[Question #4490] Transexual Encounter

29 months ago
Hello Drs, I browsed some questions and am a bit unclear on whether my risk was zero or just low. I am bisexual and was with a transexual and she gave me oral sex and i didnt have a condom on. It lasted about a min and i didnt ejaculate. I also rimmed her for about a min but not deep. I am concerned as i need to get tested for insurance. I dont have anal intercourse with men due to high level of risks.

1. Since i received oral sex is my hiv risk really zero or low. I saw some posts mention no risk while others mention low?

2. How risky was the rimming i performed, she had douched before i did it?

3. I am in Toronto Canada - is a 4th generation test used here and if so what % of infections would it catch at 3 weeks?

4. Also how accurate is a 3rd generation insti rapid blood prick test at 3 weeks?

5. Should i be concerned or worrying needlessly and is it ok to have unprotected sex with my gf if this was the only exposure i had?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Welcome back to the forum. Thanks for your continued confidence in our services.

Congratulations for limiting your sexual activities with anatomic males (including transsexual women who have not yet had gender reassignment surgery) to safe sex, i.e. avoiding anal sex. That's the important factor here, and as long as you pursue that approach, your risk for HIV will be very low, perhaps zero. However, in addition I would strongly suggest you always ask about HIV status, and perhaps avoid contact entirely -- or pay even greater attention to safe practices -- for those who are positive and not on treatment; who haven't been tested recently and don't know; or who seem evasive about it.

To your questions.

1) Zero risk vs low risk for oral sex is a matter of opinion and logic. I am unaware of even a single report of scientifically validated HIV transmission by fellatio, mouth to penis. Occasional infections do occur in the other direction, i.e. penis to mouth. That implies zero risk. OTOH, a very few persons with HIV have reported they believe that's how they were infected. An estimate by CDC is that if the oral partner is infected, the chance of transmission from a single such exposure is 1 in 20,000. That's equivalent to receiving BJs by infected persons once daily for 55 years before trahsmission might be likely. So for sure it's extremely rare (i.e. extremely low risk) and perhaps truly zero.

2) There has been little research on HIV/STD transmission or risks by rimming. However, it is not known to transmit HIV in either direction; and risks for all STDs are generally believed to be very low. The main risk is for gastrointestinal infections such as norovirus, salmonella, probably certain parasitic infections (e.g. amebiasis), and also hepatitis A.

3,4) My understanding is that AgAb (duo, 4th generation) HIV tests are the main tests used in Canada, but I doubt there are any regulations about it and some clinics, doctors, or laboratories may use standalone antibody tests. You should check with the clinic or lab doing the test. At three weeks, the AgAb tests detect 90-95% of infections, third generation antibody tests probably about 75-80%.

5) Almost certainly you can safely have sex with your regular partner and that's what I would do if somehow I were in your situation. But I cannot give a 100% guarantee about it. A middle ground, if you are abnle to contact your trans partner, would be to ask her to be tested now. (But do it diplomatically and offer to be tested yourself. Why should she trust you to know you're not already infected any more than you trust her?) If she tests negative at this time, you would know for sure she wasn't infected at the time.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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29 months ago
I was able to ask the person but got an answer which was concerning. The person didnt want to answer my question regarding hiv status and at first acted she didnt know what hiv was and after a bit of explaining just said she was clean. I wanted to find out the risks she was taking and asked if she would have unprotected intercourse with me and said sure since she was "clean".  All this now has me a bit concerned even though it seems i have not done anything to put me at risk. I am actually a bit shocked at the risks people are willing to take and ok with it. 

Based on what you have advised i have nothing to worry about but i am now regretting asking her.  Should I just forget this encounter. Just looking for some advice to get my mind of this convo.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
I agree that a hesitant or evasive response raises concern about her infection status. Still, you had an entirely safe exposure, as discussed above. But sorry I don't have more to offer, or advice about dealing with the situation. We can provide scientific facts, probabilities, statistics, and our professional opinions. Integrating that information into acceptance, understanding, and reduced anxiety is your job. Professional counseling may help.---
29 months ago
Dr Hansfield, I very much appreciate the responses. Your last response did help alleviate some of my fears but I believe for my complete peace of mind seeing the test result will be the only thing to put an end to these lingering thoughts. Just want to test as early as possible so had a few questions.

1. What are your thoughts on an HIV early RNA test? Is it true that it is conclusive between 11 and 12 days as that is what stdcheck.com advertises?

2. I recall reading about false positives with the RNA test, is this true and how often and why does this occur?

3.  When is a gonohrea, chlamydia test conclusive?

4. When is a Syphilis test conclusive?

I guess this will be your 3rd reply so thanks again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
1) RNA testing at 11-12 days will detect 80-90% of new infections; probably 95% if you wait until 14 days. But never 100% conclusive; you would also need an antibody test at 4+ weeks for conclusive resutls. Since your exposure was such low risk, I really don't recommend such testing.

2) False pos results were a problem in past years, but to my knowledge not with current testing technology.

3) 3-4 days (urine test).

4) 6 weeks.

Thanks for the thanks. I hope the discussion has been helpful. Really, don't overreact:  you were wise to have a very safe exposure with such a partner and your risk of HIV is nil and that for any other STD very low. Don't lose any sleep as you wait for conclusive test results.
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