[Question #160] Oral sex and testing

37 months ago
Hello doctors and thank you for your time.  Two part question.  I had receptive oral sex with another man of unknown status.  I sucked his penis for 3-5 minutes without a condom and then proceeded to finish each other off by handjob.  The factors I am worried about are precum in my mouth coupled with the fact that I bite my cheeks and have some scare tissue alongside both of my cheeks.  In addition my gums bleed when brushed or flossed and my dentist states that I have mild gingivitis.  I was intoxicated at the time and used mouth wash after the act was completed.  I have done some reading and it seems that these factors will increase my chances of getting infected with HIV. Specifically that ethos alcohol mouth wash and bleeding gums greatly increase the chance of oral transmission due to changing salva chemistry and oral mucous membrane chemistry.

As far as testing goes I have take. An Oral fluids Oraquick mouth swab at exactly 30 days with a non reactive result.  I will not have access to any other tests other then Oraquick oral fluids for about 2 more months due to remote location.  I have two more Oraquick tests in my possession and plan to test at 6 weeks and 8 weeks with a final blood test at 12 weeks whe. I leave my remote location.  When can I start breathing easier?  At 6 week oral fluids or 8 weeks oral fluids or not u it'll blood test that is not available for some time.  Thanks for your time and help in this matter and all the good work you do.
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago

Welcome to our Forum.  I'll try to help.  Tests for HIV antibodies  (including the rapid, oral fluid tests of the sort you used) will detect well over 90% of HIV infections at 4 weeks after exposure and result are conclusive at 8 weeks despite "official" (and overly conservative recommendations that results are not definitive until 12 weeks.)  Thus even if your exposure put you at risk (see below), your current results are strong evidence that you were not infected.

As for your risk for infection following 3-5 minutes of receptive oral sex and despite the possibility of mild gingivitis, is miniscule.  There are a handful (less than 4 or 5) instances reported in the literature in which persons may have acquired HIV through performing oral sex on an infected partner but these are the "exceptions that prove the rule".  Remember however that most persons do not have HIV and the risk for acquiring HIV through receptive oral sex is statistically less than 1 infection per 10,000 exposures.  Thus, when considering the low risk of infection, the likelihood that your partner did not have HIV, and the negative test result at 4 weeks, I would urge you to not worry further about having gotten HIV from the exposure you describe.  If you choose to test further, an 8 week test result should be considered definitive.

I hope this comment is helpful. Take care. EWH

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37 months ago
Dr.  Hook thank you so much for your prompt reply.   I was really worried due to my use of alcohol before  the oral sex added to my gingivitis and white scar tissue inside my cheeks would have made me a prime candidate for oral Hiv infection.  Also that I used mouth wash directly after the act.  I just tested at exactly 42 days negative with another Oral fluids home test from Oraquick.  Just wondering if I'm out of the woods yet.  Still plan on testing 8 weeks with oraquick and a 12 week blood test.  Thanks and have a safe and happy weekend.
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Your worries are misplaced.  The mouthwash would not, in any way increase your risk.  Be confident you did not get HIV (or anything else except a case of anxiety and perhaps guilt) from the exposure you have described.  You can test as much as you want for as long as you wish but the results in relationship to the exposure you describe will not change.  Of this I am confident.  EWH
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37 months ago
Dr Hook I guess this is my last response due to follow up question limit.  My worries about alcohol and oral mucus transmission was fueled by a study that I read Zheng 2004 about the effect of Low dose Ethol alcohol and oral Hiv transmission.  A little bit more information I work on an oil rig and that is the nature of my remote location.  Due to an abnormal situation I was able to get a rapid blood test I Bierce it was Hiv sure check from the same manufacturers as clear is stat pack. It was negative 44 days post exposure.  These forum posts have helped me more than anything else.  I feel confident that I am negative but will test again for peace of mind.  All of my symptoms " nausea" that I did not mention I. Previous posts due to there unreliability have cleared up after the rapid blood test.  In closing I would like to ask your recomendation on an HIV charity to give to.  I know that not all people have the resources to reach out to experts such as yourself and do not have the luxury to endulge in the testing that I have purchased over th last six weeks.  Once again thank you for your guidance and sage advice.   
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago

Thanks for the additional information.  It does not change my assessment however- the exposure you describe was very, very low risk and your subsequent test effectively proves that you were not infected. You can now move on with complete confidence.  The "increased risk" associated with alcohol is overstated and not something to worry about.  I suspect your symptoms were more due to anxiety than anything else- this is not uncommon.

If you would like to make a donation, I would suggest making it the ASHA, the organization that sponsors this Forum.  They do much good work across the field of sexual health and HIV prevention. 

Take care. This thread will be closed a few hours form now.   EWH

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