[Question #5195] Unprotected Oral and HIV testing

24 months ago
Hi Dr Handsfield /Dr Hook
I am followinng You  since Med help days really appreciate your work sir.
I am 27 yrs male with good health from INDIA
Regarding my exposure.-on 2/2/19 I had unprotected oral (as I was a receiver)BJ went for 5-7 minutes and protected vaginal sex. It seems like she had good oral health. didn't notice  any cut or sore around her mouth. I am really worried about this encounter...I know that Receiving oral is not a risk Regarding HIV.
But still worried...I never had any symptoms till now .But since last 3 days there are sores on the side of my tongue and whitish tongue(thrush?)but these are only on tongue .I am really worried ..May be suggestive of ARS...I also had HEPATITIS B   vaccine in 22nd Feb.
I had taken tests as follows ...May be i little bit over tested my self...
~1st  test on Day 14th EIA tridot for HIV 1&2 -Neg ,HBsAg rapid -Neg ,VDRL-Neg
~2nd test 28th day Tridot -Neg
~3rd test 34th day Tridot -Neg,HBsAg -neg,VDRL -Neg
~4th test 42nd day Tridot -Neg 
~5th test 46th day (4th gen Test for p24 antigen and antibody)CMIA -Neg
~6th test 49th day EIA tricky -Neg
~7th test 56th day CMIA 4th gen - Neg
 My questions are
1)Are my tests results conclusive?Do I need further testing?
2)Are My oral problems suggestive of ARS?
   Do I really need to worry about Oral problem      regarding HIV ?
3)CDC guidelines are now mentioning 4th gen testing window period is 45 days?It says follow up testing begin after 45 days of potential exposure?What do they mean by BEGIN?
4)Can Hep B vaccine alter the results of HIV  test?
Please help.....

24 months ago
And also 
What are my chances of contracting other STDs/STIs
24 months ago
Fogot to mention that I had this exposure with CSW at bali
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

You are correct that your exposure was low risk. Receiving oral sex is very safe in regard to HIV (i.e. mouth to penis transmission never occurs, or so rarely it can be ignored). And HIV symptoms typically start 1-2 weeks after exposure; onset several weeks later is strong evidence that the sympoms are not from HIV. More important, your test results are conclusive and prove for sure you did not catch HIV. Test results always overrule symptoms:  oral sores would never be the only symptom of a new HIV infection, but even if your symptoms were typical, your tests prove you don't have it and that something else is causing these and any other symptoms you may have. To your specific questions:

1) Yes conclusive; no more testing necessary.

2) Oral ulcers never are the only symptom of HIV. Even if they were, the test results show HIV is not the cause. 

3) You have misunderstood the CDC recommendations. 45 days does not begin the time when tests are positive, it completes it. In other words, with the antigen-antibody (duo, 4th generation) HIV blood tests, 100% of people with HIV have positive results by 45 days. Test results start to be positive much earlier:  half of all infected people have positive results by 16 days and 75% by 23 days. (On this forum, we round off 45 days to 6 weeks. There is no meaningful difference in reliability between 42 and 45 days.)

4) There are no medications, vaccines, or health conditions that have any effect on HIV test reliability. Your HBV immunization had no effect.

So all is well. For sure you do not have HIV. No additional testing is necessary.

As for other STDs, the main risks for unprotected oral exposure are gonorrhea, nongonococcal urethritis, and herpes due to HSV1. All of these almost always cause symptoms of penile discharge (usually with painful urination as well) or oral sores typcial of herpes. However, as an adult in India, it is statistically probable you had HSV1 as a child, in which case you are immune to it now. Most important, absence of symptoms is strong evidence against all three of these STDs. You needn't worry about them.

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

24 months ago
Thank you Doc...
1) So 12 weeks recommendation for conclusive HIV test is simply out of date now ...Right?
6 weeks must be considered (4th gen) now?
2)sir, Have you ever seen HIV poz patient without ARS ?Some online resources say Some people may not show ARS...Is that true?
3) Should I worry about Hep B & Hep C from this encounter?
4)Why receiving oral is 'Low risk' rather than 'no risk' situation coz saliva is the only body fluid involved for receiver and saliva  is not a carrier of HIV?(1:20000)odds
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
1) Yes, 12 weeks is old news -- really 10 years old. Since then, with the third generation antibody tests and 4th gen (antigen-antibody combo) tests, it rarely if ever takes more than 6-8 weeks for conclusive results. Many websites and other resources haven't updated their advice, however -- for a variety of reasons (inertia, misunderstanding, legal conservatism, etc).

2) People get HIV all the time without experiencing ARS symptoms. Although estimates vary, on average probably about half of newly infected people have no symptoms.

3) For sure zero risk for HCV, which has been oversold as an STD. The only proved sexual transmission occurs between men having potentially traumatic (bloody) rectal sexual practices. Among heterosexual couples, the chance of HCV in partners of infected spouses is no higher than in the rest of the population. One recent research study calculated a transmission risk, by vaginal sex, if one partner has HCV, of 1 in 190,000. That's equivalent to 500 years of daily sex before transmission might be likely (divide 190,000 by 365). As for HBV, perhaps a bit more likely, but still very low risk. I am unaware of any proved reports of hep B transmission oral to penis.

4) The biological reasons for such low risk are not completely understood. That saliva inactivates HIV probably is part of it.
24 months ago
Thank you for the quick reply sir.....
1)No Further HIV test needed for my low risk exposure ?Whatever may be the symptoms now?I have done 4th gen Test at 8th week  so if there was an exposure HIV p24 antigen must be present in blood till now ?
2)Can you explain about oral symptoms in HIV infection ?How typical they are?I read that Oral thrush is mostly at upper side of mouth and back of the throat?Does these sores and thrush appear in Acute HIV infection or late stages of HIV? Asking this because Oral problems are only my concerns.???I never had such problems before.
3)Have  you ever seen or heard of 8 weeks negative turns positive later around 12 weeks?
4) Is it  completely safe to have sex with my partner in this situation? 
5) what are your opinions About Tridot (EIA) test? Are those test reliable?Oftenly used here in India .I thought it's 3rd gen test.
6)Finally About receiving oral had lower chances of getting HIV (1:20000 according to CDC)than getting struck by lightning ??In probability?Right???
7) Can I totally Forget about HIV and move on with my life?
Very worried sir,....Really appreciated you support sir

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
You're re-asking the same questions, or at least the answers are obvious from my previous replies.

1) Correct. At 8 weeks, the p24 antigen would be gone from the blood, but antibody would be present. (It's the antibody that clears p24 our of the blood. That's why the duo test is so good:  after a few weeks, either the antigen or antibody part of the test has to be positive. A negative results proves HIV is absent.)

2) There is no point in explaining oral or any other symptoms, since it is proved you don't have HIV. You can find such information on line. The short answer, though, is that usually there are no oral symptoms during early HIV infection.

3) Nope. With the modern HIV tests, this simply does not happen. Period.

4) Yes. You cannot transmit an infection you don't have.

5) Tridot is a very reliabl;e 3rd generation antibody test.

6) In the United States, the average risk of being struck by lightning is 1 in 17,000 over the course of a lifetime. So yes, the HIV risk from oral sex is in the same range, although I have no data for your country. But since your test results prove you don't have HIV, it doesn't matter how high the risk was at the time of exposure. Even if you had had a 90% risk (e.g., injecting HIV positive blood into your vein), the test result proves you were not infected.

7) Yes. That's the whole point of everything I said above. And I'm repeating it now. Move on and stop worrying about it.

That completes the two follow-up comments and replies included with each question and so concludes this thread. I hope the discussion has been helpful.