Long story short, I had oral sex with an escort. I was protected wearing a condom but I performed cunnilingus on her unprotected. My gums sometimes bleed after brushing my teeth but I am confident they were not bleeding during the encounter. The escort assured me she did not have HIV or any other STI's. I had a 4th generation duo test done 28 days after the encounter that came back negative. However in Canada the guidelines still say 3 months to be conclusive. My question is are my results conclusive? Was I at risk for HIV? Do you recommend further testing?

Welcome to the Forum.  The short answer to your question is that you are in the clear- your exposure was virtually no risk as there has never been a case of HIV shown to be transmitted through cunnilingus or receipt of oral sex (even unprotected) and the results of your 4th generation test validate this as these tests provide conclusive results at any time more than 4 weeks following an exposure. 

Many public health agencies and manufacturers continue to recommend the three month interval for HIV test results to be conclusive but these recommendations are out of date and overly conservative, reflecting the desire of such agencies to be "110%" correct and their sense that they cannot "afford" to ever be wrong in the current legal climate.  This outlook saddens me (and most other experts) as another consequence of this stance is that it prolongs the period of anxiety for persons who may have been exposed to HIV.

I see no need for further testing.  I hope this comment is helpful to you.  Take care.  EWH

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Thank you for the response Dr. Hook. I really appreciate you taking the time to answer my questions. The only symptom I have right now is extreme anxiety. And anxiety symptoms. I also have a slight sore in my mouth. But this sore started a day after exposure. Maybe even before and it doesn't seem to be healing. Should I be concerned about that? I have had no fever, no sore throat, no rash. Just this irritating mouth sore. And I have been told this is most likely due to extreme stress and anxiety. Would you agree on that?

Thanks for your follow-up.  Your symptoms are not suggestive of HIV in any way.  The mouth sore you describe is non-specific and occurred, if anything, too early for it to be due to HIV.

As I mentioned above, 4th generation tests provide definitive results at 4 weeks following exposure.  All patients who have not been taking medications for HIV would have either detectable antigen and/or antibody present at that time.  Believe your results.  There is no reason for further testing EWH

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Thanks again for your response Dr. Hook. I trust you as an expert in this field and am confident with my results. As my last question.

Sorry, I really do not have much experience with 5th generation HIV tests.  They are not currently available in the U.S.  My understanding however is that their only difference from 4th generation tests is that the 5th generation tests differentiate between antibodies to HIV-1 and HIV-2, a distinction of a rare occurrence (nearly all North American infections are HIV-1) and which is of little clinical import for those with infection.  I see no need or benefit for you to seek further testing of any sort, including with a 5th generation test.  EWH
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Hopefully you can answer one more question Dr. Hook. I am 6 weeks past my no risk exposure and like you said I believe my conclusive 4 week duo results that I am negative. However I have developed jaw pain on the left side. Nothing is swollen it is just very tender to the touch and very bothersome. Would you be concerned about that? Thank you. 

Our Forum guidelines permit a total of three interactions from us.  This is the firth and, therefore, the final response.  This thread will be closed a few hours after this response.

Jaw pain, unilateral or otherwise in not a sign of recently acquired or chronic HIV.  My advice on this would be to see your dentist.  EWH

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