[Question #6121] Oral Sex and Risk

18 months ago
Hello Dr.

Last night I got drunk and performed oral sex on a 19 year old black man and swallowed his semen.  I always ask if my partners are are free and he said yes.  Afterward he commented that next time he would like to have anal intercourse with me with him being the insertive partner.  I said we could do that if he wears a condom.  He agreed to it, but made the comment, “I’m clean, so I don’t usually use them”.  This comment has me very concerned that he is high risk.

Based on my exposure, what is my risk? Should I seek out PEP? What testing/precautions do you recommend? Am I at risk of giving anything to my wife? (We currently use condoms for birth control purposes.

Thanks for your help!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome back to the forum. However, this is your third question describing very similar exposures. You should be confident about our evaluation and advice, based on those discussions.

Since people rarely lie when asked directly about HIV status (discussed with you previously), it is unlikely your recent partner has HIV. I agree that his willingness to have unprotected anal sex implies he is at high risk for having HIV someday, but probably he doesn't have it now. But as discussed previously, oral sex carries very low risk for HIV, The best estimate, from CDC, is that the chance of HIV transmission by fellatio, from the penile to oral partner, is around 1 in 10,000, if the penile partner has HIV. That's equivalent to giving BJs to infected men once daily for 27 years before infection might be likely. This is with ejaculation in the mouth and often with swallowing of semen. I do not recommend PEP.

So once again, you describe a low risk exposure that, in itself, doesn't require HIV testing. That said, the risk isn't zero, and the chance of other STDs is higher. For reassurance, I suggest you see a doctor or clinic for throat swab testing for gonorrhea and chlamydia, and that in 6 weeks you have a syphilis blood test. HIV testing is usually done whenever someone is tested for syphilis, and a negative HIV antigen-antibody (AgAb, 4th generation) test at 6 weeks might be more reassuring than my comments, as reassuring as I hope they are.

Should you continue sex with your wife in the meantime? I would suggest waiting until you have the results of the tests for oral gonorrhea and chlamydia. The chance of syphilis or HIV is low enough that if I were in your situation, I would resume sex with my wife at that time, especially in view of your plans for consistent condom use. However, even with condoms, I can't say the risk is zero, so you're going to have to make your own decision on it.

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

HHH, MD


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