[Question #1922] Hiv risks doctor hook

53 months ago
Doctor I am writing you from Melbourne as i need answers to questions regarding the following exposure:-
Exposure 1:- Met a tranny (Recieved oral and licked shaft for 10 second)I am not sure if there was any precum on the shaft i didnt tasted anything at all .. The tranny says she is clean:-
TESTS 18 DAYS Melbourne Pathology antigen / antibody
24 days (Dorevitch Patholody antibody / antigen Combo Serum )
31 (Dorevitch Patholody antibody / antigen Combo Serum ) 
37 (Dorevitch Patholody antibody / antigen Combo Serum )
42 (Dorevitch Patholody antibody / antigen Combo Serum )
44 (Melbourne Pathology)
55 days (Dorevitch Patholody antibody / antigen Combo Serum )

Exposure 2 :- Recieved oral sex for 10 seconds THATS IT.
14 days (Dorevitch Patholody antibody / antigen Combo Serum )  (Gonerea Chlymedia also negative))
16 days Melbourne Pathology Antigen / Antibody) (Syphilus also negative)
27 DAYS (Dorevitch Patholody antibody / antigen Combo Serum )

My questions are :1) Am i clear of HIV from both exposures  ?
 2) Do i need any more testing?
3) Can these tests miss an infection for exposure 1 and exposure 2 ? 
4) I thought recieving oral sex is not a risk for HIV at all but i have seen some forums or government sites say low risk instead of no risk.. You say there has never been a case? Do you stand by this statement?
5) I saw a doctor at Parahan Market clinic and he works in research in Melbourne sextual centre and its a hiv expert .. He said there is no point in testing after 6 weeks .. He said we can catch it in almost 2 to three weeks thats it .... and he said Recieving oral is not an hiv risk for at all and he wont recomend any testing. Do you agree to this?
6) Would you ask anyone to do hiv testing if only exposure is recieving ?
7) Why 12 weeks when melbourne sextual and prahan clinic doctor was so clear.. he said 6 weeks has been used since 2011... 
8) How did you come to this conclusion that 4th generation is conclusive at 4 --- international conference?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome to the forum. Users do not select the moderator who responds to their questions. Dr. Hook and I have been close colleagues for 3 decades and our opinions and advice do not differ from one another.

The first exposure carried no measurable risk for HIV and you were seriously over tested. You really did not need testing at all after such an expposure. However, the antigen-antibody HIV tests are conclusive any time 4 weeks or more after exposure, so your 31 day test was conclusive. The ones after 31 days were superfluous.

Exposure 2:  HIV has never been proved to be transmitted mouth to penis. So this also was a zero risk event. You should not have been tested. But the 27 day test (close enough to 4 weeks) was conclusive.

Those comments pretty well cover all your quesitons. But to be explicit:  

1) You are in the clear. 
2) No more testing is needed.
3) No, these tests cannot miss HIV when done at least 4 weeks after exposrue.
4) We stand by the statement that there have been no proved infections by this sort of exposure, even though some persons believe that's how they were infected. It isn't possible to say zero risk, but low enough that you shouldn't be at all worried about it. The US Centers for Disease Control and Prevention has estimated the risk as once for every 20,000 exposures. That's equivalent to receiving oral sex by infected partners once daily for 55 years before infeciton might be likely.
5) I agree. 
6) Nope.
7) And I would say 4 weeks. Some agencies continue to recommend 3 months out of a hyper-conservative approach, or because they haven't caught up with more recent data on test performance.
8) There are several lines of evidence about 4th gen tests being conclusive at 4 weeks. No single conference or report. It's based mostly on scientific understanding of how HIV infection devleops in newly infected persons and the biology of how the tests work.

FYI, Australia's federally funded sexual health centres arguably are the world's most expert network of STD/HIV prevention clinics, and Melbourne's and Sydney's are the best of the best. You can rely on their advice without hesitation. Give them a call if you remain concerned.

I hope this information has been helpful. Let me know if anything isn't clear.

HHH, MD

---
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
In your two new (closed) threads, you asked about an apparent discrepancy between Dr. Hook and me about oral sex risk for HIV. You have misunderstood Dr. Hook or my comments above. There is no difference between us. My reply above says that there was no risk from receiving oral sex and you did not need testing. That's what Dr. Hook always says as well.

---
53 months ago
Thank you doctor for telling me the username ... I forgot it and there was no option to recover username.. Thanks again and please accept my apology. If the web admin can contact me that will be great....

I went to Melbourne sextual centre and saw a counsellor. They from the start decided that based on my risks they wont give me any HIV test. I had to go do them through my GP for both exposures...  I am sure you also said no testing was necessary based on both risk factors.

