[Question #6356] UNPROTECTED INSERTIVE FELLATIO

15 months ago

Dear Doctor,

October 22nd 2019 had unprotected oral sex with a CSW from AFRICA (she sucked my penis) and I ejaculated in her mouth - it lasted about 45 seconds. Only activity and nothing else.  

12th Nov 2019 i.e 20th day post exposure took below test :-

HIV AB & AG Elisa Test  : Result = Negative (looks to me as 4th Gen , but the lady in Lab said its 3rd Gen)

HIV PROVIRAL DNA QULATATIVE – By Nested PCR Method : Result = Negative (Reliance Life sciences Lab)

HIV-1 DNA DETECTOR – By Nested PCR Method : Result = Negative (SRL Lab)

HCV PROVIRAL DNA QULATATIVE - Real time PCR : Result  = Negative

HBV PROVIRAL DNA QULATATIVE – Real time PCR : Result = Detected

Further below test on 16th Nov 2019 since HBV DNA PCR was detected

HBV PROVIRAL DNA QUANTATIVE – Real time PCR : Result = 110 IU / ML Detected


25th Nov i.e 35th Day post Exposure took below test

HIV AB / AG CMIA Method 4th Gen = Negative

HBSAG Serum = Negative

ANTI-HBC Igm Serum = Negative


All of the tests were done from reputed labs in Mumbai India.

 

My questions and concerns as below and the biggest of which is Risk of HIV :-


A) HIV PROVIRAL DNA test was told just screens for HIV-1 strains , any chances via this exposure to have exposed to HIV-2 strains ?  

B) Is my HIV status conclusive or any further testing needed specially after HEP B came positive and route of transmission is same for both HIV and HBV. 

C) I have also noticed  Multiple tiny spots  on the foreskin of penis & 1-2 spots are also there just on the opening of Urethra  since this incidence – what could it be ?

D) Coming back to HEP-B , I would want to understand is there any possibility that the HBV Qualitative test was false positive and further HBV Quantative could also be false negative ?

E)I was vaccinated for HEP-B in 1982 does it means I will be able to fight off the infection by my self ?


Looking forward to your reply eagerly.

Best Regards

D)

a)  

 

Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Welcome to our Forum.  I'll be glad to comment in response to your questions.  In doing so, I would like to start by pointing out that this was a low risk event for HIV.  There are NO proven instances in which HIV has been proven to have been acquired as a result of receipt of oral sex.  While less well studied, the sense is that the acquisition of hepatitis virus infection (C or B) through receipt of oral sex is rare, if it ever occurs.  As for your specific questions:

A) HIV PROVIRAL DNA test was told just screens for HIV-1 strains , any chances via this exposure to have exposed to HIV-2 strains ?  

As mentioned above, there are no documented cases of HIV acquired in this way.  While I understand that HIV-2 is seen occasionally in India, it is most unlikely that you were infected in this way and my advice would be not to worry.  If you wish for a more definitive test result, the best test would be a 4th generation HIV test, which includes testing for antibodies to HIV-2.

B) Is my HIV status conclusive or any further testing needed specially after HEP B came positive and route of transmission is same for both HIV and HBV. 

I see no need for further testing for HIV related to the exposure you describe. 

C) I have also noticed  Multiple tiny spots  on the foreskin of penis & 1-2 spots are also there just on the opening of Urethra  since this incidence – what could it be ?

I have not examined you.  I find myself wondering if these "spots" may have been there before and simply not noticed.  What you describe does not sound like herpes or syphilis and this is too soon after your exposure to be due to HPV.  My advice would be to have a trained professional take a look.

D) Coming back to HEP-B , I would want to understand is there any possibility that the HBV Qualitative test was false positive and further HBV Quantative could also be false negative ?

You have Hepatitis B DNA detected on two occasions, Oct 12th and 16th making it very unlikely that this is a false positive test.  This level of hepatitis B viremia however is very low, close to the limits of detection for the test.  If levels remain low you may have inactive chronic hepatitis B infection which is not a danger to you or you may have very, very early hepatitis B infection.  Your testing was done a bit early to be sure and repeating your tests would be helpful.  My advice would be to repeat the quantitative hepatitis B proviral DNA test.  IN ADDITION, I would suggest getting additional tests for hepatitis B- a Hepatitis B surface antigen test as well as antibody tests for both hepatitis B surface antigen and for hepatitis B E antigen.  My suspicion is that these tests will be negative and, other than for periodic repeat tests every 6-12 months) would not worry further

E)I was vaccinated for HEP-B in 1982 does it means I will be able to fight off the infection by my self ?

