[Question #11025] Dear Good Drs: Just wanted to get some guidance

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17 months ago
My last hiv test was 28 months ago - since that time I have had protected vaginal sex with 4 different females - (all four I received unprotected oral - and performed cunnilingus on three - in addition to these I have had receptive oral from 2 others and one of these I provided cunnilingus. The reason I tested 28 months ago was because i had one incidence of unprotected vaginal sex - with a bar pickup and the test was negative. There was only one time after any of these episodes - about 10 days after having protected sex and unprotected oral both ways - that I did have some flu like symptoms - (that event happened two years ago) I did have a fever although not high - i did not have a rash or any lymph node swelling - as for body aches - really do not recall any - I was traveling after the event and was able to drive a car across several states - catch flights - (so fever could not of been to high) cause they took it on boarding plane. The person I had (protected vaginal unprotected oral both ways) with was african american - she has sickle cell - and we discussed testing and safe sex - she even directed me to a study about hiv and sickle cell and how it is a hostile enviroment for HIV. I have ordered test for HIV 1/2 4th generation test hiv antibodies and p24 and a test for syphilis. The last time I had sex was back in October of 2023 - protected vaginal and unprotected oral - i had no symptoms after the event - but I became concerned about two weeks ago and it centered on a penis lesion - which I got feedback for Dr. Hook- i was concerned it might be syphilis. All these sex episodes were related to girls i met online on a sugar dating website so money was involved. I do have questions - but I do not want to exceed guidelines.


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Edward W. Hook M.D.
17 months ago
Welcome back to the Forum.  It appears that you have continuing concerns that you may have acquired HIV or syphilis from the exposures that you describe above.   As I understand it, your last sexual encounter with anyone was some time in October 2023, over 4 months ago.  As you point out, your genital exposures were condom protected making them virtually no risk;  your oral exposures, while unprotected, were statistically low risk simply because transmission of all STIs, including HIV is biologically rare from oral sex.  The be sure, you have recently ordered tests for HIV and syphilis.  I assure you that were you infected by any of the encounters you describe, the tests you have ordered would be positive.  Thus, when the tests you have ordered come back negative, as I am confident they will, you can rest assured that you were not infected.  No further testing is needed related to these past exposures.

I hope the information I provide here is helpful.  I am confident you have nothing to worry about.  EWH
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17 months ago
Dear Dr: Hook
As you are very aware logically I understand that my fears are perhaps not rational and that my lifestyle choices and how I think of these causes my anxiety - I think both you and Dr Handsfield would and have said many times before - testing is not medically necessary based on my exposures - but from an anxiety stand point it is reasonable. 

1. Is that your belief? 
2. Did i order the right tests?
3. Should i see a dermatologist or a urologist for my for better word lesions?


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Edward W. Hook M.D.
17 months ago
In reply

1. Is that your belief? 
You have prior negative tests and your exposures were very low, if not no risk.  Testing is a personal choice but I do not see the need

2. Did i order the right tests?
Yes

3. Should i see a dermatologist or a urologist for my for better word lesions?
I am not sure what lesions you are referring to.  If it is the penile lesion we discussed previously and it is still there, then seeing a dermatologist rather than a urologist  is the best course of action. If it is no longer present, I see little reason to see someone.  

You have one, final follow-up remaining.  EWH
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17 months ago
Dear Good Doctors:
I must say that I am very relieved indeed to have a negative test and to face down my fears of testing!  It was not a comfortable feeling what so ever for me to do such. The topic of HIV for me has caused much angst that borders on paranoia (Of which by reading this forum share with many others). Obviously, I need to find the root of my illogical thoughts! 

I would like to get your opinion on the CDC - and why the 1 in 10,000 is the same for performing oral sex on a male and cunnilingus? (when there has been documented cases that HIV has taken place by performing oral on a man and not a woman. Is it because we lack well documented studies? Is it because of legal liabilities ? Is it because its simply Science and with science and medicine you simply can never say never? 
If it is permissible? I would also like your opinion as to which is a greater risk performing oral on a woman or recieving oral from a woman - and finally - although I am not concerned about this based on you and Dr Hansfields advice from what I have read and you have said - The blood drawn was 16 days after receiving oral from a lady - would it have been sufficient time after this episode to pick up a potential syphilis infection?
In closing I would wish to express my many thanks for your words of courage - (such as I am confident when the test you have ordered come back  negative as I am confident they will - no further testing is needed. I have reviewed re read and your words many times and they allowed me some much needed comfort!
Thank you so much for your help !!










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Edward W. Hook M.D.
17 months ago
As you know, this will be my last response.  Some of your questions, as you point out, have no good answers and as we pride ourselves on providing evidence-based answers, If there are no data I will tell you so.

I would consider the 1 in 10,000 estimates as almost place holders.  The estimates of 1 in 10,000 exposures is just that- an estimate for events that are so rare that there are no good data.  CDC's estimates tend to be conservative and, as you point out, in science we can never say never because new, extraordinarily rare events continue to occur.   Remember, 1 in 10,000 would be performing the sex act in question on an HIV infected, untreated person once daily for over 27 years.  When you then consider that most people do not have HIV and more than half of people who do are on treatment and therefore non-infectious, the 1 in 10,000 estimate tells me that this is not something to worry about. Once estimates get that small, there is simply no good reason to worry which i n 10,000 estimate is greater than another.  It is just not something to worry about.

Regarding your questions regarding receipt of oral vs performing cunnilingus, I will point out that there are a tiny handful of instances in which persons have acquired HIV from cunnilingus while there are no documented cases of HIV acquired from receipt of oral sex/fellatio from an infected person.  

I hope that this information has been helpful.  Take care.  Please don't worry.  EWH
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