[Question #3435] Cunnilingus, PEP, HIV

36 months ago
Hi Doctors,

Thank you very much for the assessment you provide on this forum. I am a male who cannot bring myself to accept the quoted nearly negligible risk of contracting HIV through oral sex. The below is a summary of my risk:

I hooked up with a female i had been friends with a little over four months. I did not know her status. During the encounter i performed deep cunnilingus for a period of 5 to 10 minutes. She was mostly "dry" and had pretty good hygiene, at least from what i could tell. I also made an error and inserted my penis unprotected for 5 to 10 seconds, before putting on a condom. Realizing that i had put myself at risk,  the following day i went to the ER and after a negative test (and my insistence) was prescribed PEP for 30 days. I missed two doses due to side effects.

My conncerns are:
-The protracted cunnilingus (and momentary insertion) put me at risk
-That the missed doses caused the treatment to fail. 
-Somehow i did not return for follow up testing

I guess what's done is done, so i am just seeking a professional assessment of my risk. I do plan to take an HIV test soon, but all others have been negative.

Please advise.

Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Welcome to our Forum.  I'll be glad to comment.  We have many visitors to this site who have a difficult time moving forward following sexual missteps.  From the sound of things you have probably over-reacted.  Please find my assessment of your risk  related to this low risk event below.

1.  You do not mention where you are but the rate of HIV in even the very highest risk parts of the world remains relativel low.  In addition, risk of unprotected sexual activity is always less than 1% even if your partner is HIV infected and for most sexual acts is even lower. IF your partner had HIV (unlikely) the risk from even a brief unprotected vaginal sexual exposure is more than 10 times lower than the estimated risk for cunnilingus ( estimated risk for HIV acquisition from unprotected vaginal sex following sex with an infected partner is less than 1 infection per 1000 exposures while the estimate following cunnilingus is less than 1 in 10,000).
2.  The PEP you took is highly effective and two missed doses in unlikely to markedly reduce its effectiveness.

At this time, you need to get your follow-up test.  I am confident it will be negative and when it is, you need to put your fears behind you and move forward without concern.

Should you have similar concerns in the future, I suggest the following:
1.  Ask your partners if they have been checked in the past.
2.  Whether or not they mention prior testing, encouraging them to go for testing (optimally with you at the same time so you can each be confident in each other's status.  If your partner is HIV negative on the day following a sexual encounter, the chance that you were infected is negligible.
3.  Do not search for information about risks or symptoms on the internet.  Much of the information there is incorrect, taken out of context, or just plain wrong. 

I hope these comments are helpful.  EWH
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36 months ago
Thank you for your comments. I suppose that i shouldn't be surprised that they almost to a word echo those of the attending physician at the ER who said that i was being irrational before he hesitantly offered me PEP. 

But as anyone might imagine, for someone with what i consider to be a serious anxiety issues, i find that while the words are reassuring, i know that only the test will ease my fears 100 percent.

I hope all will be well.

Thanks.

Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Had you asked me for PEP, I would have declined to do so as I believe that the potential harms of PEP are greater than the benefits for the sorts exposure you report.  Your experience of side effects which kept you from taking your PEP for two days is a mild example.  I would have encouraged you to get your friend and go get tested together as described above.

That said, this is all behind you, you have finished your PEP and it is time for you to get your final tests so you can move forward without concern (I am confident your f/u tests will be negative0  Should the situation occur again, you may chose a different course of action.  I am not chastising you, just trying to help and set the stage for any future occurrences.  EWH
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