[Question #1194] Please assess my risk

48 months ago
Dear Dr Hook / Dr Handsfield,

Please assess  for exposure to HIV:

1. Oral sex with a woman - both insertive fellatio and cunnilingus.
2. Mutual masturbation - she had vaginal fluid on her hands which was rubbed on my penis head/glans 

Exposure on June 12. Symptoms -  26 June mild sore throat for 8-10 days. 12 July itchy localized rash on wrist and in between fingers of left hand. 22 July met Dermatologist -diagnosed hand dermatitis and prescribed an ointment. It subsided in 3-4 days of application. Otherwise felt fine - no fever, lethargy etc.

1. Could this be ARS - do ARS symptoms all happen together or can they spread out as above
2. Is the ARS rash localized or widespread and itchy or non itchy
3. Is fever present during ARS

My understanding is that the activities listed above are not a risk for HIV but there is so much conflicting information available. Hearing it from you would greatly help put my mind at ease.

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

Welcome to our Forum.  I'll be pleased to comment.  I agree with your assessment that these activities have not put you at meaningful risk for HIV.  Even before I comment on your symptoms, let me remind you that most people, even commercial sex workers do not have HIV and the there are NO proven cases that I am aware of in which someone acquired HIV from receipt of fellatio from or performing cunnilingus on  an infected person.  Thus I would classify this exposure as a no risk exposure.

As for your symptoms, They are not at all suggestive of the ARS.  The ARS typically occurs 1-3 weeks after infection and are manifest by a combination of high fever, muscle and joint aches, sore throat and, on some cases, a generalized rash. Thus the symptoms which you report did not occur at the same time, too late in some instances to be the ARS and symptoms such as a localized ash on the hand are not suggestive of HIV.

I see no reason for you to be worried for HIV in relationship to the exposure that you describe and see no reason related to it to seek testing for HIV.   I hope these comments are helpful.  EWH 

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48 months ago

Thank you Dr. Hook for responding. To provide context, the lady in question is not a CSW. I was in a relationship with her for one year during which the sexual activities I mentioned happened numerous times. However there was no penetrative vaginal/anal sex at any point either protected or unprotected. My last sexual interaction with her was on 12 June. Trust this does not change your no risk assessment of the oral sex in any case.

I have a couple of follow up questions.

1. Mutual masturbation with vaginal fluid on penis head. You missed responding specifically to this exposure - is this also no risk for HIV?

2. Regarding rash that sometimes presents during ARS  - is it typically itchy or non itchy?

Appreciate your inputs and time. Thank you.


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

The fact that she was not a CSW makes it less likely that she had HIV or any other STI and the number of times you or she performed oral sex makes no difference- still no risk. 

1.  There is no risk for HIV from mutual masturbation, even when genital secretions from one partner get on the other.

2.  The rash is typically widespread, unlike yours and is not itchy.

Still no risk for HIV and no need for testing related to the questions you have asked

EWH

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47 months ago

Thank you for providing clarity Dr. Hook, much appreciated.

One last question and this is really more from a going forward perspective. In all your years of practice / HIV literature, have you ever come across a case in which a man has contracted HIV sexually from a woman through an activity other than penetrative anal / vaginal sex?

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

I'm glad you found my comments helpful. 

No, I have never had a patient, not heard of a proven case in which someone became sexually infected through direct sex other than penetrative anal or vaginal sex.  No cases by mutual masturbation or cunnilingus.  In several instances in the medical literature, there have been cases which may have been transmitted through immediate penetration of one person after another roughly using sex toys such as dildos.

As you know, our Guidelines specify that we can provide just three responses to questions.  This thread will be closed later today.  Take care.  EWH

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