[Question #13694] Hiv mouth to penis

2 days ago

Hi,

On the first of January a woman had oral sex on me (her mouth on my penis) and in addition there was mutual masturbation. Two days later (03/01) I felt burning when urinating. On the third day (04/01) there was no more burning but I noticed a white secretion coming out of the tip of my penis. At that moment I imagined the possibility of an STI and ran to the health center to take HIV PEP, since it is a disease that scares me. Today (08/01), 5 days after the onset of symptoms, I continue with a transparent discharge and without any burning (the initial burning lasted only 12 hours and the white secretion was only noticed on 04/01, from then on only transparent secretion).

I have started PEP with 67h post exposure and now I am waiting for gonorrhea and chlamydia test results.

My questions:

1. What is the risk for hiv?

2. PEP with 67h is reducing any risk?

3. Should I continue PEP?

4. Would you have recommended PEP?

Edward W. Hook M.D.

2 days ago

Welcome back to the Forum. Thanks for your continuing confidence in our efforts. I’ll be glad to comment. I’m delighted to hear that you have been tested for gonorrhea and chlamydia. That’s the right thing to have done. I trust that you did not take antibiotics before getting tested. I’ll be interested to hear what your results show. They should be available quickly.

Regarding HIV, let’s put that concern aside. You do not know that your partner has untreated HIV and statistically it is unlikely that she does. Even more importantly there has never been a proven case of HIV acquired from receipt of oral sex. You will not be the first. I would have not prescribed PEP for you if you’d approached me asking for it. Thus, in response to your questions:

1. Virtually zero

2. If there was any realistic risk, PEP would have reduced any risk by about 90%

3. I don’t think you needed it and see no need to continue

4. No

I hope this perspective is helpful. Please let us know what your tests show. EWH

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1 days ago

Thanks a lot for the answer, it is a relief. I will share result here once I have it.

I would like to understand why it is not possible to categorically state “zero risk”, I mean it is a contact with saliva only… what makes the infection biologically plausible?

In addition, I am concerned that I have started PEP too close to the limit of 72h… this 90% reduction applies even for my case (67h)?

Thanks again!

Edward W. Hook M.D.

1 days ago

In science there is no such thing as "never". Extraordinarily rare rare things may occur but remain unobserved. In the same way, while I cannot say that there is zero risk of you being struck by a meteorite falling from space today but like your risk for HIV, the risk of this occurring is, for all practical purposes, zero.

The effectiveness of PEP was calculated based on a time frame, not on a day-by-day or hour-by-hour basis. While I agree with you that it is reasonable to think that the effectiveness of PEP declines over time during the 72 hour PEP effectiveness window. That said, I remain entirely confident that that you are not at risk for HIV from the encounter you have described. Please try not to worry. I look forward to hearing the results of your gonorrhea and chlamydia test results. EWH

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