[Question #6245] HIV
70 months ago
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Hello Docs. Please I had oral sex with 2 prostitutes today. We kissed and exchanged saliva and they spat into my mouth and I swallowed the spit. I also sucked their vagina with my mouth and swallowed as i sucked. In addition I sucked their anus with my mouth and one of them shit in my mouth. I swallowed some of the poop and spat the rest out. I am really scared. I don't know their HIV status. Please what is my risk of contracting HIV from this act. What should I do. I have seen in some places that oral sex and consuming faeces carries no risk of HIV. In some other places I see that it carries a low risk. I'm confused which should I believe. Thats why I have come to the experts. Please answer my question. Do i need to go for HIV screening with HIV 1 and 2 antibody plus p24 antigen? if yes after how many days should I go. In addition, considering I consumed faeces, do I need to take antibiotics. What other drugs do I need to take? Please help. I'm really scared. I'm in Nigeria by the way.
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H. Hunter Handsfield, MD
70 months ago
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Welcome to the forum. Thanks for your confidence in our services.
Bottom line: Little or no risk for HIV -- testing optional. Somewhat higher risks for other STDs, but still low enough that testing is optional.
The details:
In Nigeria, the chance your female sex worker (FSW) partners have HIV could be quite low (e.g. if they are escorts, i.e. expensive FSWs by appointment) or quite high for brothel workers, street walkers, bar pick-ups, etc. But even if infected, the average risk for transmission from a single episode of unprotected vaginal sex is 1 in 2,500 -- and it's much lower than that for the sorts of contact you describe. The apparently different advice you found online about transmission risk for cunnilingus (oral-vaginal) and analingus (oral-anal) -- i.e. low vs zero risk -- really isn't different at all. Theoretically HIV could be transmitted (hence "low") but there has never been any proved case of HIV transmission by such exposures (hence zero risk for all practical purposes). So there really is little or no risk at all for your oral-vaginal exposure(s), even with swallowing genital fluids; or for oral-anal, including exposure to feces. Kissing also is zero risk for HIV. (Saliva doesn't transmit HIV. In fact, saliva is toxic to the virus -- it kills HIV.)
The main STD risks for these events were for gonorrhea -- but here too, the chance is extremely low for either oral-vaginal or oral-anal. Chlamydia theoretically is possible, but oral chlamydia is very rare and has never been known to be transmitted by the kinds of events you describe. Syphilis is possible, but also very unlikely. As for your question about antibiotic because of the anal/feces exposure, the answer is no. The highest risk of all for you was for various non-STD intestinal infections, but the large majority of those are viral, and no virus is treatable with any antibiotic.
So as noted above, overall risks are low enough that testing is optional. However, most likely you'll decide to be tested: most people in your situation are more reassured by negative test results than by professional opinion, no matter how expert. If you go ahead with any testing, have a throat swab for gonorrhea, valid any time more than 2-3 days after exposure (it probably will include chlamydia, which is pretty much automatic with gonorrhea testing); and blood tests for HIV and syphilis at 6 weeks. Be on the alert for symptoms, like a painless sore on a lip or in the mouth in the next 10-20 days (syphilis) or nausea, vomiting and/or diarrhea (non-STD intestinal infection). If no symptoms, just sit tight and wait for the test results. Stay mellow in the meantime: all these tests probably will be negative.
I hope this reply has been helpful and eases your fears. Let me know if anything isn't clear.
HHH, MD
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70 months ago
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Thank you so much Doctor for your expert and professional advice. This is really helpful and I really appreciate. It is an honour to interact with intellectuals with so much experience like you. Thanks so much once again.
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H. Hunter Handsfield, MD
70 months ago
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Thanks for the thanks -- music to my ears. That's why we're here!---
70 months ago
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Hello Doctor. From your response can I resume unprotected sex with my partner.
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H. Hunter Handsfield, MD
70 months ago
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As discussed above, it is very unlikely you acquired any infection, but without testing it cannot be guaranteed it is safe to have sex with your partner. The risk is low enough that if I were in your situation, I would continue unprotected sex with my wife. But I'm not you and you'll have to make your own decision.---
70 months ago
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Thank you Doc.
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H. Hunter Handsfield, MD
70 months ago
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You're welcome. I'm glad to have helped.---