[Question #2452] HIV RNA Early Detection /Unprotected Oral

45 months ago
Hello Doctors, 

I am a male and I received unprotected oral sex (fellatio) by an upper scale trans escort in Canada. 

She then put a condom on my penis when some her saliva was still on my penis and we had protected sex.

14 days after the encounter I was tested with a HIV RNA Early detection test (HIV-1 RNA Qualitative TMA from STDcheck.com) and it came back negative.

At 14 days, I was also negative for gonorrhea, chlamidia, HSV1 and 2 all hepatitis types and syphilis.

A fourth Generation ab/ag HIV test was included in the package and came back negative as well.

My question is: Do I need further testing?

Thanks in advance.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Welcome to our Forum.  The encounter you describe was very low risk for HIV and other STIs.  Most commercial sex workers, including transsexual women, do not have HIV or other STIs.  Further, even with unprotected sex, only a small proportion of encounters lead to infection.  Relevant to your case, there are no cases in which HIV has been proven to be acquired from receipt of oral sex and condom protected sex is safe sex as long as the condom is worn throughout sex and does not break.  HIV is not transmitted in saliva, even saliva that might be present under a condom in the situation  you describe.  If you had asked me if you needed testing for HIV I would have told you that there was no need.  With the HIV RNA test you have now proven that you were not infected and do not need further testing. 

Similarly, your tests for gonorrhea and chlamydia are definitive.  From a theoretical perspective, you could still be incubating viral hepatitis or syphilis but the risk of these infections is so low that there really is no reason for further testing.  I would not have recommended blood tests for HSV either and, in your situation with no outbreaks at this time, I see no reason for additional herpes testing as well.

I hope that these comments are helpful to you.  EWH.   
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45 months ago
Thank you for your answer, Dr. Hook.

I was mainly concerned because of the mixed comments on health websites regarding HIV RNA tests and I wanted to make sure that this type of testing is indeed appropriate (some say it's just a confirmatory test and not a screening test).

As a last clarification, in case I wanted to rule out even the smallest possibility of having viral hepatitis or syphilis (mainly for my peace of mind), when should I get tested to consider the results conclusive (how many days/weeks after the exposure)?

Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Glad you found my comment helpful.  The problem with the RNA tests is that they give false positive results much more frequently than the more widely used, combination HIV antigen/antibody tests but a negative test at 14 days confirms that you were not infected.

Personally, I see no reason for testing for hepatitis viruses following the events that you describe but, from a theoretical perspective, if you were developing hepatitis it could take up to 6 or 8 weeks to become positive.  Your risk of getting hepatitis from the encounters you have described is lower than your risk of being struck by lightening.  EWH. 
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45 months ago
Thanks for the clarification doctor. 

Best regards,

45 months ago
Hi doctor, I think I may still have a follow up question. "conveniently" enough I woke up this morning with a sore and mildly swallen throat. No pains or aches on my body and no rashes.  I understand that my hiv Rna test was conclusive at 14 days. It has now been 4 weeks. Should I just consider my symptoms part of a cold?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Correct, with a negative HIV RNA test you can certainly assume that your sore throat is NOT a manifestation of HIV and can be confident that you do not have HIV.  This is true particularly following a close to no risk exposure.  There is no reason for you to worry about HIV.  Time for you to move forward without concern. 

Our Forum provides up to three replies to client's questions. This is my third reply.  As a result this thread will now be closed.  Take care.  EWH
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