[Question #4443] HIV risk -Oral

29 months ago
Hello Dr.
   Im a 27 year man from Texas and About 8 days(10/20/18) ago i had an encounter wih a lady ( met online)  in her low to mid 40's, i was half drunk, we made out ( kissed) 2 times - for more or less 10-15 seconds each time-. I Fingered her 2 times -for more or less10 seconds-. And Lastly, she performed oral sex on me for no more than 30 seconds 45 Max. However, i grabbed the head of my penis, and pulled it away from her, she only licked the shaft of my penis (bottom part) and sucked on one testicle. She did not have mouth/tounge/ saliva contact anywhere around the head. The next day worried i called to ask if she had any sexual infections or hiv and said no, only that she was on medication for parkinson's, something i was unaware of. (No wonder she sounded a bit drunk)  My questions are as follow.
1. Am I at risk for hiv??
2. I went to donate plasma 10/27, and they said that they will perform a NAT test on my blood ample for hiv, syphillis, hep a,b,c. Will this test show anything at 7 or 8 days IF infection took place?
3. Should i be worried and should i get tested? 

Please, your help is urgently needed. Im worried sick and full of guilt.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Welcome to the forum. Thanks for your confidence in our services.

Oral sex is safe sex in regard to HIV. There has never been a proved case of HIV acquired by oral to penile exposure. While such cases may occur very rarely, the US Centers for Disease Control and Prevention (CDC) has estimated that the risk, if the oral partner has HIV, at around 1 transmission for every 20,000 exposures. That's equivalent to receiving BJs by infected partners once a day for 55 years before transmission migth be likely. And it sounds like the head of your penis and your meatus (urethral opening) apprently never entered her mouth; oral contact with skin (of the penis or scrotum, or anyhere else) is completely free of risk. So is fingering. On top of all this,statistically it is unlikely a female partner like yours has HIV. So all things considered this definitely was a zero risk event in regard to HIV, and also extremely low risk for any other STD.

Those comments pretty well answer your three questions, but to be explicit:

1) No risk at all.

2,3) 7 days is too soon. HIV NAAT doesn't detect the virus until 10-12 days after infection. But you don't need testing anyway, so this really doesn't matter and I do not recommend any further testing.

If you'll use the forum's search function, use the pull down category menu to search questions about HIV Prevention and Safe Sex, and enter "oral sex" in the search field, you can find many questions about these same issues. Mostly you'll see comments pretty much like the ones above, but some of them go into greater detail about why the risk from oral sex is virtually zero.

I hope these comments are helpufl. Let me know if anything isn't clear (preferably after you have reviewed some other threads as well). 

29 months ago
Thank you for the reply Dr.
What do you mean by "On top of all this,statistically it is unlikely a female partner like yours has HIV." What makes you say this?
1. Can i resume sexual activity with my wife,  without concern?
2. Is hiv transdermal? After buttoning my pants back up, who knows if the head of my penis somehow came in contact with that saliva,  can it somehow "crawl" in my urethra?
3. In all your proffesional experience, and dr. Hook's, have you seen, heard or helped a patient who has hiv because of oral sex?
4. Online statistics say that this risk is ~0%-0.03% how true is this. 
5. I don't have health insurance yet, however some clinics offer the INSTI rapid blood tests. At what time are these results conclusive? If you were my primary physician, what would you recommend

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
In the US, even among the most sexually active women (e.g. sex workers), in most parts of the country under 1 in 1,000 have HIV. It can be higher in some communities and settings, but still usually under a 1% chance.

1) You can safely continue unprotected sex with your wife.

2) If by "transdermal" you are asking if HIV can be transmitted through intact skin, the answer is no -- as I said above.

3) To my knowledge, I have never seen a patient with HIV acquired by oral sex.

4) All such estimates are rough, not to be looked at as precise risk levels. In any case, 0.03% means 3 transmissions per 10,000 exposures, or about 1 in 3,300 events. That's equivalent to receiving BJs by infected partners once daily for nearly 10 years before transmission might be likely. That's higher than the CDC figure I cited above, but still awfully low risk, right? It still should be considered zero risk for all practical purposes.

5) As I said above, if I were your PCP, I would not recommend any testing at all. That said, anyone sexually active outside a committed monogamous relationship should be tested for HIV at least once. So presuming this applies to you and you haven't previously been tested for HIV, it would make sense to do it now, when it's on your mind. But not because of the exposure described above. The INSTI test is a third generation HIV test, which detects antibodies to HIV types 1 and 2. All such tests pick up nearly all (95% or more) new HIV infections by 4 weeks, but they require 6-8 weeks for 100% conclusive results.
29 months ago
1. You mentioned that it cannot be transmitted thru intact skin, does dry skin count as intact?
2. The following does not apply, but will recieving a BJ from a gay man put me at a higher risk than that of a woman of unknown status?
3. Does this act, put me at high risk of HSV2? And if low, what are the chances. Should i be worried?
4. And i read Online that You and Dr. Fascino (RIP) had different point of views in regards to testing. You say 4 to 6 weeks using a 4th gen test and he said 3 months. Why the differences? Which is correct?
5. Can i rely on your expertise, that the future tests -if any- will be negative? How certain are you?
6. I have been tested for hiv before, all were negative since july 2017 and Oct. 2017, there was no sexual encounter, there after. After all, i do not have sex with anyone else -besides this encounter which there was no penetration, and just what i mentioned- do not use drugs via IV, no sexual activity with men etc.
29 months ago
Last question, will an INSTI test at 2 weeks pretty much tell me where i stand?
29 months ago
 what are the odds that the results will be in my favor? (Negative)
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
1) Intact means no cuts, ulcers, etc. Whether wet or dry is irrelevant.
2) The frequency of HIV is far higher in men who have sex with men (MSM) than in heterosexual men or women. So this obviously would elevate the risk. But still with the low odds mentioned above.
3) Very few people have oral HSV2, so genital infection is almost never acquired by oral sex. There was slight risk of HSV1, the virus that causes most oral herpes. But even this is low risk, and absence of herpes symptoms over the next 2 weeks is further evidence you weren't infected.
4) Dr. Bob Frascino died several years ago, when tests with shorter window periods were still new and not widely used. I have no doubt that if he were still with us, his advice would be similar to ours. (When he was alive, Dr. Hook and I also advised 3 months as the normal window period, or maybe were just starting to change our advice.)
5) I am 100% certain.
6) With that testing history, you can ignore my advice above. You do not need testing on account of either the recent exposure or your past sexual exposures.

INSTI at 2 weeks would be pointless. INSTI detects around 50% of infections at 2 weeks.

The odds are 100% that any and all HIV test(s) you do now or at any time in the future will be negative, assuming you have no further possible exposures.

You aren't required to believe the science or accept my opinions and advice. But this isn't a debate, and I'm not going to discuss it further.  And anyway, threads are closed after two follow-up comments and replies, and we're there. I hope the discussion has been helpful. Best wishes and stay safe.