.Detectable HIV-1 in semen in individuals with very low blood viral loads.Virol J.2020;17:29. doi:10.1186/s12985-020-01300-6Patyka M, Malamud D, Weissman D, Abrams WR, Kurago Z.Periluminal distribution of HIV-binding target cells and gp340 in the oral, cervical and sigmoid/rectal mucosae: a mapping study. Pöhlmann S, ed.PLoS ONE. 2015;10(7):e0132942. doi:10.1371/journal.pone.0132942Clinicalinfo.HIV.gov.HIV and sexually transmitted diseases.Pasquier C, Walschaerts M, Raymond S, et al.Patterns of residual HIV-1 RNA shedding in the seminal plasma of patients on effective antiretroviral therapy.Basic Clin Androl.2017;27:17. doi:10.1186/s12610-017-0063-xJin F, Jansson J, Law M, et al.Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART.AIDS. 2010;24(6):907-913. doi:10.1097/QAD.0b013e3283372d90Centers for Disease Control and Prevention.Preventing HIV with PrEP.Food and Drug Administration.FDA approves first injectable treatment for HIV pre-exposure prevention.Rodger A, Cambiano V, Bruun T, et al.Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study.Lancet.2019;393(10189):2428-2438. doi:10.1016/S0140-6736(19)30418-0Centers for Disease Control and Prevention.Post-exposure prophylaxis (PEP).Chou R, Evans C, Hoverman A, et al.Pre-exposure prophylaxis for the prevention of HIV infection: a systematic review for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality (US); 2019.Sauka M, Selga G, Silova A, Westermarck T, Latvus A, Atrosha F.Impact of CoQ10, L-carnitine and cocktail antioxidants on oxidative stress markers in HIV patients — mini review and clinical trial. In:Pharmacology and Nutritional Intervention in the Treatment of Disease.U.S. Centers for Disease Control and Prevention, National Institutes of Health, HIV Medicine Association of the Infectious Diseases Society of America.Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents.
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J.Estimating per-act HIV transmission risk: a systematic review.AIDS. 2014;28(10):1509-1519. doi:10.1097/QAD.0000000000000298Centers for Disease Control and Prevention.How HIV spreads.Politch JA, Mayer KH, Anderson DJ.HIV-1 is undetectable in preejaculatory secretions from HIV-1-infected men on suppressive HAART.AIDS.2016;30(12):1899-1903. doi:10.1097/QAD.0000000000001130Stanford Medicine Health Care.Risk of exposure to HIV/AIDS.Centers for Disease Control and Prevention.HIV risk behaviors.Lampiao F.Coitus Interruptus: Are there spermatozoa in the pre-ejaculate?Int J Med Biomed Res. 2014;3(1):1-4. doi:10.14194/ijmbr.3.1.1Chudnovsky A, Niederberger CS.Copious pre-ejaculation: small glands–major headaches.J Androl. 2006;28(3):374-375. doi:10.2164/jandrol.107.002576Kariuki SM, Selhorst P, Norman J, et al.Detectable HIV-1 in semen in individuals with very low blood viral loads.Virol J.2020;17:29. doi:10.1186/s12985-020-01300-6Patyka M, Malamud D, Weissman D, Abrams WR, Kurago Z.Periluminal distribution of HIV-binding target cells and gp340 in the oral, cervical and sigmoid/rectal mucosae: a mapping study. Pöhlmann S, ed.PLoS ONE. 2015;10(7):e0132942. doi:10.1371/journal.pone.0132942Clinicalinfo.HIV.gov.HIV and sexually transmitted diseases.Pasquier C, Walschaerts M, Raymond S, et al.Patterns of residual HIV-1 RNA shedding in the seminal plasma of patients on effective antiretroviral therapy.Basic Clin Androl.2017;27:17. doi:10.1186/s12610-017-0063-xJin F, Jansson J, Law M, et al.Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART.AIDS. 2010;24(6):907-913. doi:10.1097/QAD.0b013e3283372d90Centers for Disease Control and Prevention.Preventing HIV with PrEP.Food and Drug Administration.FDA approves first injectable treatment for HIV pre-exposure prevention.Rodger A, Cambiano V, Bruun T, et al.Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study.Lancet.2019;393(10189):2428-2438. doi:10.1016/S0140-6736(19)30418-0Centers for Disease Control and Prevention.Post-exposure prophylaxis (PEP).Chou R, Evans C, Hoverman A, et al.Pre-exposure prophylaxis for the prevention of HIV infection: a systematic review for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality (US); 2019.Sauka M, Selga G, Silova A, Westermarck T, Latvus A, Atrosha F.Impact of CoQ10, L-carnitine and cocktail antioxidants on oxidative stress markers in HIV patients — mini review and clinical trial. In:Pharmacology and Nutritional Intervention in the Treatment of Disease.U.S. Centers for Disease Control and Prevention, National Institutes of Health, HIV Medicine Association of the Infectious Diseases Society of America.Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J.Estimating per-act HIV transmission risk: a systematic review.AIDS. 2014;28(10):1509-1519. doi:10.1097/QAD.0000000000000298Centers for Disease Control and Prevention.How HIV spreads.Politch JA, Mayer KH, Anderson DJ.HIV-1 is undetectable in preejaculatory secretions from HIV-1-infected men on suppressive HAART.AIDS.2016;30(12):1899-1903. doi:10.1097/QAD.0000000000001130Stanford Medicine Health Care.Risk of exposure to HIV/AIDS.Centers for Disease Control and Prevention.HIV risk behaviors.Lampiao F.Coitus Interruptus: Are there spermatozoa in the pre-ejaculate?Int J Med Biomed Res. 2014;3(1):1-4. doi:10.14194/ijmbr.3.1.1Chudnovsky A, Niederberger CS.Copious pre-ejaculation: small glands–major headaches.J Androl. 