[Question #578] Unprotected oral..questions about HIV / other STIs

42 months ago
Hi Doctors, thanks for the great work you do on this website. It's given me a great deal of reassurance on my current situation, but I thought I'd just get your assessment for additional reassurance.

7 weeks ago, I received unprotected oral sex from a CSW in Hong Kong. The exposure was brief - for approximately 1 minute or so. 2 weeks after the exposure, I got cold-like symptoms which lasted around 4 days (runny nose, sneezing, mild cough) after but no fever or rash, which I understand from reading the other posts, are primary symptoms for ARS.  I haven't developed symptoms of any other STIs such as discharge or sores. 

Ever since recovering from the cold like symptoms almost a month ago, I've been very tired and fatigued. I wasn't worried at first because I knew its likely to be a coincidence. But I began to worry about ARS because of how long my fatigue has persisted after the main cold symptoms have been gone.

I also began to experience strange dull pain that comes and goes in my groin area. 

Is there anything I need to be worried about, and should I get tested for HIV/other STIs? I'm worried about putting my girlfriend at risk.
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Welcome to our Forum.  As a reader at the site, I trust you will not be surprised when I tell you that the exposure that you describe is very, very low risk. Now, 7 weeks after exposure, you can be confident that you did not get an STI.  HIV is not acquired through receipt of oral sex and had you acquired gonorrhea, NGU or herpes you would have almost become symptomatic long ago  As for your groin discomfort that comes and goes, this is not suggestive of any STI - the symptoms of STIs do not come and go.  Similarly, I suspect your current fatigue is more of a coincidence than anything else.  At this point I see no reason for concern and no need for STI testing of any sort. and am confident that your girlfriend is not at risk  Rather I suggest that you move forward without concern.  EWH
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42 months ago
Thank you Dr Hook for your reply.  It gives me a great deal of comfort knowing that receiving unprotected oral sex carried no risk for HIV, which was what had me worried the most.  

I have a couple of follow up questions:

1. Is it safe to say that the fatigue that I'm experiencing isn't indicative of an STI infection absent any other symptoms typical for STIs?  I ask this because I'm thinking of going to see a doctor to get examined, but not for STIs and instead for other possible underlying conditions.

2. Interestingly, my groin discomfort hasn't reoccurred ever since I read your response to my post. Is it likely that "genitally focused anxiety" could the culprit?

3.  Just out of interest, why do some doctors such as yourself say that receiving unprotected oral sex is not a means of transmission of HIV but some others say it is a very low risk (e.g. Dr. Handsfield says it is virtually no risk and some other websites just outright say it can be transmitted through oral sex)? I'm not asking because I'm worried but rather curious about the rationale behind the risk assessment.

Thank you for your time. That will be all the questions that I have and I will move on from this lapse in judgment with confidence.
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago

1.  Fatigue is not a symptoms of STI. It could reflect some other, community acquired, non-STI viral infection that you picked up through your activities of daily living.

2.  Genital discomfort of the sort you describe could well be due to excessive focus on the genital area, "looking" for signs of infection.

3.  Dr. Handsfield and I agree that the risk of getting HIV from receipt of oral sex is virtually non-existent and less likely that your risk of being stuck by lightning.  Just  as there is some, tiny risk for being struck by lightning, there is, at least theoretically some risk of getting HIV from receipt of oral sex.  Neither of us has ever seen or heard a well documented instance of this occurring.  Performing oral sex (fellatio) is likewise low risk but there are cases described which appear to have acquired HIV this way- still remarkably low however.  As for those other websites, I cannot comment. 

Glad you found our comments helpful.  Take care.  EWH

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42 months ago
Hi Dr Hook, I thought I'd just swing by to let you know that I just had my regular screening that I get every year and tested negative for all STIs, as expected! 

Thanks for your reassuring words. take care!
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Thanks so much for the follow-up.  Glad to hear of your results as I understand that they are reassuring.  Take care.  EWH
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