[Question #5284] Oral HIV

23 months ago
Drs, had brief 20 seconds maybe unprotected oral from escort.  Concerned about HIV.  Read many threads here and got your perspective but have some questions on it.  1) you indicate no known cases of transmission from receipt of oral.  2) despite no known cases 1 in 20000 est?  How is this derived?  My math also says this means 99.995% chance no way, right?  3) CDC site says "transmission of hiv, though extremely rare, is theoretically possible if an hiv+ man ejaculates in his partners mouth". This suggests to me that CDC is only citing risk for the performer and not recipient.   Also, surprised they say theoretically if cases have actually been documented.   Help please concerned..   thanks 
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Welcome to the Forum.  I'll do my best to help although as you point out, when we deal with estimates and extraordinarily rare events people are able to say "well, I could be the 1rst".  Indeed, all scientific data leads to estimates since it is impossible to measure all known instances of an event and because new events (in this case, exposures) continue to occur.  Thus, while it is possible that you could be struck by lightning today, the estimated chance of this are extraordinarily low.  HIV is an infection and with enough exposures, infections can be transmitted but scientific studies show that some types of exposure are far less likely to lead to infection than others.  Thus:

1. Correct, no documented cases of HIV acquired through receipt of oral sex.  OTOH, there are a small number of well documented cases which have occurred as a result of performing oral sex on an infected partner (even these cases however are so rare that there are no formal studies of the phenomenon.  Resources for study are limited and what is studied must be prioritized.
2.  Your math is correct.  It's an estimate which is based on stepwise calculation, starting with other modes of transmission for which transmission risk is well documented such as the risk for infection following a single male exposure of infection to an infected female partner being 1 infection per 1,200 exposures.   

Hope this helps.  I realize it may not completely address your concerns but I hope it helps.  EWH
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23 months ago
Ok, so are you and dr handsfield in the camp that my brief unprotected oral was a no risk event as it relates to HIV? I understand that other STIs are potentially in play and I am waiting on results for those.  Just concerned here.  Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Correct.  While I'm not sure what "maybe unprotected" is, if you received oral sex from someone, I would not worry and see no medical reason for testing.  I would add that you apparently do not know that the person had HIV and, from a statistical perspective, it is unlikely that they did.  EWH---
23 months ago
Sorry, the maybe was meant for the 20 seconds.   Definitely unprotected.   I take from this relax and move on, no concerns from your end.
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Got it, thanks for the clarification.  yes, you should absolutely move on from here without continuing concern about HIV.  EWH---
23 months ago
Thanks Dr H.  One last thing, I just got my results back for syphilis,  gonorrhea and chlamydia.   All were negative but test was taken 4 days post exposure.   Is this enough time for confident results?
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
This will need to be my final response.  Our forum provides up to three responses to each question.  This will be my 4th response.  Your 4 day results are reliable for gonorrhea and chlamydia.  Syphilis results take longer to be reliable- up to 30 days or more but the chance of syphilis from such an exposure is so low that I would not worry about it.  

Hope this information has been helpful.  Take care.  EWH
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