2006;28(3):374-375. doi:10.2164/jandrol.107.002576Kariuki SM, Selhorst P, Norman J, et al.Detectable HIV-1 in semen in individuals with very low blood viral loads.Virol J.2020;17:29. doi:10.1186/s12985-020-01300-6Patyka M, Malamud D, Weissman D, Abrams WR, Kurago Z.Periluminal distribution of HIV-binding target cells and gp340 in the oral, cervical and sigmoid/rectal mucosae: a mapping study. Pöhlmann S, ed.PLoS ONE. 2015;10(7):e0132942. doi:10.1371/journal.pone.0132942Clinicalinfo.HIV.gov.HIV and sexually transmitted diseases.Pasquier C, Walschaerts M, Raymond S, et al.Patterns of residual HIV-1 RNA shedding in the seminal plasma of patients on effective antiretroviral therapy.Basic Clin Androl.2017;27:17. doi:10.1186/s12610-017-0063-xJin F, Jansson J, Law M, et al.Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART.AIDS. 2010;24(6):907-913. doi:10.1097/QAD.0b013e3283372d90Centers for Disease Control and Prevention.Preventing HIV with PrEP.Food and Drug Administration.FDA approves first injectable treatment for HIV pre-exposure prevention.Rodger A, Cambiano V, Bruun T, et al.Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study.Lancet.2019;393(10189):2428-2438. doi:10.1016/S0140-6736(19)30418-0Centers for Disease Control and Prevention.Post-exposure prophylaxis (PEP).Chou R, Evans C, Hoverman A, et al.Pre-exposure prophylaxis for the prevention of HIV infection: a systematic review for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality (US); 2019.Sauka M, Selga G, Silova A, Westermarck T, Latvus A, Atrosha F.Impact of CoQ10, L-carnitine and cocktail antioxidants on oxidative stress markers in HIV patients — mini review and clinical trial. In:Pharmacology and Nutritional Intervention in the Treatment of Disease.U.S. Centers for Disease Control and Prevention, National Institutes of Health, HIV Medicine Association of the Infectious Diseases Society of America.Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents.
Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J.Estimating per-act HIV transmission risk: a systematic review.AIDS. 2014;28(10):1509-1519. doi:10.1097/QAD.0000000000000298
Centers for Disease Control and Prevention.How HIV spreads.
Politch JA, Mayer KH, Anderson DJ.HIV-1 is undetectable in preejaculatory secretions from HIV-1-infected men on suppressive HAART.AIDS.2016;30(12):1899-1903. doi:10.1097/QAD.0000000000001130
Stanford Medicine Health Care.Risk of exposure to HIV/AIDS.
Centers for Disease Control and Prevention.HIV risk behaviors.
Lampiao F.Coitus Interruptus: Are there spermatozoa in the pre-ejaculate?Int J Med Biomed Res. 2014;3(1):1-4. doi:10.14194/ijmbr.3.1.1
Chudnovsky A, Niederberger CS.Copious pre-ejaculation: small glands–major headaches.J Androl. 2006;28(3):374-375. doi:10.2164/jandrol.107.002576
Kariuki SM, Selhorst P, Norman J, et al.Detectable HIV-1 in semen in individuals with very low blood viral loads.Virol J.2020;17:29. doi:10.1186/s12985-020-01300-6
Patyka M, Malamud D, Weissman D, Abrams WR, Kurago Z.Periluminal distribution of HIV-binding target cells and gp340 in the oral, cervical and sigmoid/rectal mucosae: a mapping study. Pöhlmann S, ed.PLoS ONE. 2015;10(7):e0132942. doi:10.1371/journal.pone.0132942
Clinicalinfo.HIV.gov.HIV and sexually transmitted diseases.
Pasquier C, Walschaerts M, Raymond S, et al.Patterns of residual HIV-1 RNA shedding in the seminal plasma of patients on effective antiretroviral therapy.Basic Clin Androl.2017;27:17. doi:10.1186/s12610-017-0063-x
Jin F, Jansson J, Law M, et al.Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART.AIDS. 2010;24(6):907-913. doi:10.1097/QAD.0b013e3283372d90
Centers for Disease Control and Prevention.Preventing HIV with PrEP.
Food and Drug Administration.FDA approves first injectable treatment for HIV pre-exposure prevention.
Rodger A, Cambiano V, Bruun T, et al.Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study.Lancet.2019;393(10189):2428-2438. doi:10.1016/S0140-6736(19)30418-0
Centers for Disease Control and Prevention.Post-exposure prophylaxis (PEP).
Chou R, Evans C, Hoverman A, et al.Pre-exposure prophylaxis for the prevention of HIV infection: a systematic review for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality (US); 2019.
Sauka M, Selga G, Silova A, Westermarck T, Latvus A, Atrosha F.Impact of CoQ10, L-carnitine and cocktail antioxidants on oxidative stress markers in HIV patients — mini review and clinical trial. In:Pharmacology and Nutritional Intervention in the Treatment of Disease.
U.S. Centers for Disease Control and Prevention, National Institutes of Health, HIV Medicine Association of the Infectious Diseases Society of America.Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents.
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