[Question #126] Concerned and worried by high risk unprotected oral exposure

38 months ago
Hello Doctor,

About 3.5 weeks ago I made a terrible mistake while on business in West Africa. Long story short, I was very drunk and met a local girl who gave me unprotected oral (fellatio) for about 10 min before I finally came to my senses and stopped her. I am very anxious and worried about this incident, particularly since I have a long term partner back home, have tested negative for STDs/HIV in the past, have been monogamous for the entire relationship, and the fact that HIV is endemic in this part of the world, particularly among the local women who hang at bars and clubs (likely sex workers).

So far I have no symptoms other than guilt, anxiety, and depression. I intend to test at 5 weeks. Are there particular tests I should take which will be conclusive? I just want to put an end to this ordeal. I'm hoping this is something that I can walk away from having learned a valuable lesson.

Many thanks for your help. 


Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Welcome to our Forum.  I will be pleased to comment and, hopefully, relieve you of some of your anxiety.  The event you describe, receipt of unprotected oral sex, is a virtually no risk event.  While there are one or two cases reported which may have been acquired through performance of oral sex on an infected partner, I am not aware of any credible reports of a person acquiring HIV from receipt of oral sex.  Thus, while West Africa does have relatively high rates of HIV, most commercial sex workers still do not have HIV and even if your partner did, there is no meaningful risk for HIV from the exposure you describe.

That said, I understand that you may want the reassurance a negative test for HIV provides.  You can test with a so-called "4th generation", combination HIV antigen/antibody test.  These tests provide conclusive results 4 weeks after exposure with a need for further testing at a later time.

I hope these comments are helpful.  Take care.  EWH
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38 months ago
Thank you Doctor.

Are the HIV strains here different than in the US that could facilitate transmission through oral sex? Also, you mention that "these tests provide conclusive results 4 weeks after exposure with a need for further testing at a later time."  How many tests would I need to take? Should I also test for other STDs even though I have no symptoms?

As you can imagine this mistake has consumed my life and made it very difficult for me to focus on anything. I appreciate your saying there is no meaningful risk but it's hard for me to accept without a negative test.
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Thanks for you follow-up.  I need to apologize for a typographical error in my response.  It should have read "WITHOUT A NEED FOR FURTHER TESTING..."  With the  4th generation tests results at 4 weeks are conclusive and there is no need for additional tests in untreated persons.

At this time, 3.5 weeks after your exposure and with no symptoms, there is no medical reason to test for other STIs which might have been acquired through receipt of oral sex.  By this time nearly all gonorrhea, chlamydia, herpes and syphilis would have caused symptoms.  As for HIV, receipt of oral sex is just not a very "efficient" means of acquiring STIs.

There are no known strain differences which might change the risk for transmission by oral sex.  As I said. There are no known cases in which someone has gotten HIV through receipt of oral sex.  Thus, you can look forward to receipt of a negative test result when you test.  EWH
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38 months ago
Thank you again Doctor.

I will try to be optimistic when I take the test. How long do I need to wait for results from the test? Ideally I'd like to find out as soon as possible as the waiting and anxiety is keeping me from focusing on work and my personal life. If I test negative, is it ok to resume sexual relations with my partner?

I very much appreciate your help and hope to be able to update you with some good news later next week.
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

The tests take, at most, only a few hours to be performed in the lab but due to time for transport, processing, and other thinks of this sort, often it takes several days and sometimes as long for results to be made evaluable.  Because this varies from lab to lab, it is best to ask this question when you test.

hen you do get your results, which I am confident will be negative, it is safe to resume unprotected sexual contact with your regular partner.

Our space for follow-up questions is limited.  As a result, in a few hours this thread will be close to further questions.  I hope my comments have been helpful.  EWH

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