I had an unfortunate casual encounter with another male on Sunday morning (6/25). 

We both performed fellatio,  he ended up partially ejaculating in my mouth, though only a little as I quickly stopped, and he also rimmed me for a short period.  Our whole encounter was maybe 10-15 minutes (not that it matters). 

This individual claims to be HIV negative as of a couple months ago (most recent test) and currently on Prep. However, I do not know them outside of this encounter, so not sure how much I can trust what they claimed.

My question is what am I at risk for here? Only a year ago I made a similar mistake… This time I didn’t go on PEP. Should I have? My nerves are getting the better of me. I’ve had a mild sore throat and noticeable slight discomfort in my urethra, though no discharge yet. Would you recommend I test at all? I can’t believe I’ve made this same mistake twice. Though the first encounter last year sounds more risky than this one, if I understand STI/STD  /HIV risk correctly.

Thank you for any reassurance.

I have to change my lifestyle and this will be where I start.

Respectfully,

Concerned 

Here are the facts upon which I make this statement:

1.  Your partner said that he was HIV negative and on PrEP.  Most people tell  the truth.

2.  His performance of fellatio on you is a virtually no risk event. We have never seen or heard of an occasion in which HIV was acquired from receiving oral sex from an infected partner.  

3. The risk of acquiring HIV from performing oral sex on him, IF he had untreated HIV (if he was infected and on effective therapy, he would not be infectious) is estimated (it has to be an estimate- the occurrence of HIV following performance of fellatio on an infected partner are so low that there are no accurate measures of this rare occurrence) is less then 1 infection for every 10,000 acts of fellatio on an infected person..

I would not be worried.  Testing is a personal choice and reflects you level of concern.  If you choose to test, at 4 weeks more than 99% of recently acquired persons would have posiitve tests, at 6 weeks results would be entirely conclusive.

I hope that this information is helpful.  EWH

Thank you for your quick and thorough reply, your words are very reassuring. My anxiety is probably getting the better of me. You would think these occasions would be enough to change human behavior. I am working on this.

I have a couple of follow up questions if that is ok:

1. Would you recommend testing for HIV or would this simply be for my own reassurance? On that topic, is there any utility to testing at 2 weeks, then 4 and 6? What is the estimated reliability at 2 weeks? Last year, in addition to getting blood drawn, I’d sent out for 4th gen Ag/Ab using a DBS method (dried blood spot). Can you confirm if that is an acceptable method? I understand Oraquick is the least preferred.

2. Are there any other STIs I should be worried about? Gonorrhea and syphilis come to mind. In the absence of any symptoms, is it important to test for these? Of course if I experience any concerning symptoms, I will get tested. Just wasn’t sure if you’d recommend testing if asymptomatic given the level of risk. 

3. Finally, based on my scenario, do you think it would be important to abstain from sex with my regular partner for any period of time?

Thank you again for your time and patience with my concerns.

1. Would you recommend testing for HIV or would this simply be for my own reassurance? On that topic, is there any utility to testing at 2 weeks, then 4 and 6? What is the estimated reliability at 2 weeks? Last year, in addition to getting blood drawn, I’d sent out for 4th gen Ag/Ab using a DBS method (dried blood spot). Can you confirm if that is an acceptable method? I understand Oraquick is the least preferred.

Testing is always a personal choice and the results can b e reassuring.  Testing at two weeks is of relatively little value, missing around half of recent infections.  OTOH, for persons who are concerned, testing at 4 weeks is quite valuable as more than 99% of recent infections will yield positive tests are 4 weeks.  The additional less than 1% would become positive between weeks 4-6 and results are totally conclusive at 6 weeks.

Dried blood spots are quite reliable.  You are correct, the OraQuick test is an antibody only test and is our least favorite.

2. Are there any other STIs I should be worried about? Gonorrhea and syphilis come to mind. In the absence of any symptoms, is it important to test for these? Of course if I experience any concerning symptoms, I will get tested. Just wasn’t sure if you’d recommend testing if asymptomatic given the level of risk. 

Persons on PrEP tend to often acquire STIs.  Oral sex however is a relatively inefficient type of sexual contact but other STIs do occur, just no t that often.  Your risk for STIs is modest.  The most common STIs occurring following oral sex are gonorrhea which is frequently asymptomatic at the throat but usually symptomatic at the penis.  Less common STis which occur following oral sex are syphilis and chlamydia but both are relatively uncommon.  You may want to test for gonorrhea (chlamydial testing is usually done automatically along with testing for gonorrhea),  You could test at this time for gonorrhea and chlamydia and anticipate accurate results from both a urine specimen and a throat swab.  Syphilis testing, which I feel less strongly about, would not be accurate until 4-6 weeks after your encounter

3. Finally, based on my scenario, do you think it would be important to abstain from sex with my regular partner for any period of time?

I do not feel strongly that abstention is necessary.  If you test for gonorrhea and are negative, I really would not feel the need to abstain.

Hope this information is helpful.  BTW, if you can contact your partner and he is willing to be tested, you could put any and all concerns behind you.  If he is negative for any off the STIs we've discussed, then he could not have infected you.  In addition, testing is routinely recommended for persons taking PrEP as he is.  EWH

I went to get tested for gonorrhea and chlamydia via urine and oral swab test. Both came back negative. This was done at 4 days post encounter. This should be considered accurate? Any need to retest? Also, you feel syphilis testing is unnecessary?

I was also hoping you might leave this thread open so I could report back on my HIV test I take at 4 weeks. Or I could post as a new question. You mentioned my type of exposure is low risk for HIV. Do you expect results to come back as negative? Having to wait 4 weeks is really making me anxious.

Your support and reassurance has really helped me through these past couple of tough times. 

Thank you.

I anticipate that your HIV test will be negative.  I will leave the thread open for up to 30 days so that you can post your results (which would be appreciated).  However, there will not be further responses to additional questions.  EWH

Just checking in to report that as I mentioned, I submitted another DBS sample for HIV AgAb testing at the 4 week mark. It took almost a week to arrive to the lab which is unusual in my experience. I am waiting to receive results and this is just to ask if you wouldn’t mind leaving this open for another couple of days until I can report back on the results.

Thank you again.

As you expected, my results came back and were negative / non reactive. Would you recommend follow-up testing at 6 weeks to be sure?

Thank you for your time and the invaluable service you provide to the community. It’s truly been helpful and appreciated. 

Take care.

I hope this perspective helps.  EWH