[Question #12347] Oral and other related questions
8 months ago
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Hi doctors,
I saw the same CSW (by appointment) that I had in the past. This is going to sound absurd but I ended up getting a 5 hr unprotected bj. I am uncircumcised. I’ve read other questions in which you docs state that short insertive vaginal sex is less risky than longer duration. I also read elsewhere that circumcision reduces HIV risk. Am I at increased risk for HIV, syphillis, or others through this exposure? Did I have any HIV risk?
Thank you
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H. Hunter Handsfield, MD
8 months ago
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Welcome back. However, this is the fourth time you have asked about HIV/STD risk from prolonged oral sex. As I'm sure we discussed previously, of course the risk of infection rises with duration of exposure. However, it also is necessary that your CSW partner have a transmissible oral infection. As we also have discussed, there has never been a proved case of HIV transmitted oral to penis. On the other hand, I'm sure not more than one in a thousand such episodes lasts as long as 2-5 hours, as for the events you have described -- so I cannot guarantee no risk for HIV. If your CSW partner has gonorrhea or syphilis, of course those are risks as well. Absence of symptoms (discharge from your penis etc) is helpful to assure you aren't infected, but asymptomatic infections are possible.
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I have no way to give a numerical estimate of your risk. It's probably very low for all these STDs, and even lower for chlamydia. There are two ways to know more: 1) Ask your CSW partner whether she has been tested recently and knows she is negative for all these, or ask her to be tested now (and perhaps offer to pay). 2) Or to be tested yourself. Gonorrhea/chlamydia testing (by urine) is valid anytime more than 4-5 days after exposure, and syphilis and HIV testing after 6 weeks. (Or an HIV RNA PCR test after 11 days.)
Repeated questions on the same topic are not permitted. This will have to be your last along these lines, OK?
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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8 months ago
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Thank you doctor. Chlamidiya and gonorrhea came back negative. And you were right on my previous occasion and she informed me she was still clean. I am now worried about HIV. Should I have sought PEP or would you have prescribed it? Does this mean I was a higher risk encounter as I know you still haven’t seen a single person come tell you they tested positive but could this qualify as one of those high risk encounters you sometime reference the first one would be?
And understood
This will be the last along these lines
Thanks
8 months ago
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Also, per your guidance I took a PCR test (day 12) and will share the results provided you allow it
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H. Hunter Handsfield, MD
8 months ago
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PEP decisions are best made by "shared decision making": never only on patient insistence and never only by a provider's insistence on PEP; always by discussion so both understand the pros and cons for that particular case. For such prolonged oral exposure, I could understand an agreement for PEP: even though there has never been a known transmission of HIV mouth to penis, the near zero risk might be higher with such prolonged exposure. I would also definitely want to know the HIV status of the oral partner perforing oral sex. If she is known to have HIV I still would not classify it as a high risk exposure, but I would understand a decision to use PEP.
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There really is no point in telling me your negative test result; I'll just agree you don't have HIV. But I will leave the thread open for one more cycle so that you can do that, if you wish to do so.
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8 months ago
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Dr. H-
The test came back negative. It was taken 12 days after exposure- am in in the clear or is further testing required?
I want to thank you for your services. I clearly lack impulse control. I have struggled with ADHD for quite some time. I’ll just say for other readers I read that the WHO notes that fear of HIV sometimes leads to fatalistic practices in some places while in others it leads to safe practices. My fault was reading that insertive oral is generally safe but not considering extended duration could increase the risk. Hope everyone stays safe.
Happy holidays. I hope to not have to return to these services.
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H. Hunter Handsfield, MD
8 months ago
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You know the answer to the first question from all my comments above: of course you're in the clear.
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Thanks for your nice comments. However, in response to you "hope" not to have to return: This definitely is your last thread on oral sex, your fears of HIV, and your concerns about HIV test results. I'm reposting part of my closing comment about repeated anxiety-driven questions:
The forum does not permit repeated questions on the same topic or exposure especially anxiety driven repeats of the same question. ...such repeat questions may be deleted with no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is intended to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding.
Best wishes and stay safe.
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