[Question #610] Unprotected oral sex on a woman

42 months ago
Hello doctor h hunter handsfield,

I am 25 yrs old male.
I had unprotected oral sex 29 days before in usa, with caucasian sex worker and protected vaginal sex. I wanna ask you some queries.

1) i have read all the threads about hiv risk on oral sex on a woman, but i am not sure about her hiv status and i figure it out that she was a drug user and ready to do unprotected vaginal sex. But i didnt do it. Now what are my chances of getting hiv frim oral sex and protected vaginal sex.

2) i got two test done. Both duo 4th gen(antigen and antibody) 1st after 8 days of exposure and 2nd after 27 days of exposure. Both negative. Can i accept this as conclusive result??

3) no typical ars symptom but i am using oncotrex medicine for my psoroisis problem(10 mg/week methotrex anti-cancer drug) from last 6 yrs. will it affect my current test result?

4) do i need another testing or should i move on with my life? It was my first exposure ever. 

Thank you for your time. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your question and for your confidence in our services.

Congratulations for having entirely safe sex during your exposure a month ago. Three main points:  First, the duo test is conclusive any time 4 weeks or more after exposure (and 27 days is close enough). Regardless of the risk at the time of exposure, your second HIV test result proved for sure you weren't infected. Second, oral sex can be considered safe sex. It isn't completely free of STD/HIV risk, but it is very low risk for any and all STDs and zero risk for some. HIV is in the last category: there has never been a proved, unequivocal case of known transmission of HIV by oral to penile exposure; and none by cunnilingus (oral-vaginal), in either direction. Third, the large majority of sex workers in the US do not have HIV -- on average probably around 1% are infected.

Those comments pretty well cover your specific questions, but to be explicit:

1) That your partner was "ready to do unprotected vaginal sex" indeed implies high risk; and so does drug use, if by injection. But even with these risks, I would guess the chance she had HIV to be no higher than 5% (1 in 20). And as noted above, oral-vaginal contact carried little or no risk for you, even if she was infected. Indeed, oral exposure to HIV infected persons is always low risk. Even blood in the mouth rarely if ever leads to infection.

2) The 8 day test didn't mean anything, but the 4 week test (27 days is close enough) was conclusive. 

3) Contrary to assumptions, chemotherapy or immunosuppressive drugs like methotrexate and others do not materially increase HIV transmission risk, and do not delay or otherwise change the reliability of testing.

4) Sorry that you've had such worries after your very first sexual experience. But you made the wise decision to have safe sex, even if your choice of partners was not very wise. In the future, if you continue sexual exposures with commercial partners, I would encourage you to spend a bit more (or even a lot more) to employ escorts rather than higher risk partners (most escorts are knowledgeable about risks, protect themselves, and are tested regularly. And for sure ask ahead of time about HIV status (most people, even sex workers, don't lie about it) and assure that they consistently use condoms with all partners. In any case, for sure you didn't catch HIV this time and no further testing is needed.

I hope these comments have been helpful. Best wishes and stay safe--    HHH, MD


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42 months ago

Thank you very much doctor. Your comments helped me a lot. I have many
Anxiety related symptoms but i am not getting much nervous about my symptoms because i did not have fever in last 29 days and that was the only relief point for me. 
Though i develop 3-4 red dots in my throat and lump feeling, but no sore throat on 23rd day. And it is lasts till now also. My gp suggest me taht you have post nasal drip, and it has nothing to do with your hiv ars symptom. 

My only last question that should i not worry about any symptom that it is due to ars, and no hib testing even if any any other symptom occur.
42 months ago
And at the last, can i continue unprotected sex with my girl friend without any worry or fear?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Thanks for the thanks. I'm glad to have helped. I wonder if I misinterpreted the closing comment in your original question. I thought you had described your first sexual experience, but perhaps you meant your first commercial sex (?).

Since your test results are conclusive, any symptoms you have now or in the future cannot be due to ARS from that exposure. Every symptom of ARS is nonspecific, i.e. the identical symptoms are caused by many disorders. I agree with your doctor that postnasal drip is not an ARS symptom, and I also wouldn't worry about the "red dots" or "lump feeling" in your throat; for sure these aren't due to ARS.

You can continue unprotected sex with your girlfriend without worry about infecting her with HIV.


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42 months ago
Thank you very much doctor. Today i feel stress free. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
You're welcome. Best wishes and stay safe.

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