Please see my comments above.  My guess is that you are not at risk and your body will control any hepatitis B which might be present.

I hope this helps.  EWH

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14 months ago
Dear Doctor

Thanks for a speedy reply . I had taken some additional test on below dates - guess it was missed to notice.

25th Nov i.e 35th Day post Exposure took below test

HIV AB / AG CMIA Method 4th Gen = Negative

HBSAG Serum = Negative

ANTI-HBC Igm Serum = Negative


A) Pertaining to HIV 1/2 @ latest test taken was on 25th Nov (35th day of exposure) which was 4th Gen test CMIA technique for HIV-1/2 Antibodies. (AG/AB) Though  u have replied stating that no need for further testing - does it means that my status is conclusive ? Or slightest / minuscule doubt to be retested ? If it requires to be repeated after how many days / weeks should this 4th Gen test be taken ?  Though every time I have taken this test I go through a lot of duress and anxiety and loss of appetite and no focus towards work till the result comes , so only if it’s necessary advise me otherwise I would want to just lay the matter to rest . Also my major worry here is only about HIV-2 strain as negative result of PRO VIRAL DNA DETECTOR from two different labs are in my favor.


B) Forgot to mention that this incidence actually happened inside a massage parlour in Dubai. The massager  was female African origin and am from India though. Would it change your opinion for testing though considering the only exposure as Oral for 45 seconds.


C) Am due to see a specialist for HEP-B by 11th of December - but with your vast experience in this field does HEP-B turns out to be fatal over a period of couple of years for Chronic carriers ?  or it can be managed well with healthy lifestyle ? 


D) sorry about this one but do you foresee any cure coming for HEP-B in coming 8–10 years with advancement of medical science.


E) Is there any feature to upload all my reports for you to go through if required or not necessary ? 


Best regards 

Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Thank you for the additional information. Before I answer your follow-up questions, a few comments.  Your exposure in Dubai makes it less risky.  In addition, HIV-2 is virtually non-existent in Dubai. STIs are quite unusual among commercial sex workers in Dubai.  The additional test information is helpful and ands further proof that you were not infected with HIV, including HIV-2 or hepatitis C.  There is no need for further testing for either HIV (including HIV-2) or hepatitis C related to the exposure you described.


In answer to your specific questions:

A.  Stop playing word games. Combined your test results prove that you did not get HIV from the exposure you described.  no medical reason for further testing.

B. As noted above, the fact that the exposure occurred in a Dubi massage parlor makes it far less risky than if it occurred in India.

C.  I suspect that further evaluation will show that no treatment is needed for hepatitis B.  Most persons with hepatitis B live a long, uneventful life.

d.  Hepatitis B is now preventable (with vaccines) and treatable.  I suspect further progress will be made towards a cure.

E.  I do not need to review your lab results.  We have no mechanism for this. 

Take care.  EWH 

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14 months ago
Dear Doctor

Thanks a lot for all the guidance and suggestion . Just a bit of clarification needed in regards to the HIV COMBO test and this would be my last Question.

A) Assuming the lady who performed oral sex was HIV+ and further more assuming that she was HIV-2 positive  (as she was from africa and most massage parlors here are unlicensed and not regulated & surely she was on Visit visa and had arrived just 2-3 weeks prior to Dubai) would you still consider the AG/AB test (CMIA) technique to be conclusive at 5 weeks mark ? Am quite convinced by reading many forums that it’s efficient in detecting HIV-1 infections by that time frame since the advantage is that it detects P24 protein of HIV-1 by 2-3 weeks but concerning my point on HIV-2 is it accurate to just detect anti bodies at 5 weeks mark ? Why some forums ask to test again at 6-7 weeks mark to be sure again.

B) The Doctor back to in India also  informed me that 99% test is conclusive - but he wants me to test again at 90 days mark by Anti body test again to make it 100% conclusive.
I would want to known why there is 1% Unconclusiviness  from his end & assurity from your end that no testing required . Is there any norm back in India to be more conservative or guidelines differ from country to country ?

Warm Regards 


Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago
Final answer.  Your followup question is a bit repetitive.  The answer is the same.  The answer to your  "what if" question that makes a number of very unlikely assumptions is that. Putting all of the information and test results you have provided, you can be completely confident that you did not get HIV of any sort from the virtually no risk exposure you have described.  I am confident that no matter how much you test and when, the results will not change!

Your doctor is being conservative and I respectfully disagree with him.  Given the exposure you described and the test results you report there is no realistic chance the a subsequent test, no matter when you test.

This is my 3rd response to your questions,  therefore, as per forum guidelines, this thread will be closed without further responses,  take care.  EWH


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