[Question #10428] HIV Exposure Risk from Threesome

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23 months ago
Myself (male) and my female girlfriend engaged in a threesome with another female recently. We all had a few too many drinks and things went too far. 

The lights were off and we were all open mouth, deep kissing. My girlfriend and the other female performed oral sex on each other and inserted fingers in one another. Both definitely engaged in vaginal oral sex and potentially anal oral sex as well. Kissing happened in between as well as attempts to perform oral sex in me. I was unable to get an erection due to alcohol consumption. No intercourse took place between myself and either woman.

We turned the lights on and noticed the other woman was bleeding. She may have had spotting between her period - not sure.

Three days after this event my girlfriend and I both became sick with fly like symptoms. Sore throat, dry cough, fatigue and fever with night sweats for two nights. We both tested negative for Covid using a nasal swab quick test. 

We discussed with the other woman and she admitted to having other sexual partners. She went to get tested and provided negative test results including a Gen 4 HIV test (negative). She admitted to having a similar illness 11 weeks prior to getting tested.

My girlfriend and I took a PCR RNA test and both came back negative. My PCR RNA test was at 9 or 10 days and my girlfriend completed her test at 10 or 11 days (the exposure happened between 11pm and 1am so not sure how to count). 

Does this sound like an event that is high risk exposure since open mouth deep kissing and oral sex with blood was involved? 
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H. Hunter Handsfield, MD
23 months ago
Greetings. Thank you for your confidence in our services.

On one level, your concerns certainly are understandable; both the blood exposure and your symptoms soon after the event obviously created concern. However, the facts are that the risk of HIV was near zero from the start. The chance of other STDs was perhaps a bit higher, but still low. In any case, blood is no more infectious for HIV or other STDs than genital fluids; no intercourse was involved; and oral sex (and by extension, exposure to saliva) are always low risk.

As for the symptoms you describe, they started much too soon to be due to acute HIV infection (onset never sooner than 7-8 days after exposure), and they aren't the right symptoms either:  HIV doesn't cause cough, and symptoms last more than 2-3 days, generally a couple of weeks. No STD causes these symptoms either. Probably one of the three of you came into the event with a common cold -- and like you I would have thought of covid and I'm glad to hear you tested negative for it.

And perhaps most important, your third-party partner's negative AgAb (4th generation) HIV test proves she did not have transmissible HIV at the time of the event. Your and your gf's negative PCR tests also are highly reassuring. They aren't quite conclusive at the times tested -- but these results combined with the other partner's negative test, plus the low risk of the exposure itself, make it certain you and your gf do not have HIV. You're free to have further testing if you wish, but I see no need and would not do it myself (if somehow I were in your situation).

As implied above, the chances of other STDs are somewhat higher but still very low. Given the oral sex aspects, you and your girl friend (and the other woman) could be tested for gonorrhea and chlamydia, including oral swab testing; and even a later blood test for herpes. But the actual risk of any of these is very low and I would consider testing optional. (If the other woman's testing included negative results for these tests, I definitely would say you and your partner don't need testing yourselves).

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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23 months ago
Thank you Dr. Handsfield. You and your partner provide an incredible service to folks. Appreciate your quick reply and reassurance.

I wanted to point out that my symptoms are still present with regards to post nasal drip and dry cough. It’s been a little over 2.5 weeks. The onset of initial symptoms occurred 3-4 days after this event. I had a bad sore throat that resembled tonsillitis for about 8-10 days that eventually resolved with an antibiotic (although at the time my strep test was negative when I visited an urgent care on day 3 of symptoms).

The third party female did test negative for all other STIs and provided us with her results. She did state she has one other partner that she has unprotected sex with regularly. I do not know his status. She also admitted to giving oral sex to a second man  during that time frame. So her negative AgAb test is reassuring but is it conclusive if she has an ongoing partner as well? 

If my girlfriend and I choose to retest for peace of mind what would be a timeframe window for that reassurance? The one time event/exposure happened on Aug 27th at 11pm until roughly 2am on the 28th.
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H. Hunter Handsfield, MD
23 months ago
HIV doesn't cause either cough (as noted above) or nasal drip or congestion. Also see all the other reasons to be confident that the third party lady did not have HIV at the time of exposure.

If you and your gf insist on going ahead with unnecessary testing, have HIV AgAb (4th generation) blood tests 4 weeks after the event (for 98-99% conclusive result) and/or at 6 weeks for 100%. Honestly, it's nonsense though. This was a non-event with a partner who, by your description, not only doesn't have HIV now but is at very low risk for it. HIV is virtually absent in women with the sort of sex life you describe for her.

Really, don't worry about this! The advice would be identical if you were someone personally close to me (my grandchildren are sexually active singles, for example).
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23 months ago
Once again, I appreciate your time and attention.

My worries were focused on the blood involved from the third person and it being in my girlfriend’s mouth (unknowingly) and then immediately attempted to perform oral sex on me. I recognized the window in which we completed our RNA blood test was premature. I wasn’t sure if we should complete that again prior to my first message. 

Also the window coverage for the negative AgAb from the third person female was a question for me because she is active and I was worried about any potential exposure she may have had in the weeks just before we had our encounter since she did not complete an RNA blood test. 

Thank you again for your patience with me and answering all of my questions. This one time type of encounter will never happen for us again!
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H. Hunter Handsfield, MD
23 months ago
I said above that blood is no more infectious than genital secretions. The levels of HIV are similar in blood and genital fluids and blood doesn't increase risk compared with sex itself. For example, sex during menstruation with an infected women does not elevate her partner's risk compared with sex itself.

On top of that, the chance such a person is in the window period is nil for all practical purposes. You seem to have an inaccurate perception of HIV frequency! You could have an exposure like this weekly for the next 10 years and not expect to get HIV. There was no insertive sex, which basically means no risk for HIV even with a known infected partner.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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