[Question #4326] Need Assurance - Oral Sex

82 months ago

Hi Doctors, I would like to know my risk and test results My Exposure - On 13th July (11 weeks as of today), I visited strip club. I received protected (5 mins) oral sex and while receiving it I do touched vagina (over panty- No directly) I haven't felt wet. But I do give the advantage to doubt, may be it was there. I do touched my penis at the end. I felt sensation (burning) when I was pulling my boxed, feeling same as usually when head touches cloth. I haven't ejaculated. Please do note, I haven't cleaned my pubic area, waited for another 30 minutes and went for lap dance (15 mins) but no sex (oral/anal/vaginal) but touched her vagina. I touched my penis after 15-20 minutes in washroom without cleaning. I clean my pubic area when I came home with plain water, later I masturbated. Sorry, I am too descriptive about my encounter but I don't want miss any scenario for risk assessment. I am from Toronto, if it makes any difference.

1. How much it is risky in practical not interested in theory?

2. I read on catie.ca (Canada) that seroconversion depends on how much virus has been contacted? is it true?

3. Does HIV 2 takes longer time? Should I wait for 12 or more weeks for testing to make it conclusive? I did a test(combo) on 9th week and 4 days (67 days) and its non-reactive.

4. For general purpose what is the difference between after 12th week, at 13th weeks or 90th day? I have already booked another test on 88th Day which is short of 2 days for 90 days.

5. I did tested for other STDs (excluding Herpes) all came negative. Done after 4th week. I believe these are conclusive. I don't have any symptoms of Herpes so I can exclude it from my worry. Correct?

6. I do had and have acne (not sure I can term it as rash) on back and under the arm. I can easily relate it to my anxiety as per my observation. I showed them to my GP and she says you are hairy and its normal if sweating occurs frequently. I had few days with extreme sweating again I will blame my anxiety.

H. Hunter Handsfield, MD

82 months ago

Welcome to the forum. Thanks for your question.

No STDs are transmitted by hand-genital contact, and certainly not by touching one's own genital area (even after contact with a partner's genital fluids). And n o STD can be transmitted through clothing. And oral sex should be considered safe sex, even unprotected -- with low risk for all STDs (much lower than vaginal or anal sex) and virtually zero risk for some, including HIV. And with a condom, there is truly no STD risk from oral sex.

To your questions:

1) I don't know the difference between risky in practice vs theory. These are the same. You were at no risk for any STD from the events you have described. Testing was unnecessary and not recommended after such events.

2) I'm not familiar with catie.ca. A quick look at the website home page, it looks like a reliable resource. However, there are no data showing that the "dose" of HIV (or any STD) has any effect on time to positive test results. Either the website is mistaken or you misunderstood what you read.

3) It does not take extra time for antibody to HIV2. However, the standard AgAb (combo, 4th generation) HIV tests only detect HIV2 antibody, not antigen, and that takes 3 months. But really this doesn't matter: you could not have caught HIV of either type; and also HIV2 is nearly absent in North America. HIV2 is too rare to worry about.

4) You apparently found older information about HIV test timing. It used to be recommended that testing was not valid until ~3 months after exposure. But that was for the earlier antibody tests that have not been in common use for the past 10-15 years. The AgAb tests are conclusive for HIV1 at 6 weeks; it is not necessary to wait 3 months. There is no measurable difference in test reliability between 12 weeks, 13 weeks, or 90 days. Your negative result at 88 days was conclusive.

5) Herpes testing takes 3-4 months for conclusive results. But there was no risk of herpes anyway. And nobody ever should be tested for HSV after exposures like yours. But yet, lack of symptoms also is reassuring in regard to herpes. As for other STDs, other blood tests (e.g. hepatitis B) requires 6 weeks. Urine testing for gonorrhea and chlamydia is conclusive any time more than 4-5 days after exposure. But you were not at risk for any of these anyway.

6) I can't tell whether you are worried your folliculitis or acne might have increased your risk of exposure, or that it could be a sign you caught HIV or another STD. The answer is no to both. I agree with your GP; this has nothing to do with the strip club events.

So do your best to stop worrying. There is no possibility you have any STD from the events described. If you have a regular partner, you can safely have unprotected sex without risk of transmitting anything.

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

HHH, MD

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82 months ago

Thanks, for your valuable inputs. It really helps me put by fears and worries down.

I read almost all your threads on this forum and another website and I understood my case is no risk situation, but I wanted to have my own scenario assessed.

