[Question #4563] HIV RISK AND PEP

27 months ago
Hello again.
Well, I had casual sex with an stranger. We used condoms for penetrative sex but not for oral sex. I was giving oral sex to him and then soon after that I felt a taste of blood. Noticed I had some tiny cuts in my mouth.  He cummed in my mouth.  I asked him to have an HIV quick test and it came back negative. Anyways, I didn't worry that much at that time but a day after I started to freak out so I decided to start PEP(it was after 32 hours of the exposure. What are my risks??
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Welcome back, but sorry you round it necessary.

The "blood-like taste" surely was not blood if you didn't see any. If there wasn't blood in obvious, visible amounts, then you were not exposed to blood in sufficient quantity to be infected with HIV. And anyway, oral exposure to HIV in any way is low risk for being infected. And with your partner's negative HIV test, the risk was even lower. In my opinion, it was a mistake to have started PEP. Even without it, there was no meaningful risk of infection -- indeed, had you come to me (or my clinic) with this story, we would not have prescribed PEP no matter how strongly you insisted. 

And there's a downside to PEP you might not have considered. If PEP doesn't work, it may take longer (up to 3 months or, per recommendations of some experts, as long as 6 months) for a blood test to become positive. So instead of having a conclusive test result after 6 weeks showing you weren't infected, you're going to be uncertain for at least 3 and maybe 6 months.

Do not stop taking PEP on account of my opinion. If these comments make you doubt the need -- as I intend them to -- then your next steop must be to discuss it with whoever prescribed PEP, and follow his or her advice whether to continue or stop it.

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

HHH, MD


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27 months ago
Actually, what happened was that I had some cuts in my mouth, they region was reddish and I felt the taste of blood. It was mine not his. And he cummed. Is it still a low risk?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
This doesn't change my opinions or advice. For receptive oral sex, with ejaculation in the mouth, the risk of HIV for the oral partner, if the penile partner has HIV, has been estimated at 1 in 10,000. And of course various cuts or inflammation in the mouth are extremely common (inflamed gums, a recently bitten lip, etc, etc) -- and still only 1 in 10,000. That's equivalent to giving BJs to infected men once daily for 27 years before transmission might be likely.

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27 months ago
Thank you for the feedback. I have one last question, are there chances of transmission of hepatitis C in this ocasion, like from potential infected semen to cuts with blood in my mouth(considering the mucosae wasn't integrate)?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Hepatitis C virus (HCV) has been over emphasized as an STD. The only scenario associated with sexual transmission is potentially traumatic rectal sex between men. The heterosexual partners of people with HCV have no higher frequency of infection than the general population. A recent statistical analysis put the risk of HCV from unprotected vaginal sex, with a known infected partner, at 1 in 190,000. That's equivalent to daily sex with infected partners for 520 years before infection might be likely. Oral sex probably is zero risk or very close to zero. 

That concludes this thread and it will have to be your last one on these sorts of risks etc. The forum does not permit repeated questions on the same topic or exposure. Future new questions along these lines may receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. 
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