Rectal secretions

Very little research addresses this topic, but a study from the University of Washington, Seattle, found that levels of HIV RNA in rectal mucosal secretions in gay men were higher than those in blood or semen – by about 500% in the case of blood and 2500% in the case of semen.1

The study found that viral loads in swabs taken from the rectum were 25 times higher than semen viral loads in the 58% of the men not taking HIV treatment, and four times higher in the 37% of men on treatment who had detectable viral loads.

The average rectal viral loads were 316,000 and 4000 respectively.

There was also a much less strong relationship between the use of treatment and reduction of viral load in the rectal swabs than there was with blood or semen.

Previous studies of HIV RNA in rectal tissues had used biopsy specimens, and HIV was very frequently detected. However biopsies may not represent the quantity of HIV in rectal secretions which insertive sexual partners are exposed to. One other study2 used anal swabs, which would sample the anal canal, rather than towards the top of the rectum, as in the University of Washington study.

Another study from the same team at Washington found that men with herpes simplex shedding in the rectum had higher HIV RNA levels, in both rectal swabs and blood plasma.3

During anal intercourse, the rectum secretes a protective, lubricating mucus that accommodates penetration. Although the mucus eases penetration and repeated thrusting, it by no means protects either partner from cuts and abrasions that can increase the risk of HIV transmission, which is why proper lubrication and condom use is necessary. In fact, the mucus may be far more infectious than any other fluids either partner might be exposed to.

The study suggests that men who have insertive unprotected anal sex and encounter this mucus are at far higher risk of HIV infection than had been previously thought. Formerly, most literature on HIV protection named blood or semen as the main culprit in HIV transmission.


  1. Zuckerman RA et al. Higher concentrations of HIV RNA in rectal mucosa secretions than in blood and seminal plasma, among men who have sex with men, independent of antiretroviral therapy. J Infect Dis 189: 156-161, 2004
  2. Lampinen TM et al. Association of antiretroviral therapy with detection of HIV-1 RNA and DNA in the anorectal mucosa of homosexual men. AIDS 14: F69-F75, 2000
  3. Kim N et al. Higher rectal HIV RNA levels in men who have sex with men (MSM) with concurrent rectal HSV shedding. 44th Annual Meeting of the Infectious Diseases Society of America, Toronto, abstract 57, 2006
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap