[Question #10500] Exposure Hiv Fellatio

22 months ago

Please help i anxiety is affecting my mental health, 6 weeks ago i gave a trans woman oral unprotected and a few seconds she inserted her penis in my rectum ( Protected) condom didnt break from what i am aware hopefully thats the case yes i know i am stupid, I had very chapped lips and they had been bleeding earlier that day. The oral was a bit rough i deep throated. She masturbated and i put my face near her penis and some sperm landed near my mouth area it wasnt much maybe few drops maybe swallowed a bit not sure if it touched my lips that was bleeding earlier that day. Im scared that i may have got HIV or Hepatitis B or C I have tested at 2 weeks using 4th gen rapid finger test it was negative. 3 weeks 4th gen blood test at local health dept negative 4 weeks again Negative blood from vein. I also tested negative for gonorhea chlamydia and syphillis and HCV as well as oral gonorhea and Chlamydia. All negative. I did a Hepatitis B test at 5 weeks and it was negative for Antigen, Negative for surfave antibody, But had 9.69miu level for immunity assuming its from my vaccine i received as a infant i am 24yrs old. I read that protective levels need to be above 10.00miu for protection what are the odds i contracted Hep B or Hiv or Hep C

H. Hunter Handsfield, MD

22 months ago

Welcome and thanks for your question.

I can't say there was no risk of STIs, but based on your description the chance you were infected with anything is quite low. The highest risk event would have been the brief anal presentation, but that risk was prevented by the condom, assuming it remained intact. Your performance of oral sex on your partner brings up the possibility of oral gonorrhea, plus far lower chances of chlamydia, syphilis, and conceivably herpes. Superficial exposure to semen (e.g. near your face of mouth) carries little or no risk. The ancillary facts you mention -- chapped or bleeding lips, swallowing a bit of semen, and that some aspects were "a bit rough" -- all make no significant difference in risk of HIV or other STIs.

Most important is your negative test results. I'm glad to to see you have a negative throat swab test for gonorrhea/chlamydia. The urine (or urethral) test was unnecessary, if I correctly understand your exposures -- but you should find the negative results reassuring. Your negative HIV AgAb (4th generation) test is nearly conclusive, but another test will be necessary at 6+ weeks for 100% certainty. Syphilis testing also should be done at 6 weeks, although absence of a syphilitic chancre plus your negative blood test so far make it nearly 100% you don't have it.

Having been vaccinated against HBV, it was unnecessary to test for it -- but it should be reassuring that you have detectable antibody from being immunized. HCV was no risk at all; the ONLY sexual practices documented to transmit HCV are traumatic (i.e. potentially bloody) anal practices in MSM.

So all is well and almost certainly you acquired no STI -- but final testing for syphilis and HIV at 6 weeks should be considered if not yet done.

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

HHH, MD

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22 months ago

Hello doctor

Wouldnt the chapped lips be considered a open wound where semen could have entered the bloodstream? I know you guys say its 1 out of 10,000 exposures but you also said in other posts that you guys have seen documented cases of hiv through fellatio did those people really give oral 10,000 times for 27 years? Also in some posts i see you say 4 weeks is conclusive and others 6 ?

As far as Hep B wouldnt i have been considered not protected since my levels where below the cutoff for protection? I was at 9.69 and i ready protected levels are 10.00 or greater.

What are chances i get gonorhea from kissing or pass it by kissing if i had it in my throat ?

Also does a negative TPPA conclude that i have never had syphillis ?

Thank you

22 months ago

Also id like to add will 6 weeks be conclusive for HIV 2 as well or what that only be for HIV 1 ?

H. Hunter Handsfield, MD

22 months ago

"Wouldn't the chapped lips be considered a open wound where semen could have entered the bloodstream?" No not really. Oral lesions, gum bleeding, chapped lips and similar disorders are extremely common, and still no known HIV transmissions. Obviously nobody can say your risk is zero -- but you've had the negative test result, which is nearly conclusive.

The AgAb (4th generation) HIV blood tests theoretically are conclusive at 4 weeks, and that was the recommendation for many authorities for a few years. However, more recent data have shown rare cases in which it took up to 45 days for positive results. However, I've never heard of any patient who tested positive at 4 weeks and later had a positive test result.

The value of 10.0 is a conservative cut-off, because the data are not precise. But any detectable level of HBsAb is believed by most experts to be 100% protective. And anyway, HBV has never been known to be transmitted by cunnilingus and in general is nearly zero risk for vaginal sex as well. Sexual transmission of HBV is overwhelmingly an issue only among men who have sex with men.

Transmission of gonorrhea by kissing is controversial. It probably happens from time to time, but almost exclusively (once again) in MSM. For unknown reasons, it appears to not occur or to be exceedingly uncommon in kissing between men and women. I can't say the risk is zero, and for reassurance perhaps you would like to have a gonorrhea throat swab test. But if somehow I were in your situation, I certainly would feel no need to do so.

Yes, negative TPPA is proof you never had syphilis.

The HIV AgAb test weeks is considered conclusive at 6 weeks for HIV2 as well as HIV1.

Please accept the basic fact that you have described a very low risk sexual exposure for any and all STIs. In addition to inherently low risk as noted above, the large majority of female sex workers do not have HIV or other transmissible STIs. Perhaps you also would like to know that in the 20 years of this and our preceding forum, with thousands of questions like yours, not one person has yet reported that they eventually tested positive for HIV. You're not going to be the first! If and when it happens, surely it will be from a genuinely risky exposure -- and certainly not in someone who tested negative after 4 weeks!

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22 months ago

I think you got confused here it was not cunnulingus i performed fellation on a trans sex worker,

I have tested today at my local county health dept using a 4th gen test from blood from a vein. I was suprised i got the results about 2 hours later and im still negative however today was the 42 days but my exposure was later in evening six weeks exactly from today. I tested in morning should i have waited until around the same time the exposure was 6 weeks ago ?

Also i know hep b is hard to transmit by giving a woman oral but i gave fellation to a trans woman. And in scared the semen entered my cracked chapped bleeding lips i had earlier that day wouldnt that be a big exposure. trans was from Mexico and is about 28-30yr old so i doubt they ever got vaccinated as a child.

Do you think i could have got trich or Mgen in my throat from fellatio or giving a woman oral? Few months ago about 4 months i gave a woman oral and about 3 days later i had ulcers in back of my throat. Never tested until now and it was negative for gonorhea and chlamydia in throat what others STDs can cause ulcers in back of throat? Im worried cause im married and afraid i passed my wife something in that time. What if cleared the infections myself but what if she still has it and it ping pongs back and forth. From kissing then gives it to my genitals from giving me fellatio.

Last question i received one dose of HPV before i was sexually active as a child do you think theres a good chance that protects me ? My wife received all 3 doses as a child before being sexually active do you think our chances of getting HPV cancers are lower? Does the vaccine provide lifelong immunity? Thank you

22 months ago

Also noticed you said 45 days is conclusive isnt 6 weeks 42 days ? Should i test again in 3 days ?

22 months ago

To finalize this also am i really speaking to

H. Hunter Handsfield or is this a automated replies or your assitant?

H. Hunter Handsfield, MD

22 months ago

Thanks for the correction. I realized that error in part of my reply and deleted reference to cunnilingus in part of my reply but not in my paragraph starting with “The value of 10.0…” Sorry. But it makes little difference: fellatio also is little or no risk for HBV, which is sexually transmitted primarily by anal sex.

A few hours short of 6 weeks makes no difference in HIV test reliability. 45 days is official for the HIV AgAb test, but 3 days makes no measurable difference and we and many other authorities round it off to 6 weeks for convenience.

Trichomonas and M. genitalium do not infect the oral cavity, and both also are absent for all practical purposes in partners like you describe. (Without vaginal contact there is no risk.)

One dose of HPV vaccine provides some protection but is not nearly as effective as two or three doses. But your wife is well protected, which is good in view of your sexual lifestyle. You might speak with your doctor about revaccination with 2-3 doses.

That concludes this thread. I hope you have found it useful.

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