I know these questions have been asked many times and I know oral sex is generally very low risk. 

For context: 

-30yo male

-Over the course of the last 2,5 years I've performed receptive, unprotected oral sex on penis of CSWs (3 distinct people in total, last one early 2024), unknown HIV-status for all three. 

-Ejaculation in my mouth didn't occur, the longest unprotected oral sex lasted around 5 minutes, after the first encounter(late 2022) I experienced mild fatigue and dry cough for around a week. 

I haven't experienced any health-related issues ever since but I am understandably anxious about the potential risk. 

I understand testing is the only option to know for sure but based on what I'm describing, can you please provide some reassurance? Have you ever had a patient who was ever diagnosed on the exposures I've described? What would you recommend?

You are correct that questions like this are common and that oral sex indeed is low risk for all STDs, and especially low risk for HIV. There has never been a scientifically documented case of HIV acquired by cunnilingus, i.e. oral-vaginal contact. That doesn't mean it can't happen, but obviously the actual risk is extremely low; there must have been millions of such exposures with HIV infected partners, with no known virus transmission to either the oral or vaginal partner. And no, I have never personally been aware of anyone who acquired HIV by oral sex. (In addition, in the 20+ years of this and our earlier forum, with thousands of questions from persons worried about HIV, nobody has yet reported they tested positive. You won't be the first!)

Even among the highest risk female sex workers, generally under 1% have HIV, and mostly it's more like one in a thousand. As for symptoms, they are far less useful than people assume in judging new HIV infections. A large number of other medical problems cause exactly the same symptoms as HIV, so even typical symptoms rarely indicate infection. And half of newly infected people have no symptoms. So presence of symptoms generally isn't worrying, and absence of symptoms should not be especially reassuring.

So all things considered, it is exceedingly unlikely you have HIV. Should you be tested? From a medical or risk perspective, it certainly isn't necessary. However, reassurance itself is a valid reason for testing. And it's a good idea for all people who are sexually active outside mutually committed relationships to be tested for HIV from time to time. So go ahead with testing. You definitely can expect a negative result.

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

HHH, MD

I very much appreciate your answer. One thing to clarify is that my exposure was receptive oral sex on penis (ie me doing the blowjob). Three encounters, no ejaculation. Does this change your answer in any way? In particular from the perspective whether I should get tested + I'd presume you never having personally seen oral sex HIV tranmission is still the case, regardless of type of oral sex.

My comments still were pretty accurate. That said, there are well documented cases of HIV acquired from such exposures -- but even here the risk is very low. A calculation published by the US Centers for Disease Control and Prevention (CDC) several years ago (based on how some persons believed they were infected, whether or not that information was accurate) concluded the chance of cathgin HIV fro a single such exposure, If the penile partner had HIV, was one chance in 10,000. That's equivalent to giving BJs to infected males once daily for 27 years before catching HIV might be likely. Note that's only with known infected partners. And this calculation was back in an era when HIV treatment didn't exist, whereas today a high proportion of infected men are on effective treatment anti-HIV drugs and cannot pass the virus to anyone.

Whether I have personally seen someone who acquired HIV in this manner is immaterial. I have never cared for a patient struck by lightning, but it happens (rarely) and no physician's experience with such patients -- or lack of experience-- makes a difference in the risk to his or her future patients. (It happens that I do not recall any such patients. but so what?)

Should you be tested for HIV after three such events? That's a personal decision -- there's no yes/no answer. On a strict risk calculation basis, I see no need. OTOH, reassurance is a legitimate reason for testing. If you're going to worry about it despite the scientific evidence and my comments, by all means be tested if you'll sleep better knowing for sure you don't have HIV.

Many thanks for your responses. They are very informative.

One final question I have - I understand this would probably be my own decision as well but if i came to your clinic after the exposure(s) I mentioned asking for PEP(within 72hrs), would you recommend it in my case? 

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.