[Question #3447] Negative Results at 11 weeks (77 days)

35 months ago
Date of Incident: December 29th 2017
Sexual Act: 5 seconds of Receptive Oral Sex (I inserted bare penis into her mouth and received BJ for 5 seconds)
Partner Description: Massage parlor Asian woman in mid 50's

Two days after the incident I've had red rash all over my upper chest and back. I was diagnosed with contact dermatitis. I received steroid injection for it on January 2nd. It was exactly methylPREDNISolone Acetate. The doctor also wrote down additional steroid to swallow via mouth but I never took it. I thought the rash would go away with single steroid shot and it did go away. In between, I kept on getting same type rash on and off on my arms and back. I had the dermatologist look at it and he told me it's allergic contact dermatitis and gave me some over the counter cream for it. As of this writing, I do have red rash on my arms and back. 

Not to mention, I also had flu type symptoms (cough, fever, chills etc...) 7 days after the BJ and it went away within few days. 

Exactly 77 days or 11 weeks post the incident, I took at home OraQuick Oral Swap HIV test today. I googled it before taking the test and this one is 3rd generation rapid antibody test. The results are NEGATIVE. However, it concerns me that it hasn't been exact 12 weeks or 3  months yet. I'm married and my wife is coming home tomorrow from extended oversees trip. In our daily communication, she emphasis on having sex upon her arrival because she wants to get pregnant. Everyone in our circle is starting family and she is getting anxious now to start our own family. That is why I had to take the test at 77 days instead of waiting for full 12 weeks mark.

Regardless, I do have following questions for you:

1) Considering the brevity of the exposure and the low risk nature, would you put 11 weeks negative result of OraQuick Oral Swap as a conclusive results in your opinion?
2) Am I risk of any other STDs?
35 months ago
3) Would steroid shot taken on January 2nd alter my results today?
4) I've received unprotected BJs from 10 other women before I got married. I never saw any STD symptoms and never bothered testing for STDs outside of HIV. Now that  baby talks are in full swing, what are the chances that I might have became infertile from previous BJs that I've received before the marriage?
5) Last question, do you recommend another HIV test exactly at 3 moths mark?

I'm sorry to bombard you with series of questions and lengthy post. It's just that I'm in the stage of my life where it's very important for me to learn about everything before we plan for baby. All that past adventurous of my life is coming back to haunt me with me being infertile nightmare.

Thank You!!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome to the forum. Thank you for your confidence in our services.

All is well; you needn't worry at all about HIV. Some general comments before answering your specific questions:  First, oral sex is safe sex in regard to HIV. Your oral sex was insertive, not receptive (the oral partner is the receptive one, penile is insertive. Admittedly confusing, because we also say "received a blow job", as you did). Anyway, there has never been a scientifically documented case of HIV transmission mouth to penis. Furhter, an estimate from CDC estimates a risk of 1 in 20,000 if the oral partner has HIV. That's equivalent to having BJs by infected oral partners once daily fro 55 years before transmission might be likely. Further, the chance any particular female sex worker has HIV is very low, probably under 1 chance in thousands. (Her ethnicity makes no difference, or if anything being Asian probably reduced the chance.) So really no risk at all for HIV. In general, HIV testing is not recommended after this sort of exposure.

Second, 3 months is old news for HIV testing. It still applies to the oral fluids test, but not the third generation antibody tests, which are conclusive any time after 6-8 weeks. (Many agencies and web sites have not updated their advice in light of current test performance.)

Third, ARS symptoms cannot start sooner than 7-8 days after exposure, and usually it's 10+ days. Your rash had nothing to do with the sexaul exposure 2 days prviously.

To your questoins:

1,5) The oral swab test is not quite conclusive at 77 days, but the third generation antibody test is. But given the low chance your partner had HIV plus the nearly zero chance of transmission if she did, with these test results the odds you actuallly have HIV is under one in many billion. You don't need another HIV test.

2) Oral sex is also safe for other STDs -- zero risk for some and low risk for all. Asence of abnormal urethral discharge, painful urination, and penile sores within a couple weeks is additional evidence against any STD from that event. But if you want 100% assurance, you should have a urine test for gonorrhea and a blood test for syphilis. You can expect both to be negative. (Chlamydia usually is automatically checked along with gonorrhea, but is one of those STD rarely if ever acquired by oral sex.)

3) No medications alter the reliability of HIV testing. That includes the steroid shot you received.

4) It's pretty much impossible for males to have STD related infertility without having serious symptoms. No worries about your fertility on account of your past sexual experiences. 

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

35 months ago
Dr. HHH -- Good to know!! Actually, I've been long time follower of you since Medhelp days almost a decade ago. I would get 3rd generation antibody or the 4th generation test right away. But, I'm having hard time sitting in lab and front desk staff looking at me like I made a mistake. That's why I decided to opt in for Oral Swab at home test where I wouldn't have to deal with public. Looking at your current response and the thousands of others that you've answered thus far, I'm fairly confident I can put this episode behind me and move on with my life. 

Indeed your answers were helpful as always. You can close the thread. I wouldn't bug you with what if anxiety driven follow up questions.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Thanks for the kind words. Indeed you can confidently put this episode behind you and move on. However, not all follow-up questions are anxiety driven -- and even those are not necessarily in appropriate. I'll leave the thread open a few days in case anything else comes to mind.