[Question #2034] Test recommendations

49 months ago
Hi, Doctors thank you for your time and help.

I would like to know what test you would recommend for my exposure.
Im a male, 2 weeks ago I received condom protected sex from a CSW female, unfortunately the condom BROKE. And had unprotected oral sex for about maybe 5 min im guessing.
I immediately stopped and I have been worring about this exposure for stds, no symptoms after 2 weeks.

1. What test do you recommend ?

2. Is it possible to acquire hiv by this exposure . I only received a blow job.
[Did not notice any bleeding in her mouth ]

3. Should of I taken PEP befor the 72 hrs of the exposure to prevent Hiv just in case?

Thank you.

Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago
 Welcome to the Forum.  I will be happy to comment.  Before I do, your answers to two clarifying questions will be helpful.  first, just to be clear, your only exposure was receipt of oral sex, correct?  I ask because STI risk from oral sex is lower than for other sites of exposure and because condom breakage during receipt of oral sex is rather uncommon.  Secondly, where did your exposure occur (geographically).  there is some geographic variation in STI prevalence.

In answer to your questions:
1.  In general, as part of routine sexual health maintenance, we recommend periodic (annual, sometimes more often) STI screening (i.e. testing in the absence of symptoms) for persons who have multiple partners or whose partners may have multiple partners.  This is recommended because STIs can be asymptomatic (particularly if one is not looking for them) and testing is easily, requiring just a urine test for gonorrhea and chlamydia at urogenital sites and swabs from the throat and rectum is exposed.  At the time of testing blood tests for HIV and syphilis can be obtained as well although both these infections are far less common than gonorrhea and chlamydia.

2.  Receipt of oral sex is considered no risk for HIV.  there has never been a case of HIV proven to be acquired from receipt of oral sex.

3.  PEP would not be recommended if your only exposure was receipt of oral sex and probably would not be recommended even if you had genital contact.  Most commercial sex workers do not have HIV and most exposures do not lead to infection making PEP risks greater than the benefits for most such exposures.

I hope these comments are helpful.  EWH

49 months ago
Thanks for your helpful responses.
Sorry for not being clear the first time, however to clarify.

1. Yes my only exposure was receiving  unprotected oral after the condom broke while I was the insertive partner.  Total time was about 5 min from begining to when we noticed condom broke. 
2.Exposure was from my penis head to her mouth.  For maybe a couple seconds or a min.

A). I had a full std panel done about a year ago. Everything was clear.
Since my only exposure was Receipt of oral sex  what test would you recommend?

B). Can I exclude Hiv test since you have metion that its not a hiv risk?

Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago
Thanks for the additional information.  With receipt of oral sex as the only exposure of concern, there is no reason whatsoever for concern about HIV.  No need to test.

As for other STIs, oral sex only relatively rarely leads to infection.  When it does, the most common problems are either gonorrhea of non-gonococcal urethritis NGU) caused by mouth organisms introduced in to the urethra during sex.  chlamydia is rare following receipt of oral sex.  When gonorrhea is present it is usually obviously symptomatic while the symptoms of NGU may be more subtle or even absent.  This sort of non-chlamydial NGU is not clearly and STI in the traditional sense, is not readily transmitted to sex partners like other STIs, and in not associated with complications.  In the Unitized Kingdom, many specialists do not treat NGU associated with oral sex. 

All in all, your risk for STI at this time from this event is quite low.  I do not feel strongly that you need testing at all but if you wish to be completely confident that you were not infected, I would suggest a urine test for gonorrhea (they will do chlamydia on the same specimen- part of the "package" but the reason for testing is to rule out gonorrhea).   I would be quite surprised if the test were positive and as I said, do not feel strongly that you need testing at this time.  EWH
49 months ago
Thanks for the additional information.
I had a chlamydia and gonarea test at 3 weeks just to be on the safe side.

1. Is this conclusive 

2. Also just for personal knowledge 
Do hiv 4th gen test detect all CRF strains.

3. Can you provide short information on what are CRFs strains?

Thanks. This will be the last question.
I really appreciate the hard work and great services you provide.
Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago
1.  Yes, your test results for Gonorrhea and Chlamydia are conclusive.  Further testing would be a waste of time and money.

2. 4th generation tests are among the most accurate tests in all of medicine.  For all practical purposes they detect all HIV infections at 4 weeks after exposure., detecting all HIV strains.  I'm not sure what CRF stands for.

3.  See above.  Typically now, after three responses  this thread will be closed.  I will keep it open for one further exchange before closing II to clarify

Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago
The term RF refers refers to " reading frames" which describe the genetic variability of the HIV virus which is used to describe different HIV subtypes.  Subtype variations, may have minor impact on the infectivity or natural history of HIV but these variations in context are not of great clinical significance.  While the Internet sometimes comments on the impact of strain to strain variation, these comments are often overblown, sometimes incorrect and inappropriately anxiety provoking.  I would not worry about CRFs.   EWH---
49 months ago
I did some research about CRF Strains.
From what I understand CRF belong to the M group.
CRFs (circulating recombinant forms) which are essentially hybrid subtypes formed from a mixture of two subtypes

This is what I found in Wikipedia: there is more similar info about this topic in different websites.

"The M group is subdivided further into clades, called subtypes, that are also given a letter. There are also "circulating recombinant forms" or CRFs derived from recombination between viruses of different subtypes which are each given a number. CRF12_BF, for example, is a recombination between subtypes B and F.

These subtypes are sometimes further split into sub-subtypes such as A1 and A2 or F1 and F2.[citation needed] In 2015, the strain CRF19, a recombinant of subtype A, subtype D and subtype G, with a subtype D protease, was found to be strongly associated with rapid progression to AIDS in Cuba.[8] This is not thought to be a complete or final list, and further types are likely to be found.[9]"

1. I just want to confirm this information with you and would like to know your thoughts?

2. Since CRF subtypes are under the M group and under HIV-1 type would 4th gen test detect all of the CRF subtypes since they keep discovering new CRF strains?
Cuba discover CRF 19 strain in 2015.

3. Im just using this for personal information and im not currently concern with a hiv infection.
Thank you once again
Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago
1.  Please see my earlier note regarding the biological significance of CRF HIV strains.  These distinctions are of importance/interest primarily  to scientists studying the biology of HIV. 
2. Yes, current HIV tests, including 4th generation tests will detect CRF strains.

This will now conclude this thread.  EWH