[Question #13649] Cunnilingus

1 days ago

Dear Doctors, please excuse my English. I am Brazilian, 39 years old. Nine days ago I had cunnilingus with a sex worker (stripper in a nightclub). The contact didn't last even 20 seconds, I didn't see any blood or sores in my mouth. My biggest fear is regarding HIV. What is the possibility of me getting infected from this contact? 1 - Should I get an HIV test? If so, which one should I take to rule out HIV the fastest? 2 - Should I stop having unprotected sex with my regular partner? 3 - During these nine days I haven't had any symptoms in my throat or sores in my mouth, but I used Doxpep about 40 hours after exposure. What tests should I take for other STIs?

H. Hunter Handsfield, MD

1 days ago

Welcome to the forum and thanks for your confidence in our services. Your English seems fine.

You are more concerned than necessary. First, it is statistically unlikely your stripper partner has HIV. To the best of my knowledge HIV is uncommon in female sex workers in your country. But even if she has HIV, there was little or no risk. Oral exposure to HIV rarely results in infection; even swallowing HIV infected semen has an estimated chance of infection about one in 10,000. And there has never been an HIV infection known to result from cunnilingus. All in all, I would estimate your risk of HIV as well under one chance in a million. Cunnilingus also is low risk for all other STIs.

1. From a medical/risk perspective, you do not need to be tested. Of course you are free to be tested anyway, for reassurance. The HIV RNA PCR tests are conclusive 11 days or more after exposure. (This doesn't mean I believe you actually are at risk. I do not.)

2. I see no reason to stop having sex with your regular partner.

3. DoxyPEP was unnecessary after this event. It is recommended only for much higher risk exposures than yours (mostly for unprotected anal sex between men). But having taken it, you definitely do not need testing for chlamydia or syphilis. You could have a throat swab test for gonorrhea, which is not reliably prevented by doxycycline -- but this too would only be for reassurance from the expected negative result.

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

HHH, MD

---
---

21 hours ago

Thank you, Doctor Hunter Handsfield, for helping me through this difficult time. 1 - In your vast experience, is a PCR of 11 days more suitable or waiting 4 to 6 weeks to perform a 4th generation test? 2 - Have you seen or know of any case of transmission via cunnilingus? Anyway, I'm going to carry out some testing, as soon as I have results I'll share the results. Thank you very much, during these 9 days I think it was the first time that I managed to calm down and reassure myself, you don't know how much it helped me.

H. Hunter Handsfield, MD

15 hours ago

1. Either the PCR test at 11 days or the AgAb (4th generation) test at 6 weeks is conclusive proof. In most settings, PCR is a lot more expensive but I do not know the situation in Brasil.

2. As I said above, no such cases have ever been known to happen. Therefore of course I have seen none myself.

I'm happy my advice so far has been helpful.

---