[Question #2204] Blood in mouth - 4 weeks post pep

46 months ago
Im from Canada but i live in London. I need your advise . 

I was at a massage parlour where i was offered a happy ending massage . I closed my eyes and as she was giving me a hand job - i suddenly felt differently.  I opened my eyes and realised she was giving me a BLOWJOB . I stopped her but there was a cold sore on her lips. She had bright red lipstick and therefore its hard to tell if there was blood on her cold sore but i feel like i saw a little bit of blood . . As i had shaved the night before there were a couple of shaving cuts on my penis. Blood could be from my cut or from her sore. 

She then put on a condom and there was some genital to genital rubbing and some kissing. There was absolutely no insertion. 

I felt very uncomfortable and left without any ejaculation . 

30 hours later i was put onto pep because of the possibility of blood , cold sore/blisters and cuts.  The clinic said protected genital to genital comtact without any insertion is zero risk.

My tests for syphilis, gon etc are negative. 

At 8 weeks post exposure iv tested negative on a duo hiv test. 

My question is as follows 

1. Uk ( BASHH) guidelines say follow up testing after pep must happen 8-12 weeks post exposure . The doctor showed me these guidelines and iv double checked on the internet. Why are US guidelines seperate?

2. Do you think that i need another test ? Would you recommed to your patients in Usa to do another test if they had the same risk as i do ? 

3. Have you ever seen anyone test negative at 4 weeks post pep but later gone onto become positive ? 

4. Statistically speaking - what do you think are my chances given a 4 week post pep negative test ?

If you were in my place - would you have unprotected sex with your wife. 

My clinic in london says move on - im just not sure what to do . 


Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
Welcome to our Forum. I'll be happy to comment.  If you had asked us whether or not you needed PEP, I would have said no.  Official estimates are that the risk of getting HIV from receipt of oral sex is about 1 infection per 20,000 sex acts and I have never heard of, or seen a person who has become infected in this way.  Even if the presence of a cold sore, gum disease, or blood in her mouth doubled the risk (which is unproven), that would still make your risk about 1 in 10,000 and that is only if she had HIV and most commercial sex workers do not have HIV.  You do not know if your masseuse had HIV  I would not have prescribed PEP for you and would not have worried.  That said, let me address your questions:

 
1. Uk ( BASHH) guidelines say follow up testing after pep must happen 8-12 weeks post exposure . The doctor showed me these guidelines and iv double checked on the internet. Why are US guidelines seperate?
Recommendations vary from group to group and nation to nation,  Some U.S. organizations conservatively recommend 12 weeks (three months) before testing- personally I think this is overly conservative and in your specific case I am confident that whenever you test, the results will show that you were not infected.  In fact, were I you, I would not even bother to test.

2. Do you think that i need another test ? Would you recommed to your patients in Usa to do another test if they had the same risk as i do ? 
I see no need for further testing.  I suggest you believe your test results.

3. Have you ever seen anyone test negative at 4 weeks post pep but later gone onto become positive ? 
No!

4. Statistically speaking - what do you think are my chances given a 4 week post pep negative test ?
Please see my comment above.  Given the type of exposure you report and your 8 week test result there is effectively no chance that you were infected in the exposure that you have described. 

If you were in my place - would you have unprotected sex with your wife.
Yes, without a concern at all

I hope these comments are helpful.  Your exposure was very, very low risk if there was any risk at all and your tets prove that you were not infected.  EWH
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46 months ago
Dear Doc

Thank you for your re-assurance. Its been an extremely hard 8 weeks for me.

Just a quick clarification and then you could close this topic -

1. I hope you didnt miss the fact that i had a cut on my penis because of shaving my pubic hair. Would your recommendation of not testing further, sex with my wife and believing my test result still hold true.

2. I took my last pep on a saturday . Then i tested 4 saturdays later. I hope that counts as 4 weeks later  or does it count as 27 days ? I mean i took it on the 28th day after the last day of pep. Is that ok ?

I really want to move on. My local doctor has said i can move on . Your assurance would be the final thing i need to move on. 
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
1.  I did not miss the fact that you had sustained a cut while shaving your public hair.  This does not change my advice. 

2.  you can count your testing as having occurred 4 weeks after completion of PEP.

I agree with your doctor.  I would feel quite comfortable moving forward without further concern at this time.  EWH
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