[Question #2224] Oral sex & HIV

44 months ago
Hi!

I had unprotected oral sex  and protected anal sex (I bottomed) on 05/01. The man I had sex with ejaculated on my face and a small quantity of his semen entered my mouth. I checked condom after sex (filled it with water) and it was intact. Nevertheless, I contracted gonorrhea (throat and rectum) and I got a shot for it on 05/19... I guess this happened because he used his saliva as a lube (is this even possible?).

I am really worried he infected me with HIV somehow... . On 05/19 I had also CBC and my absolute lymphocytes were really low (0.91) while neutrophils were really high. This made me really scared.  Since then, I had two 4th generation tests: first on 05/19, second on 05/26 - both negative.  If my lymphocytes were indeed reduced as a result of an acute HIV infection, would 4th generation tests catch it? Can gonorrhea make HIV infection more likely?

I would like to ask you to assess my risks... Should I get another test or would you consider my results as conclusive?

Thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Welcome to the Forum.  I'll be glad to comment.  A few elements of your history perplex me.  it would be quite unusual for your to acquire rectal gonorrhea from an infected partner following condom protected sex if the condom was worn throughout the encounter.  that you acquired gonorrhea from performing unprotected oral sex is less surprising.  Have their been other recent sex partners?  Are you confident that your partner wore his condom throughout the encounter you described?  That you acquired both rectal and pharyngeal gonorrhea will influence the advice I am about to give you.  Gonorrhea does act to slightly increase the risk of acquiring HIV, if exposed.

I would not worry about your recent lymphocyte counts.  While lymphocyte counts can become low with recently acquired HIV, they are also affected by many other processes and low counts can certain be normal or indicate some other, non-STI process.  If your lymphocytes were low because of HIV, your test taken at that time would have been positive.  These counts fluctuate a great deal from day to day and do not reliably indicate the presence of absence of HIV.

Until quite recently, I would have told you that your current test results ( a negative combination HIV antigen/antibody test taken 25 days after exposure) provide definitive proof that you did not acquire HIV from the encounter you have described.  Recent data however suggest that a VERY small proportion of persons who acquire HIV do not develop positive tests until between 4 and 6 weeks after exposure, causing us to revise our advice and not consider test results definitive for higher risk patients until six weeks following exposure.  You fall into this group because of your recent acquisition of gonorrhea.  Nonetheless, your negative test at 26 days after exposure is very strong evidence that you were not infected and I am optimistic that further testing at 6 weeks will provide you with definitive proof that you were not infected in the encounter you have described.  It is more difficult to acquire HIV than gonorrhea.  I would not be worried if I were you but I would re-test at 6 weeks (42 days) after your last exposure.

I hope these comments are helpful to you.  EWH
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44 months ago
Hi!

Thank you for your message. What is your opinion on this paper: https://www.ncbi.nlm.nih.gov/pubmed/26941362 ?
It seems to link rectal gonorrhea to use of saliva as a lube.


Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
This paper suggests that use of saliva as a sexual lubricant can increase risk for gonorrhea slightly.  It in no way changes my assessment or advice.  EWH
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44 months ago
Ok, thanks,

Yes, I'm fairly sure he wore condom, this was my only partner in last 3 months.

You wrote that the there is a very small proportion of people who do not develop positive tests until between 4 and 6 weeks after exposure. What is this fraction? 1% 10%?

To summarize - I should get test 42 days after encounter but I should remain optimistic that it will be negative. Right?
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
thanks for the additional information.  The precise proportion of persons who do not become positive is not well defined, in part because it is quite rare.  Certainly less than 5% and in my opinion, probably closer to 1 or 2%.  Thus your recent negative result is strong, just not quite definitive, evidence that you were not infected at the encounter you have described. 

Your summary is correct.  I would not be worried.

As you may know, our forum allows up to a total of three replies per question.  This is my third reply. Thus this thread will be closed later today.  Take care and please don't worry.  EWH
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44 months ago
Hi!

Yes, I'm aware of the rules. I'm writing this comment just to thank you for your replies. The thread can be definitely closed now.