[Question #1405] Risk and testing

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90 months ago

Dear Doctors

I had the following encounter with a female Asian CSW, her status is unknown to me except from what she told me “that she’s clean and tested recently 1 month ago”. 

I received condom protected oral. Then she proceeded to give me analingus for two minutes without protection. Obviously know i am worried about this and am thinking about testing. This encounter happened 1 week ago. I am mostly worried about HIV. I am vaccinated against Hep B & A.

My last full  STD panel test was 3 weeks ago, 12 weeks after my last exposure (before the exposure above). So as you can imagine I am back to square 1 and need to go through this for another 12 weeks, which is tough. 

Please advise me on the tests I need and the time intervals i should wait, and how worried I should be of contracting a STD, especially HIV, from my above regrettable encounter.  

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H. Hunter Handsfield, MD
90 months ago
Welcome to the forum. I'm happy to help.

This was a zero risk encounter for HIV. First, it is unlikely she is infected:  people (including sex workers) rarely lie about HIV status when asked directly, and the odds she acquired a new infection in the preceding month are very low. Second, HIV is rarely if ever transmitted from an infected person's mouth:  no transmission by kissing, and in the 30+ years of the worldwide HIV/AIDS epidemic, there has not been a single proved case of transmission by oral sex (mouth to penis). And you used a condom, which is 100% effective in preventing HIV transmission. (Among other things, saliva kills HIV, hence low transmission risk from the mouth.) There are no data on HIV risk from analingus, but for the reason above, it can be safely assumed there is no risk. (The main health risk from the analingus was for her, in the event you happened to have an asymptomatic gastrointestinal virus or other intestinal infection.)

For those reasons, you don't need any testing at all on account of this event. It does not count in any way as a potential HIV/STD exposure. However, in the chance you still want to be tested for reassurance, have a duo (4th generation) HIV test 4 weeks after the event. Three months is old news:  nobody ever needs to wait that long. The 4th gen tests are conclusive any time 4 weeks or more after exposure. (Don't misunderstand:  You are at zero risk and I am recommending that you NOT be tested at all. But from experience with anxious patients, I find that many insist on testing despite strong scientific evidence.) As for other STDs, I also recommend against any testing. But if would like that reassurance as well, have a urine gonorrhea/chlamydia test in a few days and a syphilis blood test at 6 weeks.

I hope these comments have been helpful. Best wishes and stay safe (as you obviously have done!)--   HHH, MD