[Question #5062] Hiv
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77 months ago
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You Doctors do a great service!! Thank you. I read an article on medhelp that was very in depth on hiv and oral sex from 2012. Seemed to be directed by you. Enzymes, protective shell of the virus, transmission capabilities etc. bottom line, oral sex is of no risk for hiv transmission. Is that still the case in your opinion now in 2019? Both insertive fellatio and performing cunnilingus? No need for testing and no worry of sexual relations with partner/spouse??
Thanks again!! Keep up the good work.
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H. Hunter Handsfield, MD
77 months ago
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Welcome to the forum and thanks for your longstanding confidence in our services.
It remains true that there are few if any reported cases of HIV transmission mouth to penis or by cunnilingus in either direction. A few cases of penile to oral transmission clearly have occurred. If your only exposure are receiving oral sex (i.e. you are the insertive partner in fellatio) or performing oral sex on women), you can consider yourself risk free in regard to HIV. That said, the risks of other STDs is higher (ahtough still pretty low), so you might consider periodic (yearly?) STD testing if you have ongoing non-marital exposures of this sort. Also, even though your HIV risk probably is zero or close to it, it wouldn't be a bad idea to have HIV testing from time to time, like once a year. Sometimes negative testing is more reassuring than advice based on probability and statistics, no matter how expert the source.
I hope this information is helpful. Let me know if anything isn't clear.
HHH, MD
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77 months ago
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Thank you Sir. That is what I thought but wanted to make sure. Geographic areas make no difference, right (Bangkok/Hong Kong/Tokyo versus US versus Europe?) And for psychological assurance, window period for Hiv PCR RNA?. Thanks again Dr. HHH. This will conclude my follow on questions!
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H. Hunter Handsfield, MD
77 months ago
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Obviously the risks are higher in parts of the world where heterosexually transmitted HIV is more common. That includes Bangkok and maybe Hong Kong, but probably not Tokyo. But when the risk starts out at zero ro close to it, geography makes little if any difference.
PCR is maximally sensitive at ~2 weeks after exposure. However, there are rare false negatives, so an antibody or AgAb test should always be done as well. In other words, having such a test will provide no more reassurance than going ahead with another AgAb test when you reach the 6 week mark. In my view, it would be a waste of money to have an RNA test in the meantime.
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77 months ago
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Ok, thanks. But oral sex wise, geographics does not matter as far hiv transmission insertive fellatio and cunnilingus, right? Again thanks!
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77 months ago
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Disregard last; you answered it!!
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77 months ago
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I guess I get one more follow up. So here it goes. Will you explain the percentage of people who actually get ARS symptoms and are they in fact very bad; ie. the worse type of flu that happens 1-3 weeks after exposure?? Thx. This is my last ? And please close out the thread. Take care!!!
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H. Hunter Handsfield, MD
77 months ago
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The exact proportion of newly infected persons who have ARS is quite hard to pin down. Some studies suggest 80-90%, and others calculate that it must be under 25%. Fifty percent probably is a pretty good average. Why the differences? The analyses with higher rates typically followed exposed individtuals very close and asked detailed questions about subtle symptoms. Those with lower rates just asked people with newly diagnosed HIV infections what they recallled in the weeks following the most likely exposure that infected them. There also are wide differences in populations. Some people are clueless about symptoms (consider the kid strung out on meth who has unprotected sex with multiple partners for weeks on end); or differences between educated, medically connected westerners versus someone in rural, tropical Africa who has been raised since childhood to ignore various aches and pains.
In most anxious persons, absence of symptoms is very reassuring. The more anxious someone is after a particular exposure, the more likely s/he will notice symptoms if they develop ARS. Of course this has a downside: such persons often worry that ANY ache, twinge, tingle, or sniffle could be ARS. But if an anxious, aware person has not had classical ARS (fever, inflamed nodes, sore throat, skin rash) within 2 weeks of exposure, that should be reassuring.
That concludes this thread. I hope the discussion has been helpful.
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