[Question #5218] follow up question #5206

22 months ago
sorry i must have entered an incorrect email address when registering for my question yesterday so i could not write my follow up question.

regarding the analingus incident, i follow your statements and understand this science is based on probabilities and statistics.  so i would like to know the following.  based on the fact that the woman claims to have tested clean for all STIs 2 weeks ago, and given the brief but deep 60 seconds or so of my performing analingus, what is the probability that (1) i contacted hiv and/or (2) contracted syphilis from this encounter?

also a clinic nearby has the ag/ab 4th gen alere test — is that a good one to take if i feel such a need?

i am overly anxious about this incident as i am married and want to know if i can safely continue normal realtions with her now?

thank you so much doctors. 
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
Welcome back to the Forum.  I happened to be on the Forum when your question arrived and so I will be answering this time.  As an FYI, I have reviewed your earlier interaction with Dr. Handsfield and agree with all that he said, including "In theory, there is a slight risk of oral gonorrhea, syphilis, herpes due to HSV2, and maybe HPV an HIV. However, I am unaware of any actual risk, i.e. reported cases of anyone acquiring an STD by anal to oral transmission. Certainly there are no proved HIV cases, to my knowledge."

As you were told, while there may be tiny theoretical risks, your HIV risk is effectively zero and your risk for HIV is so tiny that it cannot be efficiently studied. When you put this together with the fact that your partner indicated that she had been tested and did not have STIs, there really is no reason to worry.  

The Abbott Alere test for HIV is a highly sensitive, combination HIV antigen/antibody test which is 99+% sensitive at 4 weeks following exposure and entirely conclusive at six weeks.  

I hope my comments will allow you to put this single very, very low risk event behind you. EWH
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22 months ago
thank you that does help. 

you did not address syphilis risk and whether you think i can continue normal unprotected relations with my wife?

do you think i need testing for anything?

or can we say this was a no risk, zero risk, event for hiv or syphilis??

thank you 
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
You are being very concrete.  Precise syphilis risk cannot be calculated and from our earlier interchange, I have my doubts as to whether you would believe it anyway.  Your risk of syphilis approaches zero.  Similarly, there is no risk for other STIs, thus no medical need for testing.  Thus, clearly, there is no reason not to have unprotected sex with your wife.  EWH---
22 months ago
thank you again.   since i have one more interaction via the rules, i might as well use it.

with so much (mis) information out there, i have found some sites, even Fenway health who told me rimming can be a risk for hiv if there is rectal bleeding and if i have open sores or bleeding gums in my mouth, i am seeking further clarification.

so i am tying to envision a path for hiv to infect me in this case:

given: she told me she was tested clean for all STDs 2 weeks prior; i know i had no open cuts on my tongue and i was not bleeding; my tongue in her anus was at the end of the encounter, and i cleaned up directly after, and saw no blood on or around my mouth which leads me to believe that she was not rectally bleeding; and since my tongue was the only part of my body inside of hers, and since my tongue had no cuts into which rectal fluid or blood could have entered, and since my tongue once removed from her anus was exposed directly to air, can i be assured that there was no path whatsoever for hivi nfection since exposure to air renders it inactive?

am i thinking about this correctly?  is there any other possible means of transmission i am not considering given the brief singular exposure i had, however theoretical or remote?

if not, i think i can ease up on the nervousness.

the anxiety is rather acute, i met with my therapist to discuss my anxiety, but still find myself fearing the worst.

lastly, how reliable is a 4th gen ag/ab alere test at 15 days? 

thank you again doctor.
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
I'm sorry that you continue to worry about this interaction.  I am confident that if you search the internet you can find sites which will tell you that analingus can put you at risk for HIV however these assessments are dealing with hypothetical situations, not facts.  If infection has ever occurred this way (I have never seen nor heard of such a case from colleagues or at scientific meetings) the event is so very rare that it cannot be effectively studied.  As you point out from the Fenway site, one can hypothesize that if you had open mouth sores or advanced dental disease it could lead to infection through those lesions but again, such has never been scientifically demonstrated.  Further, I can assure you that the numbers of oral exposures by persons with mouth sores/dental disease is huge yet this leads to infection less than once in every 10,000 exposures to infected persons (CDC estimate, likely conservative).  Then when you consider all the evidence that you have that your partner was not HIV infected, there is just no realistic reason for concern - non at all.  

There a few reliable data on the sensitivity of the Alere assay for HIV detection at 2 weeks.  I would expect it to detect somewhere between 50 and 70% of recent infections.

As you know, this was my 3rd response.  thus, as per Forum Guidelines, this thread will now be closed.  I should also warn you that we discourage repetitive, anxiety driven questions and that should you return to the Forum with continuing concerns about this encounter, the thread may be closed administratively without an answer and without return of your posting fee.  This is done out of compassion, nothing more.  

Take care.  EWH
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