[Question #3009] Please assess risk after oral exposures.

40 months ago

Hello Doctors Handsfield and Hook,

First, thank you for offering your expertise through this service. I’m reaching out to ask for an assessment of my STI and, most specifically, HIV risk from some recent activities. On October 6th I met up with a girl from a dating app, and after a good discussion and several drinks retired to her apartment where we engaged in some activities, specifically her performing a blowjob on me, timing me quite aggressively, and me rimming her for about 10 seconds. About three weeks later, I went for a very intense run where I ran two miles in 13:30 (not bragging). Before I went to sleep I noticed that one of my lymph nodes near my groin had swelled up, which actually happened once before this summer after an intense run. The next morning I woke up with a fever of about 100.4 and a whole body ache which entirely dissipated by noon. I also had the one painful lymph node. My big concern with this girl is that she is a former heroin user (she said it’s been 4 years since she last used) and that she has has many sex partners this year. I went to City MD (I live in Brooklyn) and some with a doctor there, who told me that unless she was bleeding from the mouth I had no HIV risk from this incident. My other concern is that u have personal skin tags that occasionally bleed a tiny bit when wiping after using he bathroom, and that may have been the case before I met up with this girl.

However, I proceeded to start dating another girl, who I had protected sex with three times. One night, though, When i was very drunk, i performed cunnilingus on her for a duration I frankly can’t recall. My big worry here is that I have recently diagnosed gum disease, and I do not know the state of possible oral STIs I may have. I went to Catholic high school and did not receive any sec education, and until recently I didn’t even know you could get STIs in your mouth. More shockingly, perhaps, is that no clinic has ever offered me an oral test, and I’ve gone down in many women and some men in the Pat four years. About a week later, after hooping up with another girl who rimmed and went down on me, i woke up with what i believe was a hangover. I got very drunk two nights in a row because it was my friends bday, and after I hooked up with this girl I again woke up with whole body aches and a fever of about 100, which dissipated over the course of the day (by nighttime I’d say). I then, freaked out, contacted the girl u performed cunnilingus on. She was very understanding of my concerns, and told me that she had been tested earlier this year, was negative for everything, and had not had unprotected sex since with very few sex partners.

I normally wouldn’t be so freaked out, but I had kept seeing many references to HIV out in the world in the weeks leading up to the cunnilingus encounter. I try not to be a superstitious person,  but i would be lying if all these references I saw didn’t give me pause

So my questions are:

  1. What do you think my HIV and other STI risk was from these activities, given the histories of my partners and my oral and anal health?
  2. Do any of my symptoms sound indicative of ARS?
  3. Would a rapid test be accurate now regarding any of these instances?

Thank you.

40 months ago
Excuse my typos. The first girl rimmed me, not “timing me” as I typed.
Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
Welcome to our Forum and thank you for your confidence in our services.  The various exposures you describe are low to no risk, depending on which STIs we are talking about (including HIV) and the symptoms you report do not raise concerns regarding the possibility of HIV.  More on each of these topics below, as well as a final suggestion.

First the issue of risk.  Oral sex of any sort is a low risk event of any STI.  With respect to HIV, there has never been a case of HIV proven to have been acquired through kissing, receipt of oral sex or cunnilingus and while there are a small number of cases of HIV which have been acquired through performing fellatio (blow jobs) on HIV infected men, the estimated risk for infection, IF your partner is infected (statistically unlikely) is less than one infection per 10,000 exposures (i.e. like giving an HIV infected man oral sex daily for over 28 years).  These risks are far lower than risk for unprotected genital sex, or rectal intercourse.  There are no good data on risk for rimming but the general consensus is that the risk for HIV from rimming is likewise vanishingly low.  For other STIs, like gonorrhea and chlamydia, these infections are far more easily transmitted than HIV but again, oral sex is a less "efficient" mechanism for transmission than other sorts of sex acts.  There are no data to suggest that gum diseases or skin tags increase the risk for infection.

As far as your symptoms, these are not suggestive of HIV.  About half of persons who acquire HIV will get what is called the "acute retroviral syndrome" ARS which is characterized by severe muscle aches, fever, and sore throat, along with sometimes diarrhea or a faint, total body skin rash but these symptoms (which need to occur together to be the ARS) can also be caused by the sorts of viral illnesses that most people get from time to time. In fact, when studied, less than 1% of these flu-like symptoms are due to HIV when at risk persons were studied.  in your case, the muscle ache syndrome is well described in persons who have engaged in vigorous exercise, typically occurring up to a day or so after the exercise event. 

Finally, a word of advice.  You are clearly interested in your health and lead a normal, vigorous sex life.  As part of your routine, I would encourage you to have at least annual sexual health check ups at which time you are tested for gonorrhea and chlamydia at all sites of sexual exposure (giving or receiving) as well as blood tests for syphilis and HIV.  In all likelihood you will have a reassuring outcome, finding that you do not have infection but, since any of these infections can occur without symptoms, better to have routine check-ups (as well as of your blood pressure, lipids, etc.) than to be surprised.

I hope these comments are helpful.  EWH
40 months ago
Hello Doctor Hook,

Thank you very much for your reply, it has eased my mind quite a bit. I do have two follow-up questions, but first I think you'd like to hear that I received negative results for an oral gonorrhea and chlamydia test I had done last week. This was the first test I'd ever had done, after years and many dozens of oral sex acts performed by myself, and although anecdotal I think it lends credence to what both you and Doctor Handsfield say about the difficulty of catching STI's through oral contact.

Now, with regards to my follow-up questions:
1. I know you said my symptoms are not indicative of ARS, but what about the second instance of these symptoms? I had not been exercising in the days prior, and woke up once again with a fever (about 100.1 or 100.2) and whole body aches. No sore throat or anything else, but I don't believe it was caused by exercise. Does this change your mind at all? Also, is there any possible way that ARS symptoms could last for less than one day and then end, or is that simply not possible?

2. Could I take a rapid test at Planned Parenthood tomorrow and have my results be accurate? It has been about 8 weeks since the first exposure, and slightly over 4 weeks since the second.

Thank you again.
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Sorry for the delayed follow-up.  Answering your questions a bit belatedly:
1.  The ARS typically is characterized by high fevers (<102 degrees), sore throat and sever body aches.  Some patients describe it as the worst flu you could imagine.  Even when persons have flu-like symptoms however, less than 1% of persons with flu-like symptoms turn out to have HIV.  your symptoms were milder than would be typical for the ARS.

2.  If the test at PPH was a combined HIV antigen/antibody test, the results would be conclusive with respect to your first exposure and over 99% accurate for the 2nd.  The final 1% of positives turn up by 6 weeks after exposure.

I hope these comments are helpful to you.  Again, I apologize for the delay.  EWH