[Question #1110] Oral sex risk with CSW - HIV Risk?

48 months ago
Hello Dr.

I had an encounter with a CSW originating from Uzbekistan on 8th August while severely drunk. This is what happened.

1. We both showered separately. I lay on the bed naked, she got on top of me but did not sit directly on my genitals. She sat a little below (on my thighs) and stroked my penis
2. Then she got off and laid next to me just talking. I had a fresh wound just above my knee and I'm not sure if her vagina came in to contact with it
3. She gave me oral sex without a condom, I was standing while she was on the bed which lasted for about 3-5 minutes.
4. Then we stopped and lay on the bed for a bit. Then she put a condom on my half erect penis, I pulled the condom down to cover as much as possible and tried to enter her (doggy style) but being drunk and having the condom on effected my erection so she stopped me. (my covered penis would've touched her vagina for a few seconds). This was the end and then she showered again and left.

I've been absolutely terrified since. Please tell me, what is my risk of catching HIV through oral sex and also the possibility of her vagina touching my open wound? When I asked if she wasn't worried about catching STIs through her work, she didn't seem bothered which has scared me more. I'm planning on getting a 4th Gen. Elisa test tomorrow at the 16 day mark. Please help!

Solomon

Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago

Welcome to the Forum.  I will be pleased to comment. The activities you describe did not put you at risk.  Before I comment on the risk of certain activities, let me remind you that most commercial sex workers do not have HIV.  More importantly however, the activities you describe we no risk events.  If your partner's vagina contacted the cut on your knee, even if she had HIV, this would not put you at risk as HIV is not transmitted by this sort of simple contact but requires penetrative intercourse or injection of infected material deep into tissue to cause infection.  Similarly, receipt of oral sex did not put you at risk for HIV either- there are no proven cases in which persons have acquired HIV from receipt of oral sex- none at all.  Thus, based on the activities that you describe there is no medical reason for concern and no reason for testing. 

If you wish the assurance and peace of mind that a negative test might provide, you could seek testing with a 4th generation, combination HIV antigen/antibody test at 4 weeks after your exposure- a negative test at that time would be definitive and would prove that you did not get HIV from the exposure you have described.

I hope these comments and information is helpful to you.  EWH

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48 months ago
Hello Dr.

Thank you for the valuable feedback. It did ease my mind.  As I mentioned earlier, I did get a 4th Generation Elisa (HIV antigen/antibody) test done after 16 days  from exposure which came out Negative. I know that 16 days is not conclusive but in the context of my exposure which you said should be of no concern, do you think is worthwhile for me to get a further test done at 4 weeks or after?



Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Based on the exposures you describe which did not put you at risk for HIV acquisition, I see no medical reason for further testing.  EWH---