[Question #2473] HIV ORAL SEX

48 months ago
Hi Drs
I am a bi man!4 weeks ago i had unproteced oral sex and protected anal sex with a man i dont know!I have bleeding gums sometimes!I took his penis in my mouth for about 3-4 minutes!He didn't ejaculate in my mouth!We used condom and lubricant for anal and it lasted only a few seconds!He was the first who asked before we met for condoms and lube!I suppose this mean something!I also lick his anus!10 days later i found one non painfull lymph node in my jaw!I visited a Dr!He said me that the lymph was normal and had 0.3cms braxial axis!The other axis was 1.2cms!He said to me that a lymph node is suppose to be swollen only if braxial axis is close to 1cm!He also check my throat and he didn't see something strange!I dont have fever, rash etc!
My worries began because this was my second experience with a man!I also have a long distance relationship with a girl, which i suppose to meet her these days!So i got tested at 3weeks with a 4th gen HIV combo test!It came negative!Today (32days) I developed something strange and painfull in my mouth!My Dr told me that is due to scratch or heat!
My questions to you!
1)What are the chances of getting infected by hiv through this exposure!Some state that is low risk or even a theoritical risk only!Under what circumstances will these theoritical risk become praxis?
2)Does my Dr was true about the swollen lymph nodes?Do you meassure only the braxial axis in order to say that it is swollen?
3)If my lymph at 10days was due to HIV ARS would my 4th Gen Test at 3weeks become positive?
4)As for my mouth problem at 30days!Is there any chance that is due to syphilis or gonorrea?Does syptoms from syphilis take to long to come up?Are paifull or not?
5)Should i have unprotected sex with my gf?
6)Should i tested again for HIV and STDs?
Thank you for your time!I really appreciate you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Welcome to the forum. Thanks for your confidence in our services.

It is very unlikely you acquired HIV during the exposure you are concerned about. If your partner had it, probably he would have told you. That he sugested condoms is a sign he is sexually responsible -- it doesn't raise the chance you were exposed, it lowers it. And anyway, oral sex is safe sex with regard to HIV:  there are very few proved cases of HIV transmission penis to mouth; one estimate (from CDC) is that the chance is 1 in 10,000 if the penile partner is infected. That's equivalent to giving BJs to infected men once daily for 27 years before transmission might be likely. Finally, you have no symptoms to suggest a new HIV infection, and your doctor has reassured you that your apparent lymph nodes are not things to be worried about.

To your specific questions:

1) See above:  definitely this was a very low risk exposure. It's more than theoretical -- the virus can be transmitted penis to mouth. However, not much is known about particular factors that make it more or less likely. Ejaculation in the mouth might hve a role. But the major factor probably is whether the infected (penile) parter caught HIV recently, is not on treatment, and/or has a particularly low viral load. But even with these things, the average risk remains extremely low.

2) Your doctor's advice sounds OK to me. However, I don't understand what you mean by "braxial (brachial?) axis". Anyway, these sound like small nodes, probably not abnormal. And HIV would never cause only a couple of nodes in one area of the body. Lymph node inflammation in acute HIV infection typically involves many nodes (10 or more) body wide.

3) Yes: if your lymph nodes were due to HIV and they showed up at 10 days, the test would be positive at 3 weeks. The negative result is very strong evidence that you don't have HIV.

4) Neither syphilis nor gonorrhea is a likely cause of a "scratch" in the mouth. Oral gonorrhea usually causes no symptoms at all; or at most a slight sore throat, certainly not a "scratch". Onset at 30 days is a bit late for syphilis, but might happen. Howver, the initial sore of syphilis (the chancre) doesn't appear as a "scatch" and usually is painless.

5) While I cannot guarantee you do not have an STD from the exposure a month ago, it is extremely unlikely and your symptoms are not typical. And HIV is exceedingly unlikely for all the reasons above. If somehow I were in your situation, I would continue unprotected sex with my wife with no worry I might give her anything.

6) Whenever someone is nervous enough to ask whether they should be tested the answer usually is yes. My guess is that negative test results will be equally or more reassuring to you than anything I can say based on probabilities and statistics. So I would advise having a throat swab for gonorrhea testing; this can be done at any time. Also have syphilis and HIV blood tests. You can do both of these now, for nearly conclusive results -- although repeat testing at 6 weeks will be required for absolutely conclusive results. You could also recheck with your doctor about the oral sore, or perhaps get a second opinion from an infectious diseases or STD specialist.