Just to note my HIV test was on 67 days (9+ week) which came non-reactive and I booked another test at the 88th Day as per the Canadian/Ontario window period. As per Sexuality Health hospital, oral sex is low-risk activity and the window period for HIV test is 3 months. I do see that its 6 weeks in some countries but in Ontario its 3 months. Probably it's too conservative.

I do understand, there is no risk for any STD's in my case, however, I am taking extra precaution as I don't want to pass anything to my wife.

Thanks again for you all your work.

H. Hunter Handsfield, MD

82 months ago

Thanks for the thanks; I'm glad to have helped. It really isn't necessary to wait until 3 months, regardless of the conservative policies of your local testing agencies. But of course you are free to be tested whenever you wish!---

82 months ago

Hello Dr. Handsfield,

I didn't want to write here again however my anxiety dragged me here due to recent events. Here it started, when I went for HIV and Syphilis test (last syphilis was done at 4th week). Health nurse provided below information

1. HIV test at 6th week is 95% accurate and 99% at 12 weeks.

2. Syphilis is conclusive at 6th week

3. Even with condom insertive oral sex is a risk including HIV.

4. HIV2 is 18% of the total HIV infection in Toronto.

This drove me crazy and went into too much thinking and if else.. I was able to control myself..but I read the answer to question no 4376 (nothing wrong with the answer). Which had similar exposure like me and I got into again in too much thinking..

I had night sweating yesterday, half of the body was moist (only some areas), I can't say it sweating or something else .. however I do remember I was dreaming about chances and relating it to question 4376 and was convincing my self there is no chance.. maybe this triggered sweating. I had few times in last 3 months after strip club events. Also I experiencing red skin randomly, goes within hours or 1 day max. This also follows anxiety trigger.

and other things I never had acne issue on back and butt (may be once while but not really every day or months).. but it started after strip club event.. I scared because it was leaving black marks (hyperpigmentation) and as per mayoclinic (https://www.mayoclinic.org/diseases-conditions/folliculitis/symptoms-causes/syc-20361634) Eosinophilic leaves black mark (HIV/AIDs related).. Now I do see a change with acne.. its not leaving black marks that much..

I just wanted to confirm one more time (as really don't have that much trust in Canadian Health service in term diagnosing, it's my personal and friends experience )

1. My exposure is zero risk for HIV

2. I should not be worried about HEP A,B and C.

3. Should not be worried about molluscum contagiosum, HPV and Herpes.

4. HIV Combo at 67 days is conclusive and overrules all the above symptoms. How much are you confident 88 days test will be non-reactive?

5. Many people claim even with protection, they got infected. how much truth in this?

6. Can i conclusive say.... anxiety, and stress causing most of symptoms?

I do know I have to stay away from the internet , I have done it from last few days.

I am quite sure all this is mind playing game with me and anxiety and stress making all these symptoms. Sorry you might be feeling this person having too much anxiety. But I am even not touching my daughter in the fear.

Sorry for the long follow up question... I am hopeful that I will leave this encounter soon.

82 months ago

Forgot to add, I occasionally getting muscles pains and recently in right tonsil.

H. Hunter Handsfield, MD

82 months ago

"HIV test at 6th week is 95% accurate and 99% at 12 weeks." True for standalone antibody tests, and probably good estimates for HIV2. The usual first line AgAb (combo) tests are conclusive for HIV1 by 6 weeks.

"Syphilis is conclusive at 6th week" I agree

"Even with condom insertive oral sex is a risk including HIV." Wrong, zero risk. HIV is virtually zero risk for mouth to penile transmission even without a condom. Theoretical risk only, with few or no proved cases.

"HIV2 is 18% of the total HIV infection in Toronto." That would surprise me, but I'm not sufficiently familiar with HIV epidemiology in Canada to say anything more.

Your questions: I agree with 1-3. I agree with 4; there is no chance another test around 88 days would become positive. 5) The scientific data are clear, but some people are untruthful because they don't want to admit, or cannot admit (even to themselves) to certain behaviors, such as sex with other men. Others are unaware that a regular partner is at risk and infected, and attribute their own infections to the wrong exposures. Most people with HIV cannot know with certainty when and from whom they were infected. 6) I can't say conclusively that stress and anxiety are the cause. But certainly these are the usual explanation for such symptoms. And whenever someone suspects his or her own symptoms have a psychological origin, usually s/he is correct.

I disagree with your assessment of Canadian public health STD/HIV services. Nobody and no clinic is perfect, but in general it's a a professionally run and highly reliable organization.

That completes the two follow-up questions and replies included with each question and so ends this thread. I hope the discussion has been helpful.

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