[Question #4072] Am I risky for HIV?

33 months ago

Dear doctor,Im a young man from China with great anxiety about HIV these days.

I went to a massage parlor on July 1st.The masseuse is a CSW who only offers oral sex and handjob without kissing or vaginal sex.During the massage were both naked.She kissed all over my body, rubbed her breast and butt against my back and chest with oil,and performed anilingus on me(not deep).Finally,I received oral sex(fellatio)without protection and ejaculated in her mouth(no vaginal sex in whole process).There is no overt blood.But Im not sure if there is some blood from her gums.I felt anxious and asked a doctor and took PEP(Truvada and isentress) at 22 hours after the exposure.Another said I neednt to take PEP. I decided to take the PEP for the assigned 28 days.On July 24th, I made another mistake to receive a handjob from the same masseuse.There is no overt blood during the handjob.On July 30th, 30 days after first exposure and 2 days after the end of PEP,I got a 4th Generation DUO P24 test and is it negative.

Q:1Is there any risk for HIV in both exposures?Some says both have no risk, some says risk of receipt of oral sex is pretty low without a confirmed case.In the second exposure,if there is some fresh blood in her hands from her cut, am I risky?(It is not likely to happen but I just want to confirm)

2 Do I need to get further test like 3-month or 6-month according to guidelines of PEP?I took isentress 2 hours late twice. Does it matter?Im really anxious of waiting for get tested.



Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
Welcome to our Forum. I'll be glad to comment.  Before I get to the specifics of your question, please let me point out that most CSWs do not have HIV and the fact that your masseuse only kisses and provides oral sex makes it still more unlikely that she has HIV.  In addition, HIV is not spread by kissing. Further there is no evidence that the sort of rubbing, receipt of oral sex or analingus has led to HIV either.  I agree with the doctors who advised you that there was no need for PEP and would not have prescribed it if you had asked me for it.

In answer to your two questions:
1.  The activities that you describe were no risk activities in terms of risk for HIV.  this would be the case even if she had a fresh cut on her hand for the second event.

2.  Although in theory 4th generation HIV tests are not definitive until 6 weeks (42 days) after an exposure, in your case, I see no need for further testing as your exposures were no risk events. 

I hope these comments are helpful to you.  EWH


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33 months ago
Thanks a lot doctor. Your words really ease me a lot. I've been trapped in guilty, potential risks for HIV for a long time. Sometimes I keep recalling the past exposures and thinking about details, coming up with 'what if ' questions. I know it is unfounded and ridiculous. Maybe kind like Obsessive compulsive disorder. From your words, I don't need any test and could move back to my normal life, right? Do you think mental medhelp is helpful if I'm still suffer from anxiety? 
33 months ago
And do you have any suggestions on AIDS phobia? Like not searching the Internet? I'll do my best to get over the anxiety. THX.
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
I'm glad you found my comments helpful.  I think part of the basis of your fears are a mis-perception regarding how easily HIV is spread. It is not all that infectious.  Please remember with unprotected genital-genial penetrative sex with an infected person, infection is transmitted only once in every 1000-2000 sex acts.  When you combine this with the fact that only a minority of even the highest risk persons have the infection, you should not be so worried.  I do however strongly suggest thtat you stay off the internet.  Much of what is there is out of date, taken out of context, or just plain wrong.

No further testing is needed (there was no need for testing to start with).  Please do not worry.  EWH
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33 months ago
Thanks sir. I know I don't need testing anymore. 
Last question: According to website of CDC, oral sex has a risk though very low, is it because of conservative estimates or to exclude extreme conditions like overt bleeding?  In reality, receipt of oral sex even a little blood from gums is no risk, right? 
 Sorry to bother you.
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago
As mentioned above, to my knowledge there are no proven cases in which HIV has been proven to have been acquired through receipt of oral sex (or through performance of cunnilingus or analingus).  I presume the CDC guidance is made as a generalization out of an abundance of caution. 

As you know this is my 3rd reply to your questions.  As per Forum Guidelines this thread will be closed later today.  EWH
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