[Question #2098] MSM Oral Encounter HIV Fears

45 months ago
Hello-

I am a 20 something white bisexual male who identifies as straight. After drinking  and some disinhibited emotions I met another "straight" white male online in my suburban area who swears he is drug and disease free. We live outside a major metropolitan area. We performed mural oral sex and I at times performed vigorous deep-throating. I do believe pre ejaculate got into my mouth, however majority of the ejaculate got onto his body. I also need to confirm that I ate a sandwich earlier in the day and some scrapes on the roof of my mouth along with a semi healed cut on my inner lip from biting food earlier in the day. 

I have had only one previous MSM sexual experience with another "drug and disease free" white male where I anally penetrated him with a condom and there was mutual unprotected oral without ejaculation 3 years prior. 

All other sexual experiences within this time frame have been protected female sexual encounters. 

From what I have read PEP is not warranted as my risk is quite low. 

What is my risk of HIV from these 2 separate encounters and is HIV testing warranted? If so how long must I wait to take the test? Should I be screened for any other STIs?

I feel I am in very good health and have never experienced ARS symptoms. I am quite terrified regarding this last experience and would like some advice. 

Thanks so much in advance. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thanks for your question.

As described, both of these encounters were very safe, and I would not recommend HIV testing specifically because of them. However, it is recommended that all people who sexually active outside mutually monogamous relationships be tested routine.y for HIV and common STDs from time to time, like once a year. So assuming you haven't been tested recently, I recommend you do it now. Such routine testing in males normally includes a urine test for gonorrhea and chlamydia and blood tests for HIV and syphiils; and in your case might also include a throat swab for gonorrhea. (Chlamydia rarely infects the throat and is not really an issue.)

As for timing, it doesn't matter very much -- since the specific encounters were very low risk, it really isn't crucial. However, I can understand that you might want the tests to be done long enough to be valid for the latest encounter.  The gonorrhea/chlamydia tests are valid any time more than 4-5 days after exposure; and syphilis and HIV testing are best done 6 weeks or more after the last possible infection opportunity. 

Finally, there really is no reason to be "terrified" about the most recent event. HIV transmission by oral sex is extremely rare, if it occurs at all. One estimate, from CDC, is that oral sex -- the risk for the oral partner in fellatio, i.e. oral-penile contact -- is roughly 1 in 10,000, and that's only if the penile partner has HIV -- and it seems very unlikely your partner was infected. 1 in 10,000 is equivalent to giving BJs to infected men once daily for 27 years before transmission might be likely. And no, I don't think the vigor of the exposure, "deep throating", or the scrapes in your mouth significantly alter this very low risk.

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

Best wishes--  HHH, MD

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