[Question #2890] Need to learn from past mistakes

94 months ago

Hello Dr's,I went through quite an extensive scare last year which put me in a spiral of concern and over testing out to 7.5 months. I was assured and re-assured several times by you both that my tests were conclusive. I then finally after asking a question a few weeks back told myself that it would be the end of my concerns.

I let that past concern go after having so many 4th gen HIV and 1 antibody test at 224 days.

Seems like i didn't learn my lesson: COMPLETELY NEW ISSUE

Last week while visiting Arizona with some friends we got pretty intoxicated and some girls came over. I am not certain on where one of our friends got them from but they were young 19-20 year olds.Essentially one of the nights i cannot remember anything in regards to any sexual contact as i suffered a concussion and just woke up the next morning.

However i do know i was in the room with her. Lets assume the actions were fellatio and cunninglingus unprotected. I only say that because i am fully aware i would not be able to perform any intercourse due to my intoxication.

The second night again would have been 2-3 seconds of cunninglingus and maybe a total of 5-6 seconds of fellatio (unable to be erect though)Just a comment before a few questions: My anxiety from the last year scare has just slipped right into this one.

Now knowing so much of ARS, etc all i do is obsess with bodily sensations, and for some reason am inevetiably fearing that ARS is coming. I realize i should not be doing this but it is a worry i just can't control.

1. How risky is unprotected cunninglingus and fellatio?

2. Is there a stat that describes the possibility either way. I have seen 1:10000 and some sites have stated 1:20000

3. Do you from a medical standpoint even suggest HIV testing after cunninglingus or fellatio unprotected?

You can see my mindset in terms of other STI's. I feel like HIV has become a lop sided concern where i do not think about any other more highly passable STI's from events such as the ones i've described above.

Today is the 8^th day and I haven’t had any symptoms of any sort aside from headaches from my concussion.

Hope to hear your guidance

94 months ago

Also, forgot to mention, should i get tested for other STI's even though no symptoms up until now.

H. Hunter Handsfield, MD

93 months ago

Welcome back, but sorry you found it necessary. Directly to your questions:

1) "Lets assume the actions were fellatio and cunninglingus unprotected" and "how risky is unprotected cunnilingus and fellatio?" OK, this makes this very easy. There has never been a proved case of HIV transmission by fellatio (mouth to penis) or by cunnilingus (in either direction).

2) The statistics you quote come from CDC and are based on how some people think they may have been infected, not proved transmission. 1 in 10,000 is the estimated risk for the oral partner in fellatio, if the penile partner is infected, 1 in 20,000, which applies in your case was the estimated risk for oral to penile transmission. Note that these figures are equivalent to giving or receiving BJs (on partners known to have HIV) once a day for 27 years or 55 years. On top of that, the odds are strong your partner doesn't have HIV -- on average for single, sexually active women in the US, the odds are no more than 1 in a thousand. In other words, your risk is at least a thousand times lower than 1 in 20,000. That comes to somehwere around 1 chance in 20 million. That means zero for all practical purposes. (There are no such data for cunnlingus, but it is believed to be even less risky than fellatio.)

3) No, I do not recommend HIV testing on account of such exposures.

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

HHH, MD

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93 months ago

Dr, thank you for the information, some further questions if you do not mind.

1. The second night i was referring to in my previous post is completely remembered. Meaning there is no assumption of the events. Essentially was a total of maybe tops 7-8 second unprotected fellatio to me and maybe 4-5 seconds of cunninglingus. My concern is derived from the fact that as i started the cunninglingus i stopped but later on she mentioned that she wouldn't want that as she was on her period. Does this change things at all?

2. You mentioned no need to test on account of Fellatio as receiver and performing cunninglingus on a female. Are there any situations aside from an individuals anxiety that you actually suggest a person be tested?

3. Would you suggest i test for anything else, today is 11 days past and haven't really had any noticeable symptoms aside from my acid reflux coming back similar to the last exposure last year. Including my soft pallete is rough and that area feels tight. (Do these suggest anything to you, this started to feel like that about 4-5 days after)

4. Can you explain the RNA hiv test to me? Some sites especially businesses such as stdexpress.com and others claim that this is above 99% accurate after 9-11 days. Would you agree with this?

5. I presume since you do not even suggest testing in my case, that an RNA test would be pointless?

6. What would a 4th gen test accuracy be after 2 weeks?

7. In your honest opinion if you were in my situation would you be worried/and or test?

I am simply nervous as hell and truly cannot believe i am sitting here worrying again after honestly wasting the last year of my life in fear. To me it is truly pathetic that i'm back to worrying again and even put myself in that situation.

I appreciate your help in this.

H. Hunter Handsfield, MD

93 months ago

1) No, this information doesn't change anything.

2) The only reason I would recommend HIV testing following this kind of exposure would be for help in dealing with anxiety.

3) These symptoms don't concern me in regard to HIV. I suppose the palate area feeling "tight" could be due to an STD like gonorrhea, but it's much more typical of a physical manifestation of anxiety.

4,5) The HIV RNA test detects the virus's DNA in the blood. 99% is too high -- probably closer to 90-95% reliable at 9-11 days. And yes, I would consider it pointless.

6) About 60-70%.

7) No, if somehow I were in your situation, I would not be worried and would not have an HIV test.

Your closing comments are an existential cry for help. Just hearing my reassurance and the scientific facts almost certainly are not going to resolve your frankly irrational anxiety. You should consider professional counseling, which I suggest from compassion, not criticism.

Dr. Hook closed your thread a few months ago with "Please understand that additional repetitive questions can be deleted with no response." To expand on that, the forum does not permit repeated questions on the same topic or exposure, especially when the questions are obviously driven by anxiety or when there is apparent difficulty in believing or accepting advice already given. This will have to be your last one; future questions from you of this nature will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce the temptation to keep paying for questions with obvious answers; because experience shows that continued answers tend to prolong users’ anxieties, when professional counseling often would be a better approach; and because repeat or anxiety driven questions have little educational value for other users, one of the forum’s main purposes. Thank you for your understanding.

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93 months ago

Thank you Dr for your input, i will do my best to take your advice and work to move past my fears around this.

You mentioned, it could be gonorrhea, if it were would you suggest a mouth swab test now? Also would that feeling be something that comes and goes. Meaning it is better in the mornings and then after waking or eating it starts to decline. Aside from the tightness thats the only real oral symptom i have aside from some irritation in the back of the mouth which i am self diagnosing.

Again thanks and i will not be posting about this topic again as i feel i am way way over informed now.

H. Hunter Handsfield, MD

93 months ago

The large majority (over 95%) of oral gonorrhea causes no symptoms. I was speculating at a theoretical level about your palate discomfort; and no, gonorhrea symptoms would not come and go. This continues to sound mostly like anxiety and I think the chance you have gonorrhea or any other STD is too low to go to the trouble of examination and testing. But of course you are free to do that if the negative results would be more reassuring than my words.

I agree you're probably "way over informed" on all these issues!

That concludes this thread. Best wishes and stay safe.

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