[Question #7096] Risk assessment

7 months ago
Hi Doctors, I'm a gay male who is anxious about HIV risk. I tend to abstain from sex for long periods then have low risk encounters I think I'm comfortable with, followed by a lot of anxiety. So, 8 days ago I met up with a guy from Grindr of unknown status. We made out for a while and he performed oral sex on me. Now I have a sore throat with some mucus production but no other symptoms. I'm feeling worried I might have put myself at risk of HIV infection and I'm just looking for a little clarity on the following questions:
1. In previous posts you have said there have been no confirmed cases acquired by oral sex mouth to penis. Is that still the case?
2. Saliva is generally not listed as a bodily fluid that can cause HIV infection. Why is this - is it because HIV isn't present in saliva or because the HIV that is present is killed by the enzymes?
3. Could the sore  throat on its own be an ARS symptom?
4. What would you assess as my risk from this event?
5. If I get a negative rapid test at 4 weeks, would that be a fairly conclusive indication that I'm in the clear?
Thank you for your help and for the excellent forum you provide.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
7 months ago
Welcome and thanks for your continued confidence in our services.

When you're close enough to someone for sex, you're obviously at risk for catching any colds or other common respiratory infections that your partner might have, and colds etc are thousands of times more frequent in this situation than new HIV infections are. But the exposures described are risk free for HIV. You are worried about the wrong thing:  you need testing for COVID-19. The chance of that is hundreds of times higher than the possibility you have HIV. To your questions:

1) I remain unaware of any reports of scientifically proved cases of HIV transmitted oral to penis (or oral to vaginal by cunnilingus). That doesn't mean it can't happen, but it is exceedingly rare. 

2) Exactly as you surmise:  HIV is present in small amounts in saliva and indeed saliva inhibits or kills HIV.

3) Sore throat alone could represent ARS, but very unlikely. Usually there are other symptoms.

4) Risk assessment:  Virtually zero for HIV. HIgh risk for coronavirus.

5) A rapid AgAb (4th generation) HIV blood test would be 98% conclusive at 4 weeks. Six weeks needed for conclusive results.

Sex is the polar opposite of social distancing. With the COVID-19 pandemic raging, this is a terrible time to be having new sex partners outside one's own household. Your sore throat could be a common cold, but as suggested above, coronavirus also is a good bet. Contact your doctor to arrange for testing. Even though this forum is intended to be exclusively about HIV and other STDs, I would be very interesting in hearing your COVID-19 test result. Good luck with it.

7 months ago
Thank you Doctor for your advice. I will contact local health services (I don't live in the US) about a COVID test