[Question #12366] Oral sex and HIV risk

8 months ago

About 5 days ago, I meet with an escort in Asia (she is more pricey but high risk as she offered unprotected sex at higher charge and I noticed she had some red rashes on her body). She sucked my unprotected dick twice (less than 3 minutes). However I am too tired, I unable erect so she is just sucking my soft dick. She tried to give me a hand job. Later, she tried to put on a condom on me to ready me for vaginal sex, but I could not erect and penetrate her. So I only had oral sex. I hugged her a while and had her pussy placed on top of my face (without touching) briefly. Later I washed my dick with soap. I went out without asked her status, just knew she been worked for near 3 years and had a boyfriend whom not knowing her doing this. Also I am circumcised.

Right now my penis head is tingling and there is urge of urinating.

What is the risk for HIV from this encounter?
Do you think there is a need for me to test for HIV and other STD for this encounter?
PEP is generally not recommended for just oral sex (like this encounter) even it is within 72 hours?

H. Hunter Handsfield, MD

8 months ago

Welcome to our forum. Thanks for your confidence in our services.

This was a very safe exposure in all respects -- partly on account of your erectile problem, but even without that it sounds safe. First, escorts -- expensive female sex workers by appointment -- tend to be low risk for HIV and other STDs. They usually have low risk clients (men like you), use condoms regularly (probably with exceptions primariy for clients they judge at especially low risk), are health conscious, and get tested frequently. That your partner happened to have what you considered "red rashes" probably doesn't mean much; assuming you're not a health professional, I doubt this means anything. And the vast majority of skin rashes or other dermatologic conditions are not caused by STDs and certainly not by HIV. You had no unprotected penetration, and oral sex is very safe: not entirely free of STD risk, but zero risk for HIV. To your specific questions:

1. I would put the chance you acquired HIV at well under one chance in millions. There have been been few if any scientifically proved cases of HIV transmission oral to penis, and hand-genital contact is entirely free of risk.

2. From a medical/risk perspective, there is no need for HIV testing. I wouldn't do it if somehow I were in your situation. There are slight risks for other STDs from the oral sex event, but you're already home free for gonorrhea, the main one of importance; almost all urethral gonorrhea causes obvious symptoms -- pus dripping from the penis, painful urination -- within 5 days. The risks of others (nongonococcal urethritis due to oral bacteria, syphilis, herpes due to HSV1) are also low and absence of symptoms in the next 1-2 weeks will be strong indications you weren't infected. And to repeat the above, you are at no risk if your escort partner wasn't infected.

3. Exactly right: With few or no proved cases of HIV oral to penis, PEP would not be advised.

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

HHH, MD

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7 months ago

Thanks Doctor for the info and explanation. I do have follow up questions:

1. It is about 16 days since my exposure. Earlier last week (~10 days) I have stuffy nose and having clear phlegm stuck in the throat (been encountered this before, like due to sinus) and it is almost recovering now. I noticed there are some red bumps or aches appeared on my chest last week too, but I thinking it might be due to over sweating after I backed from running and it is very hot here. And I have some mouth ulcers now. Any of these symptoms of particularly concern?

2. I might have quite anxious and reading a lot stuffs on internet since then. Should I move on and get over with this and not further searching for these topics anymore?

7 months ago

I made a typo, I meant acne or pimples like red bumps. They appeared shortly (1-2 days) after I backed from running.

H. Hunter Handsfield, MD

7 months ago

1. HIV doesn't cause nasal congestion, phlegm in the throat, or cough; and your rash also is not typical for HIV, which doesn't cause pimples. But since you're nervous about HIV, you can be tested. Even though it's early for a conclusive test, a negative result now would prove HIV is not the cause of your symptoms. It's pretty obvious you have a cold, nothing more (or maybe covid).

2. Internet searching by persons worried about a particular health problem usually increases their fears of that problem. There's a natural tendency to be drawn to information that raises fears while missing the reassuring bits. Either stop searching or at least limit to professionally run or moderated sources (like this forum, academic medical sources, public health, etc) and avoid sites run by and for people with the problem (like Reddit, for example). Anyone can write anything, and testimony by infected or worried persons is the worst possible resource about health issues.

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