[Question #12069] Exposure

10 months ago

Is this particular scenario how risky for hiv contamination is the encounter :

Female having one encounter of protected vaginal sex with a man. Almost sure condom did not break

Female giving the man unprotected oral sex for less than 30 seconde no ejaculation, maybe pre-cum ? female having gum disease also

There was no ejaculation from beginning to end of the encouter.

The man is of unknown status but lived and was sexually active for a couple year in a country of higer hiv prevalence (1 to 4%)

Extremely anxious about the situation taking PCR about 16 days after the exposure, awainting resultats how accurate would they be.

H. Hunter Handsfield, MD

10 months ago

Welcome to the forum. Thank you for your confidence in our services.

I'll give some general answers, but you don't provide some of the most important information -- in particular the nature of partner(s) you have in mind. First, it isn't clear whether you're asking the HIV risk for the male partner if the female is infected, or vice versa. Which is is? Are you male or female? (Apologies that I'm not familiar with whether your name is usually male or female.) For either direction of transmission, there are giant differences the likelihood either partner is infected with HIV; or if infected, whether on effective HIV treatment. These things vary with country, sex work, injection drug use, and other risk factors. All these affect the likelihood one partner or the other might have HIV. To your specific questions:

With entirely unprotected vaginal sex, if one parter has HIV and not on treatment for it, the average risk of HIV being passed is around 1 in a 1,000 if the male is infected and 1 in 2,500 for the male if the female is infected. A properly used condom that doesn't break reduces these risks by 99%, reducing these risks to about 1 in 100,000 or 1 in 250,000. Not ejaculating in the vagina probably makes these odds even lower for the female partner. Pre-ejaculate fluid or gum disease probably make no important difference one way or the other.

For male to female transmission, a 1% to 4% chance he has HIV means the risk for the female partner -- using the same assumptions as above -- still remains quite low (you can do the math).

Turning to oral sex, HIV is very rarely transmitted. In the 40+ years of the world wide HIV/AIDS epidemic, there have been few if any proved transmissions of HIV oral to penis and very few from penile to oral partners. If either partner is infected, the estimates are 1 chance in 10,000 penis to oral and 1 in 20,000 in the other direction. In other words, nearly zero risk either way.

A negative HIV RNA/PCR test is 100% reliable any time 11 days or more after exposure. At 16 days, a negative result would prove for sure you did not acquire HIV.

Let me know if anything isn't clear -- in particular some of the missing information. In the meantime, I hope these comments are helpful.

HHH, MD

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10 months ago

Hello thank you for the quick answer :

I'm asking the risk for the female partner for this single exposure :

- protected vaginal sex with a man without ejaculation once and also unprotected oral sex once: the female giving the man oral without ejaculation perhaps only pre-seminal fluid.

- As for the status of the partner not much is known about him other that the fact that he said he never did any type of injection drugs but was sexually active ( supposedly mostly protected encounters , but no way of knowing for sure) in a country in a africa with a higer prevalence of hiv like i said about 1 to 4% , so his status is unknown.

So im asking the risk for the women , having incredible amxiety about this situation wondering if its a high risk one as i read a lot of conflicting reports on oral sex and its risk.

Thank you very much

H. Hunter Handsfield, MD

10 months ago

Thanks for clarifying the situation and your concerns. It doesn't change my assessment, however. Even if the male partner had HIV, the odds are very strongly in her favor, for the reasons above. It is very unlikely she was infected and can expect her PCR test to be negative.

You have one more comment coming. I'll be happy to comment further if you'd like to let me know the result.---
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10 months ago

Thank you again for your time and effort,

1)i don't mean to be redundant but im not sure i really get the risk from the unprotected oral exposure considering the factor of gum disease, i would day mild periodontis and sometimes bleeding gums, it seems that every source i find cites this as a very important risk factor of transmission and i keep finding anectodal cases online aswell so truly confused of the risk here, also there was no ejaculation as i previously cited.

2) it is is the main cause of anxiety as i understand that the risk of protected vaginal sex is pretty low ( i think?),

Again i apologize, i just need clarification, losing sleep over this.

Thank you again for the service you provide, it is unbelievably helpful

H. Hunter Handsfield, MD

10 months ago

I'm sorry you remain anxious, but I'm afraid you have been over-sold on risks for which there are no data. Let me try this: That bleeding gums increases HIV risk is an assumption made 40 years ago when the HIV epidemic was new and not well understood. Might it increase the risk? Yes, maybe. But let's say it doubles the chance of HIV from oral sex. That risk is one chance in 10,000. Double that risk and it's still only one chance in 5,000! And that's only if the guy has HIV, which your partner probably did not. One chance in 5,000 is the same as giving BJs to infected men once daily for 13 years before it would be likely you were infected!

Perhaps it will also help you to know thet in the 21 years of this and our preceding forum, with thousands of questions from people worried about HIV exposures, nobody has yet turned out to be infected. You will not be the first. If and when if finally happens, surely it will be from a genuinely high risk event -- like unprotected anal sex between two men -- and not a very low risk event like yours.

I hope these comments help a bit. I am very confident your test will be negative. When it is, I hope you can move on without worry.

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