[Question #6464] HIV risk from saliva with possible blood

14 months ago
Hello Doctors. 

I had an encounter with a stripper about 5 weeks ago where she masturbated me while using her saliva as lubricant. She wore braces and while I have no way to confirm,  in the low light it looked like there was blood in her saliva. 
She used an ample amount of saliva and the act went on for a while. I am very very worried about this encounter and have been under sever anxiety since.  

My questions to you are as follows: 

1. Am I at a risk of getting HIV? 
2. I have read about the low risk nature of this encounter but on the internet I see that blood in saliva increases the risk greatly. Is this true? 
3. I am uncircumcised. will that increase the risk?

4. While I haven't shown any symptoms, I have developed scalloped tongue for the four days. I also have an unknown small-pea sized lump on my back close to where the rib-cage ends. Is this an HIV symptom? 

5. A recent routine CBC that I did about a week ago showed reduced white blood cell count of 5.3 e9/L and neutrophil count of 2.7 e9/L. My lymphocytes are at 2.0. While all these are in the normal range, the WBC count and Neutrophil count seem to have come down from the last test 6months ago when it is was 6.3 and 4.1 respectively. Is this a concern? 

6. Lastly, do you recommend immediate testing? 

Thanks 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome to the forum. Thanks for your question.

You needn't worry at all:  you were at no risk of HIV. Saliva doesn't transmit HIV -- in fact, saliva inhibits or kills the virus, so even contact with blood-contaminated saliva is considered risk free. In addition, if you think about it, there must have been billions of hand-genital contacts using saliva and even genital fluids for lubrication, ans some of those must have had blood involved -- but there has never been a single known case of HIV transmission by hand-genital contact. In addition, the chance any particular sex worker or stripper has HIV is no higher than 1 in a hundred and usually 1 in a thousand, so it is unlikely she was infected.

Those comments pretty well answer your questions, but to be explicity to assure no misundersanding:

1. No, you were not at risk of HIV.

2. I don't know what online (?) or other resource you found, but any statement that blood contamination of salive significantly raises risk is speculation by someone who doesn't undertand the science.

3. Being uncircumcised roughly doubles the risk of HIV if exposed during vaginal or anal sex. But "double" is not the big deal it might seem. If your risk were, say, 1 chance in a million, being uncircumcised would make the risk 1 in 500,000. Still much too low to worry about.

4. These symptoms don't suggest HIV.

5. Everybody's WBC counts vary up and down within the normal range. There is no health implication of having say 2.0 lymphocytes one time and 1.4 another, for example.

6. No testing for HIV or any other infection is necessary. On the other hand, all people having non-monogamous sex should be tested for HIV and STDs (gonorrhea, chlamydia, syphilis) from time to time, like once a year. If you have otherwise been sexually active and not tested recently, this might be a good time, when it's on your mind. But definitely not because of this particular event.

I hope this helps. Let me know if anything isn't clear.

HHH, MD
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14 months ago
Thank you so much for the quick reply Dr. Handsfield. I have had no other such misadventures outside of my monogamous relationship with my wife. She is the only person I have been with and honestly this encounter has put a lot of guilt in me and I have started to believe that somehow I will come to regret it more than I already am. 

While looking for information, I have been mostly led to various forums as there are no listings of my particular scenario. Here in Ontario, Canada I read on the CATIE website that insertive fellatio doesn't carry risk of passing HIV. This gave me some idea about how risky or not my encounter could have been. But I needed an expert's confirmation. 

In any case, I understand from your explanation that I wasn't at any risk and you wouldn't recommend testing based on this one encounter. As I mentioned, I have been thoroughly monogamous outside of this one situation. Did I understand that correctly? 

Also, do you think I can continue regular sex with my partner? 
I am very very afraid of giving her something. Overtaken by guilt I told her about the scenario this morning and she seemed to know about the fact that saliva carries no risk and handjobs were safe. Speaking to her has been another reason for relief. 
I just want to put this episode far behind me and move on. 

Happy new year! 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Thanks for the clarifications. And I'm glad to hear your wife is understanding and helpful. She sounds wise, sensitive, and loving! If I were somehow in your situation, I would continue unrprotected sex with my wife with no worry I might infect her with anything.---
14 months ago
Thank you so much for the time you took to write down the replies. This helps me a lot with my anxieties. 

So to quickly sum up what I understood from your replies on this third and final post,

1. I don't run any risk of HIV.
2. You don't recommend testing for this episode.
3. I can move on with my life without the worry of infecting my wife if I continue unprotected sex with her. 

Are these all correct? 

Thanks you Dr. Handsfield.
14 months ago
Hello Doctor, 

I was wondering if you had some time to look at my last question, the third and final one. 

I was asking if the following conclusions that I have drawn from this discussion are correct, just to confirm. (I acknowledge that I am being paranoid right now. I am seeking help on that front as well) . 

1. I don't run any risk of HIV.
2. You don't recommend testing for this episode.
3. I can move on with my life without the worry of infecting my wife if I continue unprotected sex with her. 

Thanks. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Sorry for the delayed reply.

All your summary statements are correct.

Best wishes and happy new year!
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