[Question #2032] Unprotected oral with shemale/Cross dresser

46 months ago
Hello
I reside in Australia and this incident happened here.
on 7 Feb I had unprotected oral sex with a shemale/cross dresser (CSW from Thailand) both receiving and giving for a very brief time (2mins) I did feel some precum in my mouth which I swallow and I did ejaculate in her mouth. after 6 - 7 seeks I only tested for related STIs and hepatitis  and all came back negative ... here in Australia doctors advised to wait for 12 weeks i.e.  till 7th May for a HIV test .. do i need hiv testing ?.. I am panic and need your advise....I have stopped my sexual life with my female partner after this incident and under very pressure from her that why i am behaving like that ....appreciate your great help....  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum. Thanks for your question.

My first reaction is to congratulate you on having only safe sex in this situation. Oral sex, even unprotected, isn't completely free of STI/HIV risk, but the chance of all is far lower than for vaginal or anal sex -- and zero for some infections. Since you've had negative STI testing, I'll concentrate on HIV. There has never been a proved case of HIV transmission mouth to penis -- so your partner's oral contact with you was risk free for all practical purposes (with or without ejactulation in the mouth). The opposite exposure carried a bit more risk, but one estimate (from the US Centers for Disease Control and Prevention, CDC) is roughly one transmission for every 10,000 events. That's equivalent to giving BJs to HIV infected men (anatomically, your partner was male) once daily for 27 years before transmission might be likely. So the chance you caught HIV from this one event is extremely low.

That said, I don't understand the advice you have had about HIV testing. The standard blood tests in current use in Australia and elsewhere -- i.e. the "4th generation", i.e. antigen-antibody tests -- are conclusive 4 weeks or more after exposure. While it used to be said that conclusive testing had to wait 3 months, that's old news, using older ("2nd generation") antibody-only tests; even the modern stand-alone antibody tests ("3rd generation") are conclusive by 6-8 weeks.

I'm guessing you haven't been to one of your government funded sexual health centres. Australia's SHCs are, collectively, the world's best network of STI/HIV prevention clinics, and one should be nearby if you live in or near an urban area. If you happen to be in or near Sydney or Melbourne, those SHCs are the best of the best. From both professional relationships and other comments on this forum, the SHCs consider the 4th generation blood tests conclusive at 6 weeks (even though 4 weeks would be warranted, in my opinion). So you might drop by an SHC for their evaluation and advice -- or at least discuss all this with your current physician. (You could print out this reply as a framework for discussion.)

In the meantime, stay mellow. The chance you have HIV is nil for all practical purposes.

I hope these comments have been helpful. Best wishes and stay safe!    HHH, MD

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46 months ago
thank you doctor for such a detailed and prompt reply
I live in one of the top 5 cities and went to a govt funded SHC clinic - may be I put it wrongly - their doctor told me and showed me book which had the statistics in which hiv from oral is immersible, they same i found on CDC risk tool kit (but strangely it includes kissing, touching and oral sex as 1/10K)on their website and you have also answer on the same line but yes the AUS Doc told me for a conclusive hiv test i should take it after 12 weeks. the bottom line is I dont have the courage to take this test....not sure how to gather strength ...
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
OK, here comes a bit of the "tough love" you'll find from time to time on this forum:

I have zero patience with not testing for fear of the result. First, if this is your only exposure, there is no realistic chance you have HIV. Second, it isn't the test that gives someone the infection: you have it or you don't, and if you do you have to know in order to access life-saving health care. Third, if you're infected you owe it to your regular partner to be tested: if you have HIV, you had it before the exposure above, and therefore your girlfriend has been exposed, and you have no moral right to keep that information from her. Finally, when people delay testing for fear of the result, stress and anxiety always decline after testing, even if the result is positive: fear of the result is more stressful than knowing, even if the result is the one you don't want to hear.

So there should be no need to "gather strength". Suck it up and just do it. If the non-exposure event above is your only potential risk, it will be negative.

Finally, I have to believe that you happened to see an unusually conservative SHC provider. Or perhaps s/he you didn't understand how frightened you are, and also is hoping to save the clinic money by recommending only a single test rather than possible 2 or 3 tests, if the risk is high and earlier testing is negative. (Or maybe there are different policies at different SHCs.  My main experience is with Melbourne, and MSHC definitely considers the 4th gen test conclusive at 6 weeks.)

So my advice is to return to the SHC and be as frank and honest about your fears as you have been here. I'm confident they will both test you and reassure you much as I have. 

Each question includes two follow-up questions and replies, so you have one more coming. I suggest you hold off on more questions unless and until you are tested and would like to let me know the result. OK?

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45 months ago
Thank you for the tough love doc...I did a test yesterday and got the result just now it is NEGATIVE..... The nurse also told me that it is near to impossible to get HIV from oral....thank you again for your help.....really appreciate it.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Congratulations! Both for getting up the nerve to be tested and on the negative test result. Of course the result is no surprise, but glad to hear it. Obviously I and the nurse you saw are in exact agreement about HIV risk from oral sex.

That completes the two follow-up comments and replies included with each question, and so ends this thread. Thanks for the thanks; I'm glad to have helped.
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