[Question #4046] Risk during Protected Oral Sex

84 months ago

Hi, back again, hoping you can help me with this recent exposure and questions.

I recently was abroad (middle east) and ended up paying to visit a csw (she was african).

She gave me Protected Oral sex (she took a new condom out of a packet and placed it over my penis with her hands first, rolling it all the way down) and then proceeded to give oral for a few minutes. I 'think' at all times her lips/tongue stayed on the covered part of my penis. After a few minutes she stopped and used her hand to finish me off into the condom. After this, she removed the condom with a wipe/tissue and threw away.

My questions:

1) Does the above warrant testing for HIV?

2) Some sites state that HIV through oral sex is possible even though a very low risk, do you agree with this? Is this the same for being the insertive partner in oral sex and using a condom? I guess 1/20000 means there is still a chance...?

3) What about other STDs, Chlamydia/Gonn/Syphilis? How protected am i from these with a condom?

4) What would you advise i do now in regards to testing, sleeping with my partner?

5) Is the anxiety/guilt making me wonder if the condom actually protects me from HIV/STDs?

Thanks,

Edward W. Hook M.D.

84 months ago

Welcome back to our Forum. The encounter you describe was a no risk event. Most people, even most CSWs do not have STIs and when they do, most exposures to infected persons do not lead to infection In your case, your partner sounds to have used the condom perfectly and condoms remain the single best and most effective means of preventing STI acquisition if your partner happened to be infected. I would classify this encounter as NO RISK.

In answer to your specific questions:

1) Does the above warrant testing for HIV?

No. No one has EVER acquired HIV from receipt of oral sex. Even unprotected oral sex.

See above. That estimate (which I think is too high) is if the person performing oral sex on you had HIV and most people do not have HIV. While I suppose you can argue that there is a theoretical chance of infection, there is also a similar theoretical chance you will be stuck by a meteorite falling form the sky while reading this- I would say the two are about equally unlikely.

3) What about other STDs, Chlamydia/Gonn/Syphilis? How protected am i from these with a condom?

Same answer. See above.

4) What would you advise i do now in regards to testing, sleeping with my partner?

I see no medical need for testing of any sort.

5) Is the anxiety/guilt making me wonder if the condom actually protects me from HIV/STDs?

They do

I hope these replies are helpful. EWH

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84 months ago

In regards to question 2. Is the 1/20000 for unprotected oral? Am I right in thinking with a condom used properly this would be less?

Is there any concern with saliva (possibly with small particles of blood) penetrating the condom etc?

Why do you think that websites state there is still a chance to get an std using a condom if they are 100% safe?

Edward W. Hook M.D.

84 months ago

Is the 1/20000 for unprotected oral?

Yes, I said this and that the estimate was, in my opinion too high as no one has EVER been proven to acquire HIV from receipt of oral sex.

Am I right in thinking with a condom used properly this would be less?

Correct again.

No concern about saliva. What was not clear when I said " I would classify this encounter as NO RISK" above. Repeating the question will not change the result.

I will not comment on other web sites. EWH

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83 months ago

Hi - I ended up testing with an instant Alere Combo (Ag & Ab) test at 27 days. The result was negative. It is an instant duo (ag/ab) test with the result available after 20 mins.

My understanding is this test is accurate but not as accurate as the lab duo test. I also understand that it takes 45 days for the window period.

Considering the very low risk and the fact I did this test at 4 weeks rather than 6/7 weeks. Do I need to test again?

How accurate are these rapid/instant duo/combo tests at 4 weeks?

H. Hunter Handsfield, MD

83 months ago

Dr. Hook is away for a while, so I am responding. The rapid AgAb tests, like Alere Combo, are considered just as accurate as lab based tests. As Dr. Hook said above, I agree this was a zero risk exposure for HIV, for all practical purposes. No additional testing is recommended or needed.

That completes two follow-up comments and replies and so concludes this thread. I hope the discussion has been helpful.

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