Good morning Dr. Two weeks ago i performed unprotected oral sex on another man of unknown status. It lasted less than 30 seconds  and there was no ejaculation. I have good oral heath as well. I obviously have anxiety over this as I have a long history of always being safe and this is the first time I have done this. I am considering the early detection HIV test but it is expensive. I have read a ton of conflicting data and opinions. It appears to be no big deal but does not feel that way to me. Can you give me your expert opinion on my level of risk and advice on testing?  Thanks  

Welcome to our Forum.  I'll be happy to provide some information.  Of penetrative sexual activities associated with risk for HIV, oral sex is amongst the lowest.  Before we discuss risk of infection however, let me mention that I hope you asked your partner if he had HIV as most people do tell the truth about this when asked.  If not, odds are still in your favor as most people do not have HIV.  I would however suggest that you ask this question as things go forward. 

In terms of risk for infection IF your partner has HIV, there are good data that for partners who are not on effective HIV therapy the risk of infection as the receptive partner is rectal intercourse is, on average, about 1% per sex act (i.e. 1 infection for every 100 exposures to an infected partner);  as the insertive partner in vaginal or rectal intercourse, the risk is less, about 1 infection per 1, 000 exposures.  The risk associated with oral sex is lower, not because scientists have not tried to measure the risk but because the risk is so low.  There are a handful (less than 5 or 10) cases in which persons appear to have gotten HIV by performing oral sex on an infected partner but these events are so uncommon that it is hard to provide an accurate statistic on the frequency of this event - logically less than 1 in 10,000.  In contract, there are no instances that I am aware of in which a person has acquired HIV from receiving oral sex from an infected person.

Obviously, at least from a theoretical perspective, there are a number of factors which might modify risk for infection.  The fact that your partner did not ejaculate and that your oral health is good both should be associated with lower than average risk.

So, these are the facts.  Where does this lead you- your risk is quite low, certainly less than 1 in 10,000 on average IF your partner had HIV.  The best thing you could do to improve your assessment of risk would be to learn the HIV status of your partner.  If he is negative at this time, then there is effectively no risk for infection.  If you cannot do that, the risk remains very low.  If you wish to seek testing, I would wait two more weeks and then seek testing with a 4th generation test at your local health department.,  Typically, this testing is low and even often no cost.

I hope this information is helpful to you.  EWH

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Thank you for the information.

One last question Dr. I am thinking after the research and based on your answer that I will just test as normal next June as I test once a year. I don't want to be foolish and may have just scared myself into asking. Now that I have educated myself it appears to be ok in my mind just to wait as normal and move on. Your opinion?

Thanks for asking and congratulation on your commitment to routine check-ups and testing.  This is a practice that will keep you health.  I wish more people would follow your example.

I see no reason to test sooner than your normal time from a medical perspective.  EWH

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