[Question #11055] An unusual situation

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17 months ago
Hello Doctors,

I find myself in a somewhat unusual situation. Today, I met a sex worker. I received oral sex from her and also performed oral sex on her. I understand from browsing others' posts that this is considered a very low-risk exposure. However, while performing oral sex on her, my nose came into close contact with her vagina, and her genital fluids entered my nostrils. My nose occasionally bleeds, so I am uncertain if there were any wounds inside my nostrils at that time. I am certain, however, that my nose was not bleeding at the time.

If there were wounds inside my nostrils, should I be concerned about HIV and other STIs from this exposure? Can I proceed without undergoing testing?
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H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thank you for your confidence in our services.

As you probably would guess, there are no data on the risk of nasal infection in this situation. However, I would put the risk at zero or close to it. Oral sex itself is almost no risk, even though the throat is susceptible to gonorrhea (although nit chlamydia). The lining in the front of the nose consists of squamous epithelium -- a kind of tissue generally not susceptible to gonorrhea or other STDs. In this respect it is like the mouth -- i.e. susceptible tissue is deeper inside. With or without bleeding wounds, I would consider this a zero risk situation. And certainly HIV is not likely either. There has never been a known case of HIV acquired by cunniliingus (oral-vaginal contact) or from mouth to penis. I see no need for testing for these or any other STD.

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

HHH, MD
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17 months ago
Thank you very much for your reply.

Regarding HIV, which is my biggest concern, is it true that the lining in the front of the nose is not susceptible to HIV? If I understand correctly, are you indicating that this is a zero-risk event in regards to HIV, even if there were wounds inside my nostrils (which I know were not bleeding at that time), and there is no need for HIV testing?
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H. Hunter Handsfield, MD
17 months ago
As I said above, "With or without bleeding wounds, I would consider this a zero risk situation." There's no way you're going to be the world's first known case of HIV acquired by cunnilingus, with or without genital fluids in the nose. In what must have been millions if not billions of oral cunnilingus, there must have been many in which someone's nose was also exposed -- and still no known cases. I continue to see no need of HIV testing. Of course you're free to do so if you would be more reassured by a negative HIV test result. But if somehow I were in your situation, I certainly wouldn't bother.---
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17 months ago
This is very helpful, thank you!

I don't resist testing when the risk is high, but since the risk is very low, I will take your advice and not test for HIV and STIs this time.

I have a few final follow-up questions. What are the biological reasons that lead you to believe this event carries no risk for HIV transmission, even if there were bleeding wounds in my nostrils? Is it similar to how performing oral sex is considered to carry no risk, even with bleeding oral sores and gums?

Thank you again for your help.
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H. Hunter Handsfield, MD
17 months ago
My rationale is that it takes much more blood exposure than the trivial one you describe to transmit HIV. To some extent, we public health experts have to take some responsibility for so many people being so fearful of the word's "blood exposure" as an HIV risk. It takes LOTS of blood, or for it to be injected into the bloodstream; small trivial exposures just don't do it. For example, nobody in the world has been known to be infected in the household of someone with HIV, even after years of sharing toilets, kitchens, utensils and towels -- including treating each other's cuts  and such. "Blood exposure" doesn't mean any and all blood exposures are risky. As I say, public health education messages haven't been very effective in stressing these clarifications. Also, as I said before, nobody is known to have acquired HIV by cunnilingus, and such oral health problems are extremely common, there must have been millions of exposures in their presence. Finally, exposure of open wounds on the skin during sex hasn't ever been known to result in HIV infection: why should the nose be any different?

Thanks for the thanks. I'm glad to have helped. Best wishes and stay safe. 

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