[Question #2706] Worried about Oral HIV/STD

41 months ago
7w ago I visited a CSW, which included 10 secs of unprotected vaginal (I was the insertive partner, 34m), before finishing protected. There was also 2m of unprotected oral both ways.
I went to see my Dr 68h later, and was placed on 28d of PEP. I tested at baseline and 3d after PEP completion for HIV (ECLIA duo), and Chlamydia via urethral swab. Both HIV tests came up negative, but the Chlamydia test came up 'weakly positive'. I was placed on 1w of Doxy.
36h after completing the doxy, I visited yet another CSW, this time a tg woman. Everything protected, but I did end up performing unprotected felatio on her for about 60s. Afterwards, I started to get a bit of a sore throat, but thought nothing of it. The next day I was blood tested (6w post initial incident) for HIV and syphilis, both came up negative.
That night, my sore throat started to worsen, and I noticed a small blister at the back of my throat, as well as what appeared to be a tonsil (despite having my tonsils removed when I was young). The next day I visitied an ENT dr, he thought nothing of it, chalked it up to minor irritation, and provided me with an herbal spray for irritation.
1w since seeing the Dr, my throat has seemed to get worse. Blister is still there, and the 'tonsil'. Not sure if these were in my mouth before the oral incident, I'm worried that whatever they are, they may have increased my chances of HIV.
If these sores were actually in my mouth prior to the oral incident, how much higher are my odds of gaining HIV from this? 
What are the odds of an STD  creating sores that soon after an incident? 
Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
Welcome to our Forum.  From a distance it appears that you are in the habit of having sex, then regretting it, resulting in hyper-awareness and worry about having gotten infected from you recent exposure.  Oral sex is the lowest risk penetrative sexual contact a person can engage in.  IF a sex partner has HIV, there is NO proven risk of getting HIV from receiving oral sex (fellatio).  there has NEVER been a case of HIV proven to have been acquired in this way.  As far as the risk associated from PERFORMING oral sex on a person with HIV, the risk is so low that there are only sporadic cases in which this has been shown to occur and there are no large studies to precisely define risk.  The CDC, which tends to be conservative in its estimates suggests that fewer than 1 in 10,000 acts of fellatio on an infected sex partner will lead to HIV infection (i.e. like performing fellatio on a person with infection once a day for over 27 years).  In addition, it is statistically unlikely that your partner, despite being transgender had HIV- most transgender persons do not have HIV.

As for your most recent exposure, I would not be worried about the abnormalities you seem to have noticed.  There are no STIs, including HIV that would causes symptoms immediately after exposure or even in the 24 hours after exposure.  Thus the sore throat and "blister" you noted are certainly not due to HV from the sex act you describe.  Further you have been examined by a trained professional who felt there was noting to worry about.  I would suggest you take your ENT's advice. 

Finally, there are NO data to suggest that having a mouth sore, blister, tooth disease, gum disease or mouth ulcers increases risk for HIV among persons performing oral sex on infected persons. 

I hope my comments will be helpful.  In my opinion, you have nothing to worry about from the exposures you have described. I see no reason for further testing.  EWH
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