[Question #1855] Receptive Oral Sex and HIV

44 months ago
Hi Doctors,

First, thank you for all the education you provide.  I have learned much over the years about how to take care of myself from both of you.

I am a gay male and have been in a monogamous  relationship for 4 years.  I screwed up over the last weekend and preformed oral sex after a get-together of old friends while I was out of town.  The episode lasted for roughly 5-10 minutes  and there was no ejaculation.  My understanding is this episode is a minimal risk and my questions are as follows:

1. Am I correct that given current data, this episode would still be considered a low risk?
2. I feel guilty as can be about the episode and don't want to hurt my partner.  Do I need to test for HIV before continuing sexual relations with him?
3. If I do need to test, would an RNA test at 11 days (the one offered online, Aptima I think it is) be sufficient to move on?

Thanks so much for your guidance!

Travis
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

.Welcome to the Forum.  I'll be glad to comment.  Oral sex is a very, very low risk event for HIV but not no risk.  If your partner was HIV infected and not on effective therapy, official estimates are that your risk for infection is less than 1 in 10,000 but infection has occurred.  Given that there was no ejaculation, your own risk if likely even lower than that.  My advice, given that you know who your partner is and he is a friend, I would suggest you ask him about his status and explain the reason that you ask.  He should respect that and there is no reason for him not to tell the truth.  If he has been tested and knows his status and is not infected, then I would not worry further.   If for some reason you cannot get that information, then the odds are still very much in your favor. 

If you choose to test, while the Aptima is said to provide definitive results at 10-12 days, the data are rather small and perhaps more importantly, falsely positive tests do occur with this test.  A negative test would be reassuring however.  While it takes longer for definitive results (28 days) we prefer and would encourage you to test with a 4th generation, combination HIV antigen/antibody test.  REsults of this test are more reliable than the Aptima, as well as cheaper. 

I hope these comments are helpful to you. 


1. Am I correct that given current data, this episode would still be considered a low risk?
2. I feel guilty as can be about the episode and don't want to hurt my partner.  Do I need to test for HIV before continuing sexual relations with him?
3. If I do need to test, would an RNA test at 11 days (the one offered online, Aptima I think it is) be sufficient to move on?.

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44 months ago
Thanks Dr. Hook.   I got in contact with my friend yesterday evening  per your advise, and he shared that he was negative. 

Do you recommend I still wait to test before resuming regular sexual activity with  my partner? 
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
With this knowledge, I would assess your likelihood of having been infected as very, very low and would not feel that testing was absolutely necessary.  EWH
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44 months ago
Hi Dr. Hook,

I went ahead and did the Aptima RNA test at 10 days and a few hours after the unprotected oral sex (no ejaculation) episode I described above and it came back negative.  This weekend I did have several days of what appeared to be sinusitis/seasonal allergies (stuffy head/nose, pressure, little/to no fever) but nothing else to speak of.  Do you recommend that I need to invest in the DUO at 28 days or given the low risk episode and negative RNA at 10 days I should move on?
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
My advice would be to move on without concern.  The combination of the negative Aptima and the very, very low risk nature of your encounter really make the odds that you were infected by HIV in the encounter you describe vanishingly rare and not something to worry about.

This is my third reply to your queries. Thus, as per forum Guidelines, this thread will be closed later today.  Take care.  EWH
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