[Question #113] Receiving blow job with warm water in mouth

98 months ago
Dear Dr, i was having a blow job from a girl with unknown status with warm water in mouth, i have no idea whether she has any gum or bleeding in mouth or not, or any blood left after brushing her teeth. The unprotected blow job last not over ten seconds, no vaginal sex. My questions are
i. Will the water make it more easy to transfer the blood from her mouth to my urethra?
ii. Will the water kill the hiv in blood?
iii. From thebody, dr bob mentioned that hiv easily taken up from urethra, is it true? is there any barrier there or the uptake depends on concentration?
iv. do i have risk getting hiv?
thanks in advance, i am really panic now.
H. Hunter Handsfield, MD
98 months ago
Welcome to Ask the Expert. Congratulations on having only safe sex with your apparently new and unknown partner. There is virtually no chance you caught HIV.

As you seem to know, oral sex carries little or no risk for HIV transmission. There have been a few cases of transmission from the insertive (penile) to the receptive (oral) partner, but never a proved case in the other direction, i.e. mouth to penis. People don't normally have blood in their mouths; even with gum disease, probably not enough to transmit HIV. Also, saliva kills HIV. These are two of the reasons oral sex carries little or no risk. On top of all this, the chance "a girl with unknown status" has HIV is extremely low, so your partner almost certainly didn't have HIV.

To your specific questions:

i.   Probably not. I don't see any reason why the presence of water in the mouth would change the extremely low risk
ii.  Water at least would dilute any HIV in the mouth and might help inactivate the virus.
iii. The urethra (and the underside of the foreskin in uncircumcised men) indeed is susceptible to HIV. But the other factors mentioned keep the risk zero for practical purposes.
iv. No risk for practical purposes.

I would urge you to entirely disregard the potential biological reasons why transmission risk is low. They don't matter. What matters is that nobody in the world has been known to catch HIV from exposures like yours, and you aren't going to be the first. So no worries, and no need for HIV testing.

I hope this has helped east your fears. Best wishes and stay safe ---  HHH, MD

98 months ago
Deaf Dr HHH, thanks for your reply, please allow me asking for a few more question
i. so if even hiv blood passby urethra, infection might not occur because of not enough?
ii. how about blood after brushing teeth? will those blood totally killed by saliva
iii. the risk still low? honestly the girl did the blow job is a sex worker
iv. with the blow job less than 10second will it reduce down the risk?
v. how about others std?
sorry for asking so many question, i quite panic now
H. Hunter Handsfield, MD
98 months ago
All these questions relate to the biological reasons that there is no measurable risk of HIV risk from oral sex. As I said above, those reasons don't matter. The fact is that there has NEVER been a proved case of oral to genital HIV prevention. And if you think about it, there must have been millions of exposures that included blood contact or other factors you have asked about -- and yet nobody infected. But the answers to i to iii are that these factors do not significantly elevate the risk; the source of the blood makes no difference in whether saliva will inactivate it. Question iv: logically reduced duration of exposure reduces risk still further. There are no data, but it's hard to reduce a zero risk any further!

Questaion v, other STDs: Oral sex is safe sex. The risk of STD from oral sex always is low. Some infections are rare in the oral cavity, and others simply are not easily transmitted by the mechanics of oral sex. The risk is zero or nearly zero for chlamydia, HPV, HSV2, andhepatitis B), and quite low but not zero for others (gonorrhea, HSV1, nongonococcal urethritis).

Here's a statistic for you:  One estimate of the risk of HIV, oral to penile (from CDC), is once for every 20,000 exposures. That's equivalent to receiving BJs from infected partners once daily for 55 years before transmission might be likely -- and it's never been proved to have actually happened anyway. And the vast majority of commercial sex workers DO NOT have HIV, and most have no STDs in their mouths. 

Note your posting fee covers two follow-up comments/questions, so you have one more if anything remains unclear. But please do your best to accept and believe the science-based reassurance I have tried to give. Don't overthink it. This really was a no risk event in regard to HIV, and very low for other STDs. If you remain nervous, you are free to be tested. But if somehow I were in your situation, I wouldn't do it and would continue unprotected sex with my wife without worry.

Best wishes and stay safe!
98 months ago
Dear Dr HHH, thanks again for your advise, lastly, please allow me to ask the following questions
i. all the hiv case around the world have to be reported to cdc? is it possible there is case due to unprotected oral not being reported?
ii. after six days of that event, i feel on and off discomfort at my genital and ball but not considered pain, will it due to over anxiety?
iii. dr, can i forward my result to you 3 months later if find out to be positive? hope in future people will aware of the risk having unprotected oral
thanks in advance for your reply, dr
H. Hunter Handsfield, MD
98 months ago
i.   Of course not all cases are reported, and of course this could have happened. I did not say the risk is zero, only that it's extremely rare.
ii.  Such symptoms are typical of gentialy focused anxiety.
iii. If this is your only exposure, there is no chance your HIV test will be positive. There is no need for people to be "aware of the risk of having unprotected oral", at least not in regard to HIV. Oral sex is safe sex!

And you don't need to wait 3 months for a definitive test. The 4th generation HIV blood tests (also called duo or combo tests) are conclusive any time 4 weeks or more after the last exposure.

This forum permits two follow-up questions, so this thread will be closed. If you need additional advice after you are tested (regardless of the result), feel free to start a new thread. In the meantime, try to stay mellow and stop worrying -- and stay safe! Best wishes--