[Question #3324] Oral sex HIV risk?

38 months ago
Hello,

About 5+ weeks ago, I performed brief unprotected oral sex on a man who is an acquaintance of mine, but whose HIV status I do not know. (There was no ejaculation).  I immediately regretted my carlessness and shortly thereafter decided to go get tested for any STIs.  All results came back clean, but I am still very concerned about any HIV risk.   I have read that oral sex is considered to be ‘low risk’, while other sources claim it is no risk at all.  What is the truth regarding this?

Since this occurrence, I have tested negative a total of 4 times.  The first test was an antibody blood test, the second and third were both rapid hiv swab tests (all taken within the first few weeks afterward) and the most recent one was the combination antigen/antibody blood test.   The combo test was taken 32 days past possible exposure, and as I stated, came back negative. I have read that combo tests taken after 1 month are essentially conclusive, but again, it all depends on where you are reading the info.  Regardless, I do plan to re-test 3 months after the incident.

My ridiculous paranoia has completely overtaken my life.  It is AWFUL.  It’s like everyday, I feel as if I am noticing or feeling a new symptom.  All I want to do is to be able to put this experience behind me and move forward.  Do you feel that I should be as concerned as I am, or should I trust the results I’ve gotten thus far and stop worrying?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum.

You really needn't worry. As you have already learned, oral sex is safe sex in regard to HIV. It has never been proved to be transmitted mouth to penis or by cunnlingus (oral-vaginal contact), and the risk for transmission from penis to oral, i.e. your exposure, has been estimated at 1 chance in 10,000. And that's only if the male partner is known to have HIV. That's equivalent to giving BJs to infected men once daiily for 27 years before transmission might be likely. And you have no particular reason to suspect your partner has HIV:  if he is not at typical risk for HIV (gay, injection drug user, etc), then almost certainly he does not.

I'm not sure I understand the details of your testing -- there is no "swab test" for HIV, unless you mean the oral fluids test. But the important test you had is the combo test at 32 days. That result is nearly 100% conclusive.

So here's a calculation that may help you. Let's assume there's a 1% chance your partner had HIV (which probably is too high an estimate). If so, then the 1 in 10,000 risk becomes 1 in a million (0.01 x 0.0001 = 0.000001). Your 32 day combo test is around 99% reliable, i.e. 1% chance it missed a new infection. Now the odds you have HIV calculate to 1 chance in a hundred million. I hope you'll agree that's zero for all practical purposes! (And contemplate a bit on just how low that is. It means that if all 300 million adults in the US performed oral sex today on HIV infected men, only 3 of them would catch it.)

So in all honesty, I would not have seen a need for you to be tested at all, and you can definitely consider yourself home free. But if you would like the additional reassurance of a 100% conclusive result, test once more at 6 weeks. You do not have to wait 3 months:  that's outdated advice from the pre-combo test days.

In the meantime, I suggest you cease any and all further internet searching about all this. Like many anxious persons, you're being drawn to information that inflames your anxiety -- which is still further increased by the inconsistency of information. It isn't worth the stress.

So kick back, pour yourself a glass of fine wine, and stop worrying. There is no chance you have HIV.

I hope these comments have helped. Let me know if anything isn't clear.

HHH, MD
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38 months ago
Doctor,

Yes, thank you so much for your words.  It’s very helpful to have someone put things into perspective the way that you did. 

When I said “swab test” I guess what I meant was the test using oral fluid, like you said.  Oraquick was the name of it I believe & to the best of my knowledge, that looks only for antibodies.  

If I were to decide to confirm my results at 6 weeks, would I be able to use another Oraquick test to do that, or would it need to be a second combo test?  I only ask because I appreciate the convenience of the Oraquick (buy at drugstore, results in 20 min).  If that wouldn’t be sufficient, I would need to ask my family doctor to write for another blood test - as he initially did not send me for the combo test, only the antibody one.  I specifically had to ask for the antigen/antibody test. 

Again, thank you so very much for your input!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Thanks for clarifying. The Oraquick oral fluids test is the least reliable of all tests, especially when concerned about a particular recent exposure. It's one of the few that requires 3 months to reach maximum reliability, and even then it misses a small proportion of infections. It's just not as good as any of the available blood tests. Since your risk is so low already, a negative result with that test, at either 6 weeks or 3 months, would further confirm that there is almost no chance you caught HIV. But given your concerns, "almost" may not cut it. For conclusive results, ask your doctor for another Ag/Ab test at 6+ weeks.

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38 months ago
Hello,

I understand that this is my last question. 

My anxiety in regard to this situation, although I realize is probably borderline ridiculous at this point, is still getting the best of me a little bit. 

Yesterday, one day shy of 6 weeks (41 days), I had another combo test done.  I’ve gotten the results back already, and it was negative.  I understand that this is ‘technically’ before the 6 week mark.  Do you still believe it is fairly safe to consider this result conclusive?

I’m really sorry if I sound silly.  Just looking to be done with this.  Thank you again. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
There is no statistically significant difference between 41 and 42 days. This result is conclusive. You can stop worrying! I hope the discussion has been helpful.

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