[Question #1918] doubts about my situacion

53 months ago
Hi doctor hook, Im a male 39 fron mexico for the last 3 years i had 12 sexual partners all protected vaginal only, 4 of them were sexual workers and the rest girls I met, my really worry comes from the amount of oral sex I have recived (reciving blowjob) around 13 diferents (basically the same persons i had vaginal sex with) 1- is there really no risk for reciving oral, why not ? 2- when you mention that unproctected vaginal sex from woman to man only an infection takes place for every 2,000 I would like to know the medical aspect of that risk number, I mean why ist that could be with an infected person and not be infected why is that ? 3- in your experience, how many patientes have you told " your risk for unproctected vaginal one exposure are low risk" and then they came back to the forum and told you they were hiv + ? 4- Do you consider nigth sweats with out fever a comon ars symptom and when ( if infected) do nigth sweats show up, how heavy they are and can you coment on things that could cause nigth sweats, I´ve read that even low blood sugar, green tea and execive work out are a cause also.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome to the forum. I'm pleased to answer these common sense questions. Dr. Hook and I take non-herpes questions on our own schedule, without regard to requests for either of us. We have worked together closely for 30 years and our opinions and advice are always the same, even if we have somewhat different styles. My first reaction is to congratulate you on your commitment to condoms for these sexual encounters. The chance you have HIV is nearly zero, and the risk of other STDs also is very low. Directly to your questions:

1) Although the data are old (2005, https://www.cdc.gov./mmwr/PDF/rr/rr5402.pdf), CDC estimated the risk for oral to penis transmission as once for every 20,000 exposures. That's equivalent to receiving oral by infected men once daily for 55 years before transmission might be likely. Most experts agree there has never actually been a proved case, even though some people believe that's how they caught HIV. So zero risk for all practical purposes. Why? Probably because there is little HIV in the mouth. Among other things, saliva kills HIV.

2) Different infections are transmitted more easily or harder than others. Every infection is different. For example, exposure to a single rabies virus is fatal, and measles and influenza require exposure to only a few virus particles. For HIV, lots of virus must have access to certain cells deep inside the body. Beyond that, it's very complex and the details are not understood. The data in support of one in 2,000 for unprotected vaginal sex, female to male, are in the same resource linked above.

3) In my 30 years experience in the STD/HIV business, I have never had this happen. I'm pretty sure the same is true for Dr. Hook. But this doesn't matter. Rare things happen, and certainly it happens to some people.  Whether or not I or Dr. Hook have personally seen such a case doesn't change anything.

4) Night sweats can be one of the symptoms of HIV. However, any infection can cause night sweats -- influenza, pneumonia, malaria, tuberculosis, and many others -- as well as certain non-infectious, and several non-infection health problems. Low blood sugar, but only along with other severe symptoms, like fainting. But I've never heard of green tea or strenuous workouts causing night sweats. Google "night sweats" for lots of information about it. 

The sexual lifestyle you describe is very low risk for HIV, especially if there were no unrecognized condom failures. The chance of other STDs is somewhat higher. Everybody who is sexually active outside a committed, mutually monogamous relationship should be tested from time to time, just to be on the safe side. In your case, I recommend you have blood tests for HIV and syphilis and a urine test for gonorrhea and chlamydia. I expect all of these to be negative.

I hope this has helped. Let me know if anything isn't clear.

HHH, MD

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53 months ago
Hi doctors here with a follow up, I couldn´t think of the number ofu unproctected sexual intercourses that take place in one day in mexico or the us for that matter(vaginal or anal) but Im willing to bet that is twice the number of people that recive unproctected oral sex, because its easier to perfom, so it got me thinking, if in deed this was a cause of transmision, there wil be at least a 40 percent more of total cases of hiv infected people in mexico or the us, does this make any sense ? taking in consideration that is the easiest and probably most comonn sexual act (recieving oral sex ) questions 1-Do you know if the risk numbers for female to male vaginal intercourse in mexico also apply in the 1 to 2000 ratio 2-If you were a  male uf unknow hiv status ans had sex 5 times with a female and after 6 months she tests negative, would this give you some reasurance that you are also negative ? 3- Have you ever heard nose bleeding to be a symptom of ars ? 4- Do you recall your wost case scenario patient, one who you said "I think this one is doom" and came back negative ? 5- If you are reciving oral sex and her mouth is bleeding, can you get hiv ? 6- There is a rapid test "NEOGEN" by MedLab here in mexico after 6 months would it be conclusive and ist reliable ? 7-Im nervous to take the test bacause of the amount of sexual partners(12) over the last 3 years but they were all protectedvaginal intercouse is the oral sex that I recived that worries me, does it make any diference that they were 12 diferent females giving me oral sex ?8- have you had a patient with this many partners of reciving oral sex, what was the outcome ? thanks so much for all you do
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
I don't follow your reasoning about 40% more HIV cases in Mexico compared with the US. You'll have to take me through those numbers and your assumptions -- but I very much doubt this is the case.

