[Question #5394] HIV risk and Oraquick Oral Swab

23 months ago
Hello Drs.
I have followed your posts on here and your previous forum for a while and have always valued your words. 

To my case: 
About a year ago I had protected vaginal sex on two separate occasions with two separate massage parlor workers in LA. 

On the first occasion, I had a small pimple at base of penis, not covered by condom. On second occasion, I only did vaginal for about 30 secs out of fear, so she took off condom and masturbated me. 5 months after last encounter, I tested with Oraquick oral swab test. Negative.  Also never had symptoms of anything. Only guilt. To my questions:
1. Did having a pimple come into contact with fluids put me at risk? 
2. Did getting masturbated vigorously on my uncircumcised penis with vaginal fluids left on her hand from removing condom put me at risk? 
3. Can I consider my Oraquick at 5 month conclusive? Or should I retest with blood? 
4. Can I safely resume sex with wife? I've been making a thousand excuses, but I'm afraid of exposing her. 

Much appreciated. I consider you both the standard when it comes to HIV risk assessment.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Welcome and thanks for your confidence in our services, and for your kind words about our services.

You had no risk of HIV. There's probably under one chance in a thousand either of your massage parlor partners has HIV (it is more rare in women than you might think, even in sex workers); and you wisely used condoms. To your speicfic questions:

1) No, exposure of a pimple to sexual fluids does not increase risk of HIV.

2) Neither does hand-genital contact, no matter how vigorous.

3) Your test result was conclusive.

4) You did not need to stop having sex with your wife and should resume doing so now.

In summary, there is no possibility you have HIV. You didn't even need testing. If I had been in your situation, I would never have stopped sex with my wife and would not have been tested for HIV. This is not a relationship counseling service. However, I think it almost certain your wife suspects exactly what is going on. In men who have been having regular sex with their wives who suddenly stop and make various excuses, almost all women kinow that there really is only one reason. I'm not necessarily advising you to discuss it with her. But I'll bet she knows!

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

23 months ago
Thank you, doctor. Yes, these comments are very helpful. I'm sorry, I know you've covered all four of these questions thousands of times over the last decade on your forums, but fear wouldn't let me think rationally. We have a young child together, and my wife is a saint, and I couldn't stand the thought of infecting her and ruining both of their lives. It convinced me that I:
1. Found the ONE CSW with HIV
2. Had the ONE condom failure that went unnoticed or some other kind of condom malfunction, or would be the first man to catch HIV via masturbation with vaginal fluids.
3. Was part of the small percentage of Oraquick oral fluid test with false negatives, even well past the window time. 

Insane? Yes. But the fear was paralyzing enough that I couldn't stand the .00001% chance that I had HIV and passed it on.

Your answers are even more thoughtful than I expected, despite already holding both of you Docs to the highest regard. I truly, truly appreciate you for being a strong voice of reason, in an online world full of misinformation and fear mongering. 

I will do my best to seek counseling and move on. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Thanks for the thanks. I'm glad to have helped.---
23 months ago
Doctor, first of all, thank you. Your last reply did wonders in terms of calming my nerves throughout most of the day. I still wake up every single morning and think, "but what if?" and I cope with this anxiety by repeating your replies to myself until I come to my senses.

Probably not the healthiest way to deal with it, but it's working. 

Since I have one more reply (I guess) until the guidelines dictate you close the thread, I though I could use it to ask a question that would clarify something for me, rather than be tempted to ask further, "what if" questions:

I realize the general sense is that perhaps a handful of cases (or less) in the entire history of HIV globally have occurred via the performance of cunnilingus. For the purpose of HIV, is cunnilingus strictly a matter of INSERTING tongue/lips into the vagina? I ask because I have engaged in licking inner thighs close to the vagina, and lightly kissing (with closed lips), the outer labia. At no point, has my tongue ever touched the inside of a vagina during my screw ups with sex workers. Can that still be considered cunnilingus, or not? Is this activity safe for HIV, or still pose a theoretical risk? I feel foolish asking this as an adult male, but was raised so as never to discuss these matters.

I thank you in advance for  your clarification, and since I know your next reply will end the thread, I thank you for the help you have provided me and many others. God bless you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
There are no data on which to base an answer to your cunnilingus question. It is logical to assume that duration, vigor of exposure, extent of tongue insertion, and such things could increase STD/HIV transmission risk, but this has not been systematically studied. But given the overall extremely low risk, if these things make a difference, it probably isn't by very much. In any case, the relatively superficial sort of contact you describe probably is risk free for all practical purposes.

As you anticipated, that concludes this discussion. I hope it has been helpful. Best wishes and stay safe.