[Question #12294] Oral sex risks

8 months ago

I had protected oral sex with a sex worker on October 12th, in which I finished in the condom (i’m not sure if it broke, but I also didn’t notice any holes when I took it off). The encounter was pretty long, i’m thinking 10 minutes plus. I haven’t tested yet for STIs, however am concerned that I may have potentially infected my partner. We last had sex was November 3rd—24 days ago now— and she just now told me today shes been breaking out with acne in weird places and has small red dots under her eyes. Is this a sign of Hiv? or Any other infections? Realistically whats my risk.

Also just worth noting my partner and always have protected sex every time.

The sex worker showed me her patient portal with test results from 2 days prior that were negative across the board.

I’m sorry if this seems very obviously risk free, i’m just feeling guilty and nervous about the whole situation.

8 months ago

Also want note that I too have been getting more acne in strange spots and have noticed red dots under my eyes and cheeks.

H. Hunter Handsfield, MD

8 months ago

Welcome back. I reviewed your recent discussion with Terri and agree entirely with her assessment and advice. I can confirm her closing statement about HIV risk; HIV isn't transmitted oral to penis at all, even without condoms.

Unprotected oral sex is also low risk for all other STIs, and having used a condom all risks were zero for all practical purposes. The amount of saliva exposure, which you described to Terri, also makes no difference. Saliva rarely transmits infection -- in fact it is toxic to most STI bacteria and viruses. Neither your partner's acne nor "red spots" on her skin fit with HIV or any STI. There is no such thing as microscopic condom leaks that permit STI transmission. That's an urban myth, and inspecting condoms after sex is pointless; if a condom hasn't broken wide open, protection is complete. On top of all that you now have your SW partner's negative test results.

This event was no risk at all and you do not need testing for anything. Don't confuse guilt over a sexual decision you regret with STI risk: they aren't the same!

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

HHH, MD

---

8 months ago

Ok, thanks for clarifying the condom thing. I tested today 46 days after the exposure, if it comes back negative am I conclusively free of any STIs? I also wanted to know, is HIV transmitted from oral to vagina? Is it possible to get from oral sex? Everything I’ve read for the most part is a 50/50 split between yes but it’s super unlikely and in some cases, such as now talking to an expert, no.

H. Hunter Handsfield, MD

8 months ago

As I said, you really didn't need testing -- it's fine you did it for the reassurance you will gain from the negative result, but there was no point in it from a risk standpoint. You don't say what you were tested for. HIV definitely will be conclusive and so will your negative syphilis blood test. So will urine tests for gonorrhea and chlamydia. Herpes blood tests take 3+ months, and even then are unreliable. Any other tests in standard panels were unnecessary and for the most part don't matter if positive.

HIV by oral sex? Nobody can say it's truly zero risk, and a few cases definitely have occurred penis to oral. But there have been no reliably documented cases by culliingus (oral-vaginal) or by oral to penis. Of course it's biologically possible, so nobody can (or should) honestly declare zero risk. But with no known cases, what does it matter? And with a condom, it's fair to conclude the risk truly is zero.

---
---
---

8 months ago

So my test 46 post exposure full panel came back all negative. Has there ever been a case in which negative results post 6 weeks became positive later down the line?

Am I ok to engage in unprotected sex with my partner with no worry of infection (we have protected most of the time, but sometimes do it with no protection with precautions)?

8 months ago

Hey I know i’m exceeding the limit I had meant to ask and completely forgot but my main question is would a lot of alcohol consumption (enough to get you hungover) impact test results?

H. Hunter Handsfield, MD

8 months ago

"Has there ever been a case in which negative results post 6 weeks became positive later..." No, not to my knowledge. Of course you can safely have sex with your partner; if somehow I had been in your situation, I never would have stopped (and would not have been tested for HIV).

Alcohol makes no difference in risk if exposed and has no effect on timing or reliability of tests for HIV or any STD.

Perhaps you'd also like to know that in the 21 years of this and our preceding forum, with thousands of questions from people worried about HIV, not one has yet tested positive. If and when it finally happens, it certainly will be from a genuinely risky exposure (think unprotected anal between men) and not a near-zero risk situation like yours.

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.

---