[Question #1819] Doctor Need reassurance for my HIV risks

78 months ago
1) Exposure Number One - I met a tranny - Got oral sex and Licked her shaft Skin  Not sure if there was precum on her shaft --
I was not worried about the recieving part but just the licking shaft park which i am Not sure if it is a risk ?
--- Test done 18 days (Antigen/Antibody) Negative
24 days (Antigen / Antibody Test (Siemens Centaur Advia COMBO) - Negative
30 days (Antigen / Antibody Test (Siemens Centaur Advia COMBO) - Negative ( Not sure if i need any more test) . 
Are these tests definitive after 4 weeks or 6 weeks ?

2) Exposure Number 2 - Recieved oral sex 10 seconds thats it.... Not sure if this is a risk? Called Melbourne sextual and PEP line they said its not a risk but also i read that there is never been a single case in which insertive person who is recieving got HIV ? 

Can i please move on without a concern for both exposures

Edward W. Hook M.D.
78 months ago

Welcome back to our Forum.  While your questions are not the same as the previous two questions that Dr. Handsfield and I have answered for you, they are similar with much overlap.  It appears that you remain quite nervous about risks associated with very low and no risk events, as well as the results of testing.  Further, I note that you tend to want us to comment on the results you received from the Melbourne sexual health and PEP lines which we typically agree with.  In considering this, it occurs to me that what is really going on reflects some sort of anxiety regarding sexual activities in general and might be better addressed by discussing your sexual preferences and activities with a qualified counselor, of whom I am sure there are many in Melbourne than allowing yourself to worry in the manner that you display in your questions.   Now on to your questions.

1.  No one has ever gotten HIV from receipt of oral sex, not ever.  This seems to be the same message that you got from the folks on the Melbourne help line.  As for licking the shaft of her penis, this too is a very, very low risk event.  The risk of getting HIV from performing insertive oral sex on an infected partner is estimated to be substantially less than one in 10,000.  The encounter you describe is lower still as you do not know that your partner had HIV (most transsexuals do not) and pre-ejaculatory fluid present on the outside of the shaft is likely to be less infectious than direct exposure to ejaculate during oral sex,  I would not have recommended testing for you related to this exposure.  you tested however and have definitive test results- 4th generation, combination HIV antigen/antibody tests provide definitive results at any time more than 4 weeks after exposure.

2.  See above, there is NO risk from receipt of oral sex, even if your partner did HIV, which you do not know.  As you were told, there has never been an exposure of this sort proven to have led to HIV infection.

It is past time for you to move on from these exposures.  I hope my comments will help you to do so.  EWH .

78 months ago
Doctor.. Firstly i wanted to say thank you.
I have some more questions:- 

I am now no more worried for exposure 2 (Recieving oral sex for 10 seconds) -  Did a Gonorhea / Chlymedia test after 2 days - Negative. You said dont need hiv test for this.

Exposure Number 1

When i went to Melbourne sextual centre i saw a counsellor and explained what has happened she said i dont need any HIV test .Even when i said i licked the shaft. (It was only 6 seconds) --- 
She said to me the only test i have to do is a syphilis test after 6 weeks and thats it.. They said period they wont do any HIV test..
 1) You also mention i didn't need testing? 
2) How can this be a low risk ?
3) But i went to GP and asked for HIV tests... Also my test is conclusive the last one i did.? I did it at 30 days post exposure... COMBO... Can i now move on without any more retesting or you recomend i test again in another 2 weeks (TOTAL 6 WEEKS)  for exposure 1 ?

Edward W. Hook M.D.
78 months ago
I.  Unless you licked a lesion you are just not at risk for Syphilis.  The counselor you spoke to was being cautious. In my opinion you do not need testing for HIV or Syphilis.

2.  Silly question.  I provided statistics.  The sort of exposures you describe are simply not of the same risk level as genital or ano-genital sexual contact.

3.  Testing with 4th generation tests at any time more than 28 days after an exposure is definitive  and no further testing is needed. You have been told this on multiple occasions. It should not need to be repeated. 

78 months ago
Doctor.... Thanks But i dont know why i am still concerned about the exposure ... Last time you said there was no risk from licking shaft as HIV is not outside the body.. I although did testing ...

-- Test done 18 days (Antigen/Antibody) Negative
24 days (Antigen / Antibody Test (Siemens Centaur Advia COMBO) - Negative
30 days (Antigen / Antibody Test (Siemens Centaur Advia COMBO) - Negative ( Not sure if i need any more test) 

I have some last questions please..

1) I called Melbourne sextual nurse and explained i had a test and explained i licked shaft.. She said does not matter when you test you had no risk.... ( Do you agree) ? 
2) You told me 4th generation test (I had three) at 30 days was conclusive...... Is that your own CLINIC research Doctor Hook or the board you sit in with experts have this ? Melbourne sextual follows a 6 weeks window period.. My question is why you have never told anyone to retest after a 4 weeks DUO negative? 
3) Can i now move on without a worry or any further testing?

I am sorry I just need these answers please...

Edward W. Hook M.D.
78 months ago

Your concerns are not warranted.  Your 30 day test results are conclusive (you have been told this in the past on more than one occasion.  Repeating the question will not change the answer.  In answer to your final questions:

1.  Yes, I agree.  I said this above.

2. Both my clinic and in consultation with other experts.

3.  Yes, you can and should move on without further concern or testing.

This is my third and final answer to these repetitive questions.  Future questions of this sort will be deleted without comment and without refund of you money.  EWH