[Question #6951] Worried about hiv

9 months ago
Hello, 

On medhelp.com and poz.com the latest comments are that giving unprotected oral in msm towards hiv infection, even with sores, ulcers, gingivitis etc. is a negligible risk or no risk and not worth testing over. On medhelp they even add previous comments from Dr. Hook and Dr. Handsfield that unprotected oral isn't a risk. 
I had an hiv duo at 6 weeks which came back negative. The day after I gave unprotected oral and had protected anal. The condom didn't fail. I took prep intermittent dose and started with dose 1 hr before instead of 2 hr and ended after 2 days. I reduced my partners to 1 and the guy I know about a year. He hasn't been tested since September 2019 but he claims always to use condoms and does unprotected oral without ejaculation. He doesn't do anal without but he's gay and has sometimes several partners. Medhelp and poz say that when you use condom you shouldn't worry and they base their comments from Dr. Hook and Dr. Handsfield. 

Kind regards 


Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
Welcome back to our forum. I do not see a specific question here however the sorts of encounters you describe are quite similar to the encounters that you have described to Dr. Handsfield and I within the past two months. Our answers and assessments of risk related to various sexual encounters have not changed in that interval. The estimated risk of acquiring HIV, if your partner was infected and untreated, is less than one infection per 10,000 unprotected acts of oral sex.  As described before, there are no known cases in which HIV has been proven to be acquired through receipt of oral sex from an infected partner.

PrEP is highly effective for HIV prevention.  Fourth generation HIV tests do provide conclusive results six weeks after an exposure. For persons who have taken PrEP, results are not conclusive until at least 4 to 6 weeks following completion of the last dose of the antiviral medication.

Thus, the sorts of encounters that you were describing are very very low risk for HIV and not a major concern. If there are specific questions please answer them and follow up. EWH
---
9 months ago
Hello Dr,


1) Can I continue giving unprotected oral to the guy I know for a year and that he not ejaculate in my mouth, reading that it's very low risk from your comment?
2) Do you think I should wait 6 weeks for hiv duo test?I always have protected receptive anal but I always stop before he can ejaculate with condom on inside me.
3) Dr Handsfield and you said in my previous post that rarely infections occured giving oral. Were those cases reliable? Because now you write there are now proved 
     cases.)
4) Should I worry that I took prep 1 hr before I had sex instead of the recommend 24hr to 2hr prior to sex? I am taking prep to reduce my hiv anxiety and I did enjoy more this time but now the anxiety came back. Studies say if prep taken correctly it's 100%, but not in real life, a bit like condom use. 

KInd regards,

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

Straight to your questions:

1.  It is very low risk for you to give him oral, whether or not he ejaculates but that is not no risk. This risk for infection is about the same as your risk of being struck by lightening.  It would be even safer if he was tested and you knew he was negative. 

2.It is not clear to me how long since your last encounter but your risk is quite low.  If it has been 4 weeks or more, then the results of a 4th generation test will be 99% conclusive.   Waiting until 6 weeks will make the results 100% conclusive.  Not much difference but you need to decide whether it is worth waiting two weeks. 

Precisely how long before sex you take PrEP is not known.  Clearly however, even PrEP take at one hour is much better than no PrEP.  Sorry I cannot be more precise.

Hope this helps.  EWH

---
9 months ago
April 8th I had encounter with him, got tested 6 weeks after (17th May) with negative result. Day after my result, which was 18th May I had again encounter with him with activities described earlier.
He got tested in September 2019 but wants to test too,also for my anxiety.

1. Is testing needed from my latest encounter? Should I worry? 
2.Should I wait for his result to see him again as I want to do same activities?
3. How many hiv testing for msm is needed in a year? 

Kind regards 

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

1.  Testing is a personal decision however your risk is low.  I do not see a need for you to test after every encounter with this partner whom you have seen repeatedly.  I would not worry particularly but this is a situation where is might be worthwhile to discuss and possibly agree upon plans to both test every 6-12 months so you can each be confident of the other's status.  Personally, I would probably not re-test at this time.

2.  See comment above.

3.  The frequency of testing should vary with the risk and numbers of partners.  As you describe it, you have just one partner and he has tested within the past year.  In addition, given your commitment to condom protected sex and that your only unprotected encounter is oral sex, I would think testing once a year would probably be sufficient.

Hope this helps.  As you know, we provide up to three responses to each question. This is my 3rd response.  Thus this thread will be closed shortly without further responses.  I also hope that you will not need to continue to return to the Forum unless your situation changes.  Take care.   EWH

---
9 months ago
Thank you for the advice and reassurance doctor.