[Question #4783] HIV Oral Sex

27 months ago
I recently went to a masseuse who performed oral sex for a brief 30 second (or less) window which I deeply regret without a condom. It was a moment of stupidity. I was the insertive. I have no prior medical issues and I am not sexually active previously. My insertive organs had no visible issues and she spit right after I told her to stop. And I immediately went to wash up. I didn't see any blood there in her saliva. If it was red, I would like to think I would have noticed. It's been 5 days or so. I have feeling feverish (~100F) and occasionally facing some panic attacks (not going to lie about that). I am fairly large and quite fit otherwise. I am a little frightened and decided to have a RNA Test ready to go just as soon it it hits the 9-11 day mark. If the fever is in fact a sign of HIV, is it ok to take the test by day 6 or so?

I guess my worry is that even if it were to come out negative, what are the chances that I have no issues for the future? As in, we may never know if people document HIV passed through oral sex. I guess in some sense, how do we trust our findings? Yes. I am a little freaked as you might be able tell.
27 months ago
Should I take a PEP although it is 5 days (just learned about it today)?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Welcome to the forum. Thanks for your question.

Your worries are over. This was a zero risk exposure. There has never been a proved case of HIV transmission by oral sex, mouth to penis. You will not be the first case! And anyway, the chance any particular sexually active woman has HIV (in North America and western Europe) is also near zero, probably no higher than one chance in a thousand. As for your symptoms, they are not at all suggestive of a new HIV infection.

So there's really no need for testing. But if you do it, the RNA test will be negative. If so, it will be around 95% conclusive. For a truly conclusive result, you'll also need an antigen-antibody ("due", "combo", "4th generation") blood test at 6 weeks. It also will be negative.

Really, mellow out. There's no way you have HIV.

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

HHH, MD
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27 months ago
Thank you very much. Just wanted to follow up. I suppose worrying is good to a certain degree as it helps me understand the issue better. I’ll take your guidance on this matter because the internet seems to have all sorts of issues.

1. Are there cases where the RNA test has failed multiple times that the antigen test has caught?
2. Are there cases where both tests have failed but then later on it’s become an issue?
3. What comprises a proved case? Could it be that no one has brought it up?
27 months ago
Additionally, I’m curious how much blood is actually required to transmit the virus through saliva if actually transmitted. Does it need to be a mouth full of blood or a small droplet that I can’t really see that might have gotten mixed with the saliva like it might happen if you floss a bit too deep on your teeth.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
1. "Are there cases where the RNA test has failed multiple times...?" I doubt this has ever happened.
2. "...where both tests have failed....?" Probably not.
3. "What comprises a proved case?" A positive blood test, then followed by additional testing to determine amount of HIV in the blood and tests to judge immune system damage. If the blood tests are negative, and done sufficiently long after exposure, the results are 100% reliable.

And I repeat that this was a zero risk exposure for HIV. Take a relaxed, realistic attitude and forget about all this. Don't confuse your apparent anxiety and guilt over a sexual decision you regret with disease outcomes from that event. They aren't the same. Deal with the former as you need to (maybe counseling if you remain obsessed about it), but do your best to accept my expert, reasoned, science based reassurance and forget the latter.
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