[Question #6396] Unprotected oral with woman of Cameroonian descent

16 months ago
Dear Dr. ,

am back again, (needlessly?) worried. I have not managed to regain an emotional relationship/sex with my wife. I now frequented dating sites and met up with a woman from Cameroon, living for 5 years in Germany, separated from her German husband but still married. She seemed to have a normal sex life, i.e. sometimes new partners, but not overly promiscuous. Still I have some additional (unwarranted?) fears because of her West African background. 8 and 9 days ago we performed prolonged mutual masturbation, kissing and she gave me unprotected oral (I didn`t reciproke). I have no symptoms at all. We both performed a HIV-rapid test from the drug store (VIH autotest, detects HIV-1/2 antibodies), for both of us negative. I was lab-tested in August 2019 for gon, chlam, syph, HIV-1/2, HCV, all negative. I am vaccinated against HAV/HBV.

My questions:

1. I`ve just started to fear HIV as I (mis)used my analytical skills again and researched the net to find reports that there are HIV-types and groups possibly missed by test kits, like HIV-2 and especially HIV-1 group O, both prevalent in Cameroon. Rationally I tell myself, that this woman was just tested negative for HIV1/2 and several times before in the last years (she was unsucessfully trying to conceive a baby, so definitely was lab-tested). AND... my only "exposure" was oral. How would you rate my "risk"? I think I can pedict your answer.

2. Same question for HCV. No recent test from her as far as I know, but probably in the past.

3. Are other tests (gonnorhea, chlam., syph.) justified? I have made up a plan to get tested in 6 weeks, but probably the once-a-year-approach is more appropriate.

4. I would love to resume sex with my wife. Can I have sex with her or should I wait until being tested? (Again, I have no symptoms.)

Thx Dr. and have a decent Advent Season!
Karl
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago

Welcome back to the Forum.  As a previous user you know that it is not unusual to receive a response this quickly but I happened to be on the Forum when your question arrived.  If there are follow-up questions responses may not be so rapid. 

The exposure you describe was very low risk- kissing and mutual masturbation are no risk events for STIs, including HIV and receipt of oral sex rarely leads to infection and has never been proven to lead to acquisition of HIV.  Further, you are protected from hepatis B based on your vaccination and can be confident that your partner did not have HIV-2 based on the recent tests you both had.  In answer to your questions:

1. I would rate your risk for HIV as ZERO, based both on the sex acts you took part in and the test results.  I suspect that the research you have performed was in the internet where much of what is said is incorrect due to being out of date, taken out of context, or because it was simply wrong.

2.  HCV is very, very rarely transmitted sexually.  When sexually transmitted, transmission typically occurs in the setting of receptive rectal sex.  I would not worry in the least about hepatitis C.

3.  With the sorts of exposures you describe, once yearly testing is a good idea.  More than 90% of gonorrhea leads to obvious symptoms and both gonorrhea and chlamydia are somewhat uncommon following oral sex.  If you do not develop symptoms, I would not be particularly worried.

4.  Were I you, I would not be worried about resuming sex with your wife.

I hope these responses are helpful. Take care.  EWH

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16 months ago
Dear Dr. Hook, 

thank you very much for this quick and thorough answer. This is definitely reassuring!

I have to say that I somehow cannot let go of this HCV-related worry. I've read on the internet 

"Cameroon is thought to have one of the highest prevalences of hepatitis C virus (HCV) infection in the world (4.9% among adults). A marked cohort effect exists in several communities where ≈50% of the elderly are infected. "  

But probably that makes no difference as my only exposures were kissing, mutual masturbation and unprotected oral and I guess I think only the oral deserves (if at all) to be mentioned.

I am a "numbers man", so can you give me any probability how likely a transmission of HCV from the mouth to penis could possibly be? I had 2 such exposures with said woman from Cameroon.

Thank you Dr. Hook!
Karl
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago
Let me state clearly, what you have seen on the Internet is misleading.  There are no data to determine how frequently hepatitis C is transmitted sexually other than through receptive rectal intercourse.  Thus as a "numbers guy" you can understand why,that with a frequency too low to estimate I cannot give you an estimated probability of acquisition on infection with what are no risk exposures.  That the frequency of hepatitis C is relatively high makes no difference.  Still no risk from the exposures you describe.

I hope this makes sense and is clear.  Worrying about hepatitis C from the exposures you describe is a waste of time.  EWH
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16 months ago
Dear Dr. Hook,

I couldn't stop my worries. Basically I wanna know one thing:

How would you rate the probability that the VIH autotest (ratiopharm) might miss any HIV-infection (HIV-1, subgroup O or HIV-2) that is prevalent in Cameroon but not in Europe or the US?

I hope that this profound estimate of yours will finally ease my worries and will help me to have a decent Christmas.

Merry Christmas to you and your family!
Karl  
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago

As you know, since this is my 3rd reply, it will be my final reply.  Following the reply, the thread will be closed.  I trust you will not need to return with additional questions related to the virtually NO RISK event we have been exchanging information on.

I states above that "...your risk for HIV as ZERO."  This includes HIV-2 and all subgroups of HIV-1.  Your concerns related to the fact that she was from the Cameroon are misplaced. 

Thanks for your Christmas blessings.  Same to you.  EWH

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