[Question #4999] HIV oral multiple exposures

78 months ago

Drs,

I have noticed your answers to HIV and oral sex (receptive fellatio) all to be in unison when regarding ONE exposure.

So what about more than one exposure??

My story:

29 year old female gave receptive oral to the same male unprotected about 5 times

July 2009- 2 times; once with ejaculation another without (maybe pre ejac)

July 2010- 3 times; no ejaculation maybe (pre ejac)

each time lasted under 2 minutes

I know realistically that if ive had HIV for 9 or 10 years id be either dead or riddled with symptoms (which I never even get sick and never experienced any ARS symptoms after any of these events)

So what are my HIV risks from these 5 exposures?? I am married and terrified that I possibly infected my husband.

Can I move on? or should i be worried? My anxiety is unbearable!

Thanks

H. Hunter Handsfield, MD

78 months ago

Welcome to the forum. Thanks for your qeustion.

Also thatnks for reading other questions similar to your own. But you must have missed some. We often talk about the increased risk with multiple exposures. Of course the risk is higher with multiple exposures, whether by vaginal, oral, or anal sex. But for oral sex, 5 exposures till means little or no risk. The chance of catching HIV after 5 oral sex events is 5 times higher (500% higher!) than for only one exposure. That's obvious by any common sense understanding. But if the chance for one exposure is, say, 1 in a million, after 5 exposures it's 5 in a million. In other words, one chance in two hundred thousand. That's equivalent to having oral sex with infected people once daily for 547 years before catching HIV.

And your chance of HIV is even lower than this, because you do not know your partners had HIV. Probably they did not. You also are correct that lacking symptoms over all these years is additional evidence you don't have HIV. Considering all these factors, I would put the chance you have HIV at no more than one in a million.

But the answer to your fears is not on this forum. You should have an HIV test. Almsot certainly it will be negative, and that result probably will be more reassuring than anything I can say. I'll be happy to comment further after you are tested, if you would like to return with a follow-up comment to tell me the result. In the meantime, try not to worry. You can coundt on a negative result.

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

HHH, MD

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78 months ago

Thank you doctor!

I do have some further questions:

1. If you were me, would you wait until your next annual exam in 6 months to be tested or would you go to a planned parenthood immediately? I’m asking because I don’t want to infect my husband and if you say I should not wait, I will stop sleeping with him (he knows of my worries but just laughs it off because he says I shouldnt worry either)

2. You answered question #2473 with this response:
“And anyway, oral sex is safe sex with regard to HIV: there are very few proved cases of HIV transmission penis to mouth; one estimate (from CDC) is that the chance is 1 in 10,000 if the penile partner is infected. That's equivalent to giving BJs to infected men once daily for 27 years before transmission might be likely.”
Do you still condone that statement?

3. I should have mentioned this: I have extremely health anxiety. I have panic attacks from time to time that have felt like heart attacks lasting upwards of 10 minutes. I know my risk is minuscule and nothing to worry. (The man in question comes from a family of doctors and lawyers and hes in law as well, so I’m sure if God forbid he was positive, he would have let me know). Your words are definitely encouraging but I can’t shake this feeling of doubt caused by guilt and shame. I’m so sorry for the aggravation...

H. Hunter Handsfield, MD

78 months ago

1) There is absolutely no hurry except whatever urgency you feel because of your worry about it. From a medica/risk perspective, it's certainly OK to wait for your next routine exam. You deifnitely should not stop having sex with your husband because of this. (If I were in your situaiton, or if you were might daughter, I would not be tested at all. Except for the fact that CDC and other public health experts recommend that all Americans have an HIV test at least once, regardless of recognized risks. On that basis, someday you should be tested. But not because of the oral sex events you have described.

2) Yes, I still stand by that statement. And remember, those low risks are for oral sex with known infected partners -- and you have no particular reason to suspect your partners were infected. Even if some of they were gay, bisexual, or injection drug users, the odds are low they didn't have HIV at the time of your sexual encounters with them. So your risk is far lower than these numbers indicate.

3) This certainly is no surprise! I assumed you had anxiety or OCD over such issues from the opening lines of your questions. This is no cause for apology: you are who you are and it is what it is. Of course if this or similar anxieties are dominating your life and especially if getting worse, you should address it forthrightly with your doctor. Germophobia and reliated anxieties can be early signs of serious mental health disability -- for a great example (but one that might induce its own anxieties!), see The Aviator, the film biography of the "eccentric" (prfoundly mentally ill) indistrialist Howard Hughes. A great movie, by the way, with Leonardo DiCaprio and Cate Blanchett.

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78 months ago

Dr,

Your response brought me to tears. Thank you so much for the honesty. And the last part of the post is very much me. I am a super germaphobe.

My last question would be if brushing my teeth before the first two exposures or having a root canal and dental fillings somewhere around those times would change your assessment?

Thanks

H. Hunter Handsfield, MD

78 months ago

No, these things make no difference. Think it through logically (it is obvious you are very intelligent, which equally obviously has nothing to do with your germophobia): there have been billions of oral sex events between HIV infected and uninfected persons, and equally obviously millions of them must have been in people who had recently brushed their teeth or had recent dental work. And yet still very few documented cases of HIV transmission. And so what if the baseline risk is, say, 1 in 10,000; and because of tooth brushing maybe would be 1 in 8,000? Still extremely low risk; and it also would be necessary that one or more of your partners had HIV. (I'm making up the numbers, but you get the idea.) I'm confident that, intellectually you'll get it -- even if the intellectual knowledge itself doesn't eliminate the anxiety. (That's almost the definition of anxiety and OCD -- not responsive to rational analysis, or only partly so.)

Thanks for your kind words. That's why we're here. That concludes this thread; I hope the disucssion has been helpful.

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