[Question #5848] Receptive Oral question

22 months ago
Hello Doctors,

Hope this finds you well.  Hoping you can help me out with the risks for the folllwing.  Went to a massage parlor and entered into a sexual situation where the female attendee gave me receptive oral and I gave her analingus.  There was also deep kissing.  I brought a bottle of hanitizer with me and was using it constantly while we were performing these activities.  The hanitizer is made up of Ethyl Alcohol 70%.  I did not use a condom for the oral but I layered the hanitizer on top of my penis before she gave me the oral.  She had no problem with this.  Also the analingus I may have applied the alcohol but I do not remember.  What I do know is that she was clean down there, no smell, no feces, no blood, very clean.  Please assess the HIV risk for:

1. Receptive sex with tons of hanitizer on penis (and in her mouth subsequently)
2. Giving analingus.  Is this a risky activity?  Can one get an STD from this?  I prefer this versus cunnilingus as I assume the latter is riskier activity.  Is this true?
3. I’m not worried about the deep kissing.

Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome back, but sorry you found it necessary. This is another low risk exposure. As discussed in your three previous threads, the only way HIV is sexually transmitted is through insertive sex. If your unprotected penis (i.e. no condom) does not enter a partner's vagina, rectum, or mouth, there is no STD risk, or so little that it can be ignored. For HIV, even oral sex is essentially zero risk, with no scientifically proved cases of HIV being transmnitted mouth to penis. As for analingus, the main health risk is for the oral partner, and is for various gastrointestinal infections that are passed by oral-fecal exposure, but little or no risk for HIV or other STDs. Amd whatever low risk there might have been was probably further lowered by use of an alcohol based sanitizer. You are correct in your understanding that kissing is no risk for HIV. I will also remind you that the large majority of female sex workers (and certinaly massage workers) do not have HIV. There is under a 1% chance your partner has HIV, probably closer to 1 chance in a thousand.

Those comments pretty well cover your three questions, but to assure no misunderstanding:

1) I think you mean insertive, not receptive oral sex -- i..e. your penis in your partner's mouth. Even without sanitizer, no risk:  as noted above, there are no known cases of HIV being transmitted oral to penis.

2) Little or no HIV or STD risk from performing analingus. Risky only for gastrointestinal virues or bacteria.  

3) We agree:  no risk from kissing.

In the future, I would recommend against alcohol based sanitizer in such situations. The risk is virtuallly zero even without it, and alcohol can be quite irritating to senstive genital and anal skin and mucous membranes.

You do not need testing for HIV or any other STD on account of the events described and if you have a regular partner you can safely continue your normal sexual practices without putting her at risk.

Please note that the forum does not permit repeated anxiety driven questions on the same topic. This is your fourth, and your second in a month, about obviously low risk situations. There should be no further need to ask about any sexual exposure that does not include insertive vaginal or anal sex. Repeated anxiety driven questions with predictable answers are not permitted because ASHA is not keen on getting paid for information whose answers already have been given or are obvious based on previous replies. Also, repeated answers often prolong anxiety rather than helping relieve it. Finally, such questions have limited educational value for other readers, one of the forum's main goals. Thank you for your understanding.  

HHH, MD
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22 months ago
Hi Doctor,

Thank you for your timely response.  I was told when I called my state hotline that the analingus has risk because of exposure to “anal fluid” which is 1 of the 6 fluids that contain Hiv.  They said if that fluid reaches a mucus membrane inside the mouth (like cheek lining), I could have been exposed.   They did not object for me going on Pep for the 28 days.

I understand now that the happy ending massages have no risk (my prior question) but this is a completely different activity I wanted clarification on.   I am considering starting pep tomorrow which would be about 48 hours after the activity.

Also you are right, today (24 hrs after) I had strong diarrhea, most likely due to a Gastro infection from the analingus.  I’ll never do that again.

Please advise on the above.

Thanks, 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
In theory, analingus could be a risk for HIV, for the reasons stated by the hotline. However, I am unaware of even one case of HIV reported to have been so acquired, I can't say it doesn't happen, but if it does, it is an exceedingly rare event.

You should not take PEP after the event described. As I said, it isn't even worth being tested for HIV.

With diarrhea as the only symptom, and with such rapid onset, it is unlikely your diarrhea was caused by an infection from the analingus.
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22 months ago
Hi Dr,

I started the Pep today (40 hrs after incident). Even if there is a slight risk, as you say, I want to be better safe than sorry.  I have these follow up questions:

1. How effective is Pep after a theoretical exposure?  Hotline told me 99.9% but wanted to confirm with you 
2. So judging from what your saying after my exceedingly low risk + the pep, I should be fine, right?
3. Any side effects I should be aware of with the pep.  It’s the Truvada + isentress 

Thanks very much and thank you again for your great educational service.  

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Oh good grief. You might not be able to find a doctor willing to prescribe PEP, Assuming you are truthful about the exposure. In my STD clinic, we would refuse your request.

Another option is to contact the sex worker and ask her to be tested. If she is negative, you would know you could not have acquired HIV.

Finally, consider the major downside of PEP in this situation. Without it, you can have definitive HIV testing in 4-6 weeks. If PEP doesn’t work, it can take 3-6 months for conclusive testing. So you will be looking at up to 6 months of anxiety until you know you’re home free, instead of six weeks.

I strongly urge you to reconsider this unwise decision.
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago

That completes the responses to two follow-up comments and so concludes this thread.


Also please note the forum does not permit repeated questions on the same topic or exposure, and this is your fourth about low risk events, your third in just two months. This will have to be your last one about obviously low risk HIV exposures. Future new questions about this exposure or otherwise along the same lines will receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. 

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22 months ago
Hi Doctor,

I already started the Pep this morning (40 hrs after activity).  I anticipate my anxiety will be held in check as I know this was an exceedingly low risk exposure to begin with plus the extra preventive measure of the prep.  I know myself and I will be more relaxed this way.   I will take your advise and try to contact the worker.  

I was also seeking to understand the following:

1. Given that do everything right with pep protocol, take it everyday without missing dose, no more exposures, etc., how effective is it?
2.  Any unusual side effects  I should be aware of?

Thanks 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
My advice remains that you should not be taking PEP. The data on PEP efficacy are not very precise, but the estimate of PEP effectiveness that you quote is probably about right. At least 90% effective anyway. The doctor who presscribed it is the proper source for advice about side effects, and to discuss whether you really should be taking it.---
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