Dear doc, I encountered a trans sex worker in a club. I licked her face with my tongue quite vigorously for around 10-15 min and nothing more. Later I saw she had a deep cut on her forehead where I was licking and the cut did not look old. It looked a day or two old. It might have been bleeding when I licked  her face. I used my tongue a lot rubbing it on her face and forehead. This was on 11th Dec2024. On 19th Dec I got mild fever, runny nose and cough. I got tested in a lab with blood from vein on 4th gen ab/ag test which was reactive on 26th jan. My above symptoms had just resolved a day earlier( maybe it was flu, don’t know)and lab asked for fresh sample which I gave on 28th Dec 2024. This sample was reactive on one 4th gen test (cmia 2.4 value). However, the next 4th gen ag/ab performed by lab on the same sample was unreactive (elfa method). Ab test by tri dot was negative. I gave blood to another lab on 2nd jan 2025where 2 4th gen test came positive and tri dot for ab negative. Submitted a fresh blood sample on 2nd jan 2025( 21st day after exposure)itself for RT PCR RNa test for hiv-1. It came negative. I am really worried by the positive 4th gen test. Did i take direct blood from her wound in my mouth. What are my chances of getting hiv? Can my 4th gen be reactive due to recent cold or flu? Really worried about direct blood in my mouth. Can i trust RTPCR RNA detection test at 21 days after exposure when i had positive 4th gen test on 15th, 17th, and 20 days after exposure. Really scared.scared about transmission of direct blood in mouth by wound due to licking. Please help and clarify.

Welcome to the Forum.  Thanks for your questions and your confidence in our service.  I'll be glad to comment, first on your exposure and then on your test results.  You do not have HIV.---

Thanks a ton doc. Just one or two details that I missed telling you. 1. The cut on her forehead seemed really deep. 2. The last negative antibody test was 5 days after the last reactive 4th gen ag/ ab test. The result of 26th December were not communicated to me as the lab wanted a fresh sample( predictably 26th sample was positive as well but i don’t know which type test was positive as no result communicated to me)Also, can I completely rely on the RT PCR RNA hiv-1  negative result as being true negative. The RTPCR sample was taken on 21st day after exposure. The RT PCR was real time quantitative by Cepheid( Geneexpert) which detects min 40 copies of hiv RNA. If i had hiv infection, what amount of virus would be detectable in blood especially by 21st day on RT PCR test especially as 4th gen was reactive at that time?Can i rely on the last negative result by RT PCR or do I need to test again? And once more, is blood in mouth not really a risk for hiv especially if a lot of tongue was involved? Will oral mucous membrane be not susceptible to infection.The positive test results really scared and confused me. Need closure. Would my RT PCR at 21 days be definite at 21st day or could there be a false negative? Would antibodies be detectable in 5-7 days of detection of antigen. Also I did get one non reactive4th gen ag/ab test on the sample on 28th( ELFA method 0.05 reading) My RT PCR just said negative. All of this had really confused me. Moreover, in my facts, what is the real risk of catching hiv infection by blood in oral mucous membrane. Also would initial infection by low viral load also show up on RT PCR by 21st day. Test only measures more than 40 copies. Sorry for pestering but I am so scared for my family and they are as well.please help.

Sorry for adding, just wanted to add that u had chapped lips which were kind of bleeding. Would that be a risk if infected blood goes in those cracks in lips as I kissed her forehead many times. Also would any cuts or sores in my mouth make transmission of virus to me. I can sometimes have bleeding gums but u am not sure I have any sores in my mouth. At least not any that are clearly visible or painful. But there may be cuts also from licking her face and hair so vigorously. Moreover, I had a broken tooth on the tooth where root canal was performed  which might be exposing some nerves. I hope and pray all of these pose no risk. Again confused due to as many positive results. Sorry for bombarding you with such technicalities but I trust your opinion and don’t know many specialists in the field here in India.

This is largely repetitive and I will not repeat myself other than to point out that ingestion of HIV is not a risk for infection, deep cut and/or actively bleeding or not.---

Thanks for your clear reply. You did not comment at all on cuts on my lips and possible cuts  in the mouth/tongue and the broken tooth. More importantly, in your expert opinion should I test again by the method you mentioned or should I consider myself in the clear and not test again and consider my negative RT PCR result as conclusive. A clear reply on this test results conclusiveness aspect would be greatly appreciated. And I appreciate your overall opinion. Forever indebted.

Thanks for your thanks.  I’m glad I could help.  Final reply.---