[Question #1233] Receiving Oral Risk?

47 months ago
Dear Doctor,

I hope that you can ease my anxiety and worry. I've been worrying for 9 weeks even tough I'm quite sure that I have negligible risk of my exposure.
I had a hot stones massage in San Jose California 9 weeks ago. I'm enjoying & facing down with naked body covered hot stones on my back. 20 minutes 
later, she starts massaging me. Suddenly I felt that she was licking my ass ( about 15 second). Then, she turned to lick my penis for about 30 second to 1 minute.
I was totally shocked & blank in my mind. Then, she asked me want protected vaginal sex or not. I stopped her & told her no sex. But she gave me a hand job for finishing. I didn't see any sores outside her mouth but not sure any sore on her tongue or inside her mouth. 
I've a long chat with her and she told me no worry, she is clean.She is new immigrant just came to USA 5 months ago from Vietnam.I believed that she had medical checkup before came to USA but not sure still up to date or not.  
I has a STD 10 panels tests 12 days later and COMBO test as well. All results are negative except HSV-1. HSV-1 IgG is high, and I did not notice any sore or blister since my exposure. I did have a mild sore throat on day 21 for two days only then following a little bit cough . I believed I caught it from my colleagues because all of them also started with sore throat then coughing and running nose, but this kind of symptom make me very nervous.

1) Do I have any HIV risk? 

2) How reliable the COMBO test I did in 12 day. I checked the Quest labs that P24 antigen can detect 0-20 days (median is 5-8 days). So at 12 days my negative result is a good indicator right?

3) I keep on checking any sore on my penis because I am afraid of the syphilis. I did not see any sore on my penis but I am not sure my ass because she also licked my ass. What is my risk of syphilis?

4) Do you suggest I am going to test HIV and Syphilis blood test again.

5) Can I resume unprotected sex with wife without any risk

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

Welcome to the Forum.  If facts can help your anxiety and concerns, then this response should help.  The event you describe was a no risk event for HIV and very, very low risk for other STIs.  There are no proven cases of HIV which were acquired through receipt of fellatio or analingus.  Thus, had you asked, I would have told you that there was no reason for testing related to the events you describe.  Your negative 4th generation combo test at 12 days is further strong evidence that you were not infected. 

Your HSV-1 test almost certainly reflects a longstanding infection that you acquired sometime in the past, not from the events you describe.   12 days is too soon for an HSV-1 antibody test to be positive and over 90% of people in the general population who have HSV-1 (56% of American adults have HSV-1) do not know that they have it.

As for your specific questions:

1.  You are not at risk for HIV from the events you describe.

2.  Your negative combo test is strong but not definitive evidence that you were not infected.  Combo test results are 100% reliable at about weeks (28 days) after exposure.

3.  Your syphilis risk is very, very low and would not concern me if I were you.  In California over 80% of syphilis is occurring among men who have sex with other men, not women.  Further, syphilis from receipt of oral sex is extraordinarily rare.

4.  If I were you I would not have further HIV or syphilis tests.  There is absolutely no reason for more HIV testing related to these events and virtually no realistic risk of syphilis.

5.  Yes, you can assume that you did not get any STI from the events you describe and could resume unprotected sex with your regular partner. 

I hope these comments are helpful.  EWH

---
47 months ago
Dear Dr Edward,

Your comments are very encouraging. I am fear of something which I don't understand and misinterpreted in information in the internet, such as saliva also can cause the HIV infection. I've suffered heavily stress and anxiety because of this unexpected
unprotected received oral activity. This was not my intention to the massage palour, I just want the
hot stones massage, and just because this was my second time visit, the masseuse, who she is around 38 years old, offered me
something special but indeed become a nightmare  to me for past few weeks. As I said, I've been very stressful for the past 9 weeks,
I also have itching sensation recently which I believed is due to the anxiety and I check my penis
time to time to see any open sore or not. I don't sleep well at night for almost couple weeks,wake up middle
of the night most of the time. You comments easing me down which the facts indicated that I have no HIV risk to start with, 
which mean that I worry for no reason, right? I have somemore questions to ask if you don't mind because this would educate me.

1) would it be the HIV risk increases if the masseuse has bleeding gum or blood in saliva?

2) Internet always say syphilis the great imitator and most people don't ever notice it. Would it be possible in secondary stage people
   still cannot identify the syphilis rash. And, syphilis incubation period is 3 to 90 days, which normally begin in the 21 days. Did 
you ever seen any patient has late primary stage, or the immune system just keep on fighting the bacterial and  end up with the late primary stage.

3) based on the facts and my exposure, nothing for me to worry and no more tests needed. So I should move on, right?

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

As we have said more times than I can remember, much of the information on the internet is incorrect.  there are no documented cases of HIV acquired through receipt of oral sex, no matter what you read on the internet.  Blood, oral sores or dental or gum disease would make no difference- still no risk. 

2.  See my comments about the internet and syphilis above. 

3.  As I said, nothing to worry about.  I meant it the first time and still do.  EWH

---
47 months ago
Dear Dr Edward,

Thanks a lot of your explanation and confirmation. I really appreciate what you've providing to me the facts. This is why I found that this Ask the Experts website is very helpful. Your clinical experiences can sure  comfort people like me which basically just stuck in the loop and keep on "What If" in my mind and don't accept the fact that no risk is no risk.

Thanks again and I should sleep well tonight.