[Question #12829] Follow up questions - Receptive oral sex and HIV Risk

4 months ago

Dear Doctors,

This is follow up to #12821 question.

Key takeaway I got from your informative answers was that I should get tested to relieve my anxiety. The issue is I live alone and I'm looking for further re-assurance and am afraid of testing, I hope you can emphatize with that.

For context: My exposure was unprotected oral sex I performed on penis(ie. MSM) three separate times,. No ejaculation in my mouth occurred, maybe, just maybe pre-cum., each exposure lasted maximum 3 minutes.

Questions:

a) Symptoms - Confused here. I understand ARS occurs within 2-6 weeks of infection and I also understand not having symptoms doesn't mean I didn't contract HIV. Where I'm a bit confused is the fact that (doing my best to use public health language/messaging) most people, if infected, WOULD experience some immune-related response at 15 months since exposure(whether ARS or anything else later on, e.g. persistent diarrhea, permanently swollen lymph nodes etc.. I haven't had any of these) ?I understand this doesn't apply to ALL people.

b) Your personal experience (whether on this forum or in your practice) with seeing HIV infection via receptive oral penile sex without ejaculation? I understand that your personal experience doesn't provide 100% guarantee I'm not infected. Only test can prove that.

Edward W. Hook M.D.

4 months ago

Welcome back to the Forum. On this occasion I happened to pick up your follow-up questions and will be commenting. In preparing to respond, I reviewed your interaction with Dr. Handsfield and agree with all he said. Performing fellatio on an untreated, HIV infected partner has a very low, but not no risk of acquiring HIB. On average, estimates are that only 1 in 10,0000 such exposures would lead to infection (i.e. 99.99% of the time infection would not occur). I would not encourage someone in your situation to pursue PEP.

Regarding testing. While I understand your hesitancy to test, let me point out that there is a trade off between fear of testing and test results vs the costs of not knowing on your mental health. Clearly you have enough anxiety of this that your fear is effecting you and will likely continue to do so. Testing will NOT change whether or not you are infected BUT it will give you reliable knowledge on your infection status and in the extraordinarily unlikely situation you were infected, would give you the possibility to seek treatment, transforming infection to a completely manageable chronic illness.

In response to your specific questions:

Several parts of your summary are incorrect. You are right that not having symptoms does not mean that a person is not infected. The ARS occurs in less than half of persons who become infected and occurs within 30 days (not 6 weeks) of acquistion of infection. After infection, the process occurs slowly and it may take as long as 8-10 years for an infected person to become symptomatic. The disease does not progress as fast as you suggest.

I have seen a few patients with HIV which appears to have been acquired through oral exposure. It is rare and I've only seen it with persons with hundreds of partners. Whether ejaculation occurred or not is unknown but there certainly genital secretions that are present even without ejaculation.

I hope this information is helpful. Like Dr. Handsfield, I suspect that getting tested is the best approach to addressing your anxiety. EWH

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4 months ago

Dear Dr. Hook,

Many thanks for your answers and for the additional clarification.

One more question I have - Given that neither you, nor Dr. Handsfield would enourage taking PeP, does that mean you're confident that, based on the exposure I'm describing, the test result will be very likely negative? I know only test can prove my actual status.

Edward W. Hook M.D.

4 months ago

I am not a bettor however I would be willing to bet a large amount of money that if you choose to test, the test will be negative. EWH---

4 months ago

Dear Dr. Hook,

thank you, one last follow up: When ARS does occur, what are its typical symptoms, how long does it last and do symptoms occur simultaneously?

Many thanks once again.

Edward W. Hook M.D.

4 months ago

The ARS typically occurs between 7 and 21 days and virtually never more than 30 days after acquistion of infection. Typical symptoms include high fever, severe sore throat, muscle and joint aches and occasionally a widespread rash or diarrhea, all occurring at the about the same time. The ARS typically lasts 5-7 days.

This thread is now complete. There should be no need to return. EWH

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