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

HHH, MD

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48 months ago
Hello Dr and thank you for your reply!You helped me a lot but I have some more questions for you!1)At another thread I read that gonorrea or chlamydia are treated by immune response even without medication at 6-12 weeks post infection!Does this occur at oral gonnorrea too?I am asking you because I had a similar exposure 4 months ago!If I had catch gonnorrea should it treated by itself at three months?I ask this because as I read in many sources stds could rise the possibility of HIV infection!2)Is there any possibility of infected by any std during oral to anus sex?3)My mouth sore is healed within a day almost so I suppose it is nothing to worry about!right?4)As for my lymph my dr said me that you measure only the short-small axes in order to say if they are swollen or not!Because of their shape they have 2 axis, which one of them is almost bigger than the other, and you take in mind only the short one!Is that true?5)I didn't do an oral swap but my dr checked my throat via camera which was inserted by my nose!He didn't mension something strange and he said that my throat seem ok!In case of Gonnorrea would he see something strange?6)How much conclusive is my 4th gen test at 21days since the average seroconversion is 22. Days!7)How about the 3 big studies of magnetic couples during them they were no infections via oral sex!Are they reliable?8)The 1:10000 odd of CDC is for oral sex with ejaculation or without?9)And finally my partner had asked me if I want to s**ow his s**n!So i suppose that he was aware of his meg status!I state that because I don't think that anyone would put at risk someone!Maybe some but they are the exception!Thank you once again Dr!You are really helping me!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
1) It often takes a lot longer for spontaneous cure by the immune system; the figures you quote are averages. Throat gonorhea usually clears up in weeks, but it can take months.
2) Analingus (oral-anal contact) mainly risks gastrointestinal infections like viral diarrhea etc. STD risk has never been studied but believed to be low risk.
3) This is further reassurance about syphilis or other STDs, which wouldn't heal so quickly.
4) I've never heard of such precise measurement of the size or shape of lymph nodes. I agree that such small nodes usually are not abnormal.
5) Most throat gonorrhea causes no symptoms and the examination usually is normal. The only way to know about such infection is to have a throat swab to test for it.
6) The average seroconversion time for 4th gen tests is about 2 weeks; 22 days is about right for antibody-only tests. But even antibody tests almost always are positive within 10 days of onset of symptoms. Your negative results so far therefore are highly reassuring that your lymph nodes are not due to HIV.
7) I don't know what "3 big studies" you mean.
8) The CDC1 in 10K figure is generally assumed to be with ejaculation in the mouth. The risk probably is lower without it, but nobody really knows. When the risk is so low anyway, it really doesn't matter much.
9) I agree this lowers the risk he has HIV.

Don't overthink this. Almost certainly you weren't infected with anything. For reassurance you should have the additional tests I advised yesterday, but stay mellow in the meantime. You definitely can expect negative results.

You have one additional follow-up comment and reply coming on this thread. I suggest you hold off until you have your additional test results, assuming you would like my input about them.

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48 months ago
Thank you once again Dr!As far as the 6week mark is in 8days i prefer to ask some more questions!Indeed I appreciate that you would like to hear about my probably negative results but since your answers are really helping me in order to relief the pressure of me I prefer to make some more!
1)The three studies I mentioned are those who study over magnetic couples about the risk of oral sex!The positive partners had variable viral loads from undetactable to high!They studied these couples for 3, 5 and 10 years where in the 10year study they were 19000 acts of oral sex and no infection of HIV!In conclusion they were not reported cases of HIV infection at these 3 studies where anal or vaginal sex was protected and oral sex was unprotected!Are they reliable?
2)I checked my lymph node via ultrasound!(In case of missunderstanding it was only one lymph node)As far as my Dr suggested no more testing since my lymph is normal and as you said it sounds to be normal, I will put it away and trust my results that firstly it is not due to HIV and secondly it is normal!Since i didnt have fever I suppose that is a plus too right?I mean at other threads of you i read that enlarged lymph nodes are commonly go with fever which i haven't!
3)Does deep oral makes any difference?I read that salive and air inactivates HIV and since we have salive and air at mouth and throat i suppose that it lower the risk!Moreover I read that the cells in which HIV attacks are not present at mouth or throat, or they are deeper at oral mucuosa!
4)The previous 4th gen I had was 2 months ago!I performed it at the same lab!But my last test (3week) ago had a higher index value!Is that something that would concern me?
5)In "%" percentage how much accurate is a 4th gen combo lab test could be?Since as you mentioned the average is 2 weeks and at 21 day p24 must be present at this period of time!
I suppose that I didn't forget something to ask!There are 20 questions in which every one of your answer is helping me a lot in order to stay calm until the 6week mark!I read many threads of your expertise and you are very kind and you are helping people to calm down their fears!This is remarkable!Anyway thank you very much and have a nice day Dr!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
1) I'm not familiar with those particular studies (will look them up), but your description suggests they are well done and the results reliable. And reassuring.
2) The main feature of lymph node inflammation in acute HIV is involvement of multiple nodes body wide. I've never heard of a single or two involved nodes being due to HIV.
3) Intensity or depth of exposure might make a difference, but no data are available.
4) The tests are highly standardized and automated. Therefore results usually are the same and equally reliable in any and all labs that perform them.
5) Sorry, I don't understand this question. In newly infected persons, he 4th gen tests are positive in bout 98% by 4 weeks and 100% at 6 weeks and longer.

That concludes this thread. Repeated questions on the same topic are discouraged, so please don't be tempted to start a new one, even when you have another test result to report. For the reasons we have discussed extensively, you can be confident the result will be negative, and you should not need our agreement that indeed the result is reliable. It will be. But I do hope this discussion has been helpful. Best wishes and stay safe.

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