[Question #13417] [Question #13333] - insertive oral case

1 months ago

Dear Drs. Relating to the previous question asking about HIV risk from unprotected insertive oral from 2 different Thai CSW in Bangkok.

I neglected to add that the CSW were in a brothel like setting (bar/ brothel type place) and probably were more likely to be infected than the average CSW? Another detail I missed was that I was a bit under the influence of alcohol and took 15-20 minutes to finish, and masturbated to "help" rubbing her saliva on my penis - which may rub infectious fluid into receptive cells.

My symptoms have passed, but still still ache in the inguinal lymph nodes and I still have 3 spots on my left tonsil.

H. Hunter Handsfield, MD

1 months ago

Honestly, this question is nonsense. You obviously did not understand or perhaps just did not believe Dr. Hook's assessment and advice in your recently closed forum. The additional details of the sexual exposures make no difference in HIV risk, and you have ignored Dr. Hook's statement there there has never been a scientifically proved transmission of HIV oral to penis; which you also were told when you posted a very similar question 5 months ago. In other words, your risk of HIV was zero for all practical purposes.

Further, your symptoms were not typical of an HIV infection; and also they started too soon (ARS symptoms don't start sooner than 8-10 days after exposure and usually it's 2 weeks or more.)

From a medical/risk standpoint, you do not even need HIV testing. Of course you are free to be tested for HIV anyway. A negative result with an AgAb (4th generation) blood test now will prove your symptoms are not caused by HIV; and another test at 6 weeks would prove you were not infected. Or you could seek an HIV RNA PCR test 11 days or more after the exposure; that negative result would make it certain both that your symptoms were not due to HIV and that you were not infected. I am not actually recommending testing -- it would be only for reassurance if you need a negative test result in order to believe you aren't infected. If you test, it will be negative.

Let me know if anything still isn't clear. But do not ask anything already answered on this or your last thread, or whose answer is obvious from that discussion and this one. If you do, the thread will immediately be closed without further discussion.

HHH, MD

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1 months ago

Thanks for your reply, Dr Handsfield. Apologies for my repetitiveness, although you may have missed the 2nd part of my message. My symptoms this time started on the 4th day, the receded after 4-5 days and started again on the 14th day, almost like I had 2 illnesses, with the 2nd illness more in line with ARS than the first (mild fever, headache, some lymphadenopathy, limb weakness and bad shoulder ache), and this is what has set off my descent into despair.

I do believe yours (and Dr Hook's) stance on insertive oral hiv transmission risk and if I had been reading a post about any other person other than myself, I'd be wondering what all the worry was about. Unfortunately, I'm very much a worrier, which makes it so frustrating that I get into these situations. I have arrived back in my home country and now I'll arrange an ab/ag hiv test.

Thanks once again to both you and Dr Hook - I appreciate this wonderful service.

H. Hunter Handsfield, MD

1 months ago

I understood the sequence of your symptoms; it makes no difference in my response. The only problem here is your own statement "I'm very much a worrier". Your upcoming HIV AgAb test will be negative.---

1 months ago

Dear Dr Handsfield,

I had a 4th generation Ag/Ab today and the result was negative as both yourself and Dr Hook anticipated. Thanks for your help.

1 months ago

I forgot to add: the test was 6 weeks and 5 days from the events described in the 2 threads.

All the best.

H. Hunter Handsfield, MD

1 months ago

Or course I'm not surprised -- your test could not have been positive -- and there was no way you were going to be the first ever forum questioner who turned out to have HIV, after 21 years and thousands of questions about it! But glad to hear you're feeling good about the situation.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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