1) I see no reason the risk from vaginal sex would be any different in Mexico than elsewhere.

2) TIf each exposure carries only 1 chance in 2,000 of transmission, then in theory the odds would be 1 in 400 of catching HIV after 5 exposures. This outcome would be only slightly reassuring.

3) Some cases of ARS are accompanied by low platelet counts, reducing blood clotting function -- in which case various kinds of bleeding are more common, including nosebleeds. However, nosebleed would never be the only symptom of ARS.

4) I do not recall any such patients. In any case, my personal experience with rare conditions means nothing, and hearing it from me should have no effect on either your confidence or worry about catching HIV. If I had a patient who was struck by lightning, would it have any effect on your risk of being struck?

5) Maybe that would increase the risk a little bit. But bleeding in the mouth is not rare, and yet still no proved cases of oral to penile HIV transmission. So if this elevates the risk, it is still too rare to worry about.

6) I'm not familiar with that test name. But every blood test all over the world is conclusive when done 3 months or more (and usually 4-6 weeks) after the last possible exposure. So I'm sure your 6 month result is conclusive.

7) It is never appropriate to delay testing for HIV (or any other serious condition, e.g. mammograms in women) for fear of the result. The test isn't what gives you the infection; you have it or you don't. If you have it, you have to know both for your survival and to protect partners. And when people delay testing for fear of the result, when they finally do it, stress always declines -- even if the test is positive. Worry about the result is actually worse than the stress of learning the wrong result. Therefore, I have absolutely no patience with delaying testing for this reason. Suck it up and just do it. Based on your sexual history, almost certainly it will be negative.

8) My clinic has had hundreds of non-gay patients with far more sex partners than you, and almost none of them tested positive.

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Please note that each question comes with two follow-up comments and replies. I suggest you not post anything else until you are tested, then return to let me know the test result. Until then, I won't have any different advice.

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53 months ago
Im sorry doctor but since the begining I bougth 2 questions because I have a lot of doubts, I think that if you ask what´s the common denominator in all of us that come to this forum, its that we are all desperate and reach out to you for some reasurance, I dont think you know how valuable you answers are to us. What i meant when I mention the 40 percent more cases of hiv, was that if reciving oral sex was a way of transmision, in stead (for example) of beeing 10 cases of hiv+ in all of the us, there will be 14(for example) because is the most common act of sex, Dont you agree ? questions 1- If I had 100 sexual partners, but they were all protected vaginal intercourse, with out condom failure, will that make a diference in your risk infection ? 2-If a person gets ars symptoms wich, out of all the symptoms, would you say is always present ?3-How many woman have you found to be infected after only one exposure, from an hiv+ men in your clinic or in the forums? 4-Would you please explain from a medical stand point, why reciving oral sex is not a way of transmision, and I read in one of your forums that there would have to be a considerable amount of blood in the mouth, to be at risk of getting infected from reciving oral sex, is this true ?5-Is hiv really that common? 6-Would you agree that there are many different causes for nose bledding 7- My situattion again: 12 sexual partners over the last 3 years vaginal intercouse all protected, but 12 acts of reciving oral sex unproctected8- In your last stament, you mention that in your clinic you had hundreds of patients, with far more sexual partners than me, and almost no one tested positive, of those patients you mention, did their risk was also from unproctected reciving oral sex or also from unproctected vaginal sex and other sexual acts(assuming they are all male ) Once again thank you for your expertise and patiance !



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
1) If I understand your reasoning, you mean that there might be a 40% higher chance of HIV from receiving oral sex in Mexico because you think oral sex might be more common among Mexicans than in the US. I don't accept that premise; I doubt there is much difference. But even if that is correct, what does it matter if there were 14 such infections in your country each year instead of 10? It makes no difference in overall risk of HIV at a national level, or for any particular person.

2) According to most studies and estimates, 40-60% of people with new HIV experience ARS symptoms.

3) I can't say how many women in my clinic caught HIV after one particular exposure. Not very many. But this is the same sort of question as no. 4 yesterday. Re-read that reply.

4) The biological reasons for low risk from oral sex are not completely understood. But the virus is not present in the mouth, at least not in great concentration, in most people with HIV. And saliva kills HIV.

5) Yes, I already said that.

6) Also a repeat question. You are at little or no risk for HIV from the sexual lifestyle you have described. But I still suggest you be tested.

You came here for our expert advice, but instead of accepting my reasoned, science-based reassuring, you are fighting hard to prove to me that you really are at risk. What's the point? If you weren't going to accept or believe the advice, why are you here?

That completes this thread. Please do not start a new thread with these same questions. Repetative or anxiety driven questions are against forum policy and are deleted without reply, and without refund of the posting fee.

Best wishes and stay safe--  HHH, MD



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