I have some follow up questions please:-

1) I am not worried about my first exposure now at all since i have done 7 HIV TEST till 8 weeks.... My second exposure 4th generation test for recieving oral 14 days, 16 days 27 days are conclusive? The reason i say is i tested one day earlier but based on my risk should i retest at all ? 
2) Have you seen a person who was negative at 14, 16 , 27 days and positive on 28 ?
3) I have seen Dr sean/ Dr jose  from freedomhealth who use to be on your medhelp forum state quite clearly "YOU WONT GET HIV FROM SUCKED" do you agree to this ? 
4) In your entire HIV epidemic, you saw that someone recieved oral sex and 27 days antigen antibody negative got HIV in your clinic?
5) Why some doctors say recieving oral is a low risk instead of no risk  ?  My doctor in Prahan market clinic who is an hiv expert said "NO "
6) Should i test again or just put this behind and move on  ?
7) If i was your patient or somewhat related to you what would be ur advise?

Thanks doctor .. your comments will definitely help me  i myself dont wanna go through an HIV test again but need confirmation from experts like you before i can move on...


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
1) Already answered. See my original reply, second paragraph plus reply (4).
2) No, I have never seen this. I'll bet it has never happened, anywhere in the world.
3) Again, see (4) above. The risk is zero for all practical  purposes.
4)  Same question as no. 2, same answer.
5) As I said above, nobody can say that oral to penile sex is zero risk. But it's close enough to be considered zero. I have never seen a person with HIV infected by oral sex. Different doctors just have different ways of saying the same thing.
6) Do not test agin. Put it behind you and move on...
7) ...which is exactly what I would tell my own clinic patients or a family member.

Before you ask anything more, please carefully re-read everything above. Chances are that anything else on your mind has already been answered.

---
53 months ago
Doctor, Thank you for all your replies first of all.. You are a great professional and i have read so many of your threads on medhelp etc...
To be honest i just got a bit confused about the second exposure (RECIEVING ORAL ).. I have seen Doctor hooks other threads, where he clearly says:-

"There has never been a case of HIV accquired by receipt of oral sex;not even one. This is case irrespective of Bleeding gums, dental disease in the person performing oral sex. You will not be the first"..

I can see that your replies are a bit different and you even have asked people to test in that situation.

Anyhow i did another test again which was 35 days (combo antigen/antibody 4th gen test - Dorevitch Pathology) after the recieving oral sex as last test was 27 days.  Please can i relax now and can you please answer my questions now:-

(YOU SAID I DIDNT EVEN NEED TO TEST IN THE FIRST PLACE)

1) Dont you agree with what doctor hook said above?
2) If you were in my situation and received oral sex would you test for HIV ? 
3) EXPOSURE 2 :- Receiving oral :- TEST 14 days , 16 days, 27 days ( You said dont test ) but i did 35 days (HIV NEGATIVE -- all test 4th Gen)  - Is this result now conclusive ?
4) Can the three test above miss antigen / antibody window ?
4) Any more testing required for HIV at 6 weeks or etc?
5) Can i now put both exposures behind and move on since my last test was 9 weeks from EXPOSURE 1 AND 5 WEEKS FROM RECIEVING ORAL ?
6) Any other recomendations for me ? 

Please also for the worried wells on the forum who always ask questions about the window period.. MSHC AND PARAMATTA SEXTUAL CLINIC HAVE OFFICIALLY WINDOW PERIOD of 6 weeks. This is not from now, its from 2011. This was changed with confirmation from VIDRL which are a reference lab for HIV.   I also went saw DOCTOR VINCENT at prahan market clinic who works in MELBOURNE SEXTUAL IN RESEARCH AND A SPECIALIST OF SEXTUAL MEDICINE, he and the nurse at MSHC clearly said its actually 3 - 4 weeks where we can detect if there is HIV or not... he said they have been saying six weeks for years and years.He also said recieving oral is not a risk.



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
I agree 100% exactly with the statement you quote from Dr. Hook. Any difference you think you have found between us is nonexistant. As I said in the opening of my original reply above, there are rarely if ever any significant differences between us, on any STD/HIV topic. (Don't over interpret minor differences in wording and style; and always take into account the exact question to which we are responding.) And as for testing advice, both of us often recommend tests for reassurance purposes, even when the risk was zero. In other words, advice to be HIV tested is not necessarily evidence we think there was any risk. Some clinics take a more conservative stand than others on time to conclusive testing. Dr. Hook and I stand by our advice about 4 weeks for the 4th generation (antigen-antibody) tests, i.e. in agreement with MSHC's Dr. Vincent. And obviously we also agree about no risk from receiving oral sex.

Beyond that, these questions have already been answered and I see no need to repeat myself. But to be explicit:  1) Yes, we agree. 2) No, I would not be tested. 3) Yes, conclusive. 4a) No, not possible. 4b) No. 5) Repeat question; yes; see above. 6) I have no further recommendations for you except to move on without worry.

Please note that the forum does not permit repeated questions on the same topic or exposure, especially when the questions are obviously driven by anxiety or when there is apparently difficulty in believing or accepting advice already given. This will have to be your last one; future questions on this topic or about this exposure will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce the temptation to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users’ anxieties.  Finally, repeat or anxiety driven questions have little educational value for other users, one of the forum’s main purposes. Thank you for your understanding.

Best wishes and stay safe.


---