[Question #7381] Receptive Oral Event MSM with Ejaculation.

57 months ago

Hello Doctors,

First of all, thanks for providing such a great service.

I am a "straight" male and 14 days ago, I had receptive and insertive fellatio (with ejaculation both ways) with another male I met online who claimed to be Bisexual and in a relationship with a female partner.

For information, this was my first activity with another male in my life and there was no other activity than what has been described already.

It has since transpired that the male in question regularly barebacks for receptive and insertive anal and when questioned on his status, promptly blocked me.

I would like your expert opinion on the exposure as it is 2 weeks after the event today, I have had a very upset stomach for the past 4 days (beginning Sunday) slightly sore throat and temperature of 37.0 degrees celsius. I also had/have some gum disease at the time of the event.

Should I be concerned about this exposure with regards to HIV?

Many thanks in Advance.

Edward W. Hook M.D.

57 months ago

Welcome to the Forum. Thanks for your question and your confidence in our service. Amongst penetrative sexual activities, oral sex is the lowest risk activity with the receipt of oral sex being lower than active fellatio. As I'll note below, the risk for non-HIV stis is higher in both instances than the risk for HIV.

Receipt of oral sex. There are no proven cases of acquisition of HIV from receipt of oral sex - none! OTOH, persons do acquire gonorrhea and non-gonococcal urethritis from these sorts of exposure. Both gonorrhea and NGU are symptomatic more often than not, typically within a week of exposure.

Performance of oral sex. If your partner had untreated HIV, estimates are that your risk for acquiring IV would be les than 1 in 10,000. In other words, if he had HIV (statistically unlikely), there is a 99.99% chance that you would not get HIV. In general this is not something to worry about following a single exposure. In general, we do not see a need for HIV testing following such an exposure. There is, once again, a small risk for acquiring gonorrhea of the throat from an exposure of the sort you describe.

Your symptoms are not suggestive of HIV or any other STI. Persons who have symptoms of recently acquired HIV are quite sick with high fevers, severe sore throat and muscle and joint aches. Oral STIs, when they occur tend to be asymptomatic.

Bottom line, this was a very, very low risk encounter in terms of HIV. You may want to have penile and throat testing for more traditional STIs (gonorrhea/chlamydia) however. I hope this information is helpful. EWH

---

57 months ago

Many thanks for your prompt response Dr Hook and you have been most helpful.

I have arranged a test for later today where they will swab my throat and take urine sample for Gonorreah/Chlamydia and they have said they will test my bloods for Syphilis and HIV in 4 weeks time which I have also booked, though the clinic did not seem overly concerned with HIV in this instance despite the profile of the other male.

In your opinion, would you test to eradicate any doubt in this instance or would I be testing for peace of mind ?

Edward W. Hook M.D.

57 months ago

Great, glad to hear of your plans for testing. In your situation, risk for HIV is close to zero and your risk for syphilis is quite low as well. Testing however, if it gives you peace of mind or you have had other past exposures is always a good idea.

I hope this is helpful. EWH

---

57 months ago

Thanks again for your answers and assistance with this matter.

For information, I have had zero other exposures since my last sexual health screen last year.

So to clarify, with your vast experience, you would likely expect a negative result for HIV in this instance and there is no urgent need for HIV testing other than peace of mind, regardless of the existing gum disease and current stomach upset/temperature symptoms I have been experiencing?

I will continue with the full sexual health screen (Hopefully it will be negative for HIV and other STI's) as it puts me in a better position mentally to move on from the discussed event.

Best regards.

Edward W. Hook M.D.

57 months ago

Thanks for the clarification. Based on that information, I anticipate that an HIV test would show that you were not infected and see no need for testing other than the reassurance it would provide. Your gum disease and current symptoms do not impact this assessment in any way.

As I suspect you know, we provide up to three responses to each client's questions. This is my 3rd response. Therefore this thread will be closed shortly without further responses. Take care. Please don't worry. EWH

---

57 months ago

Thanks again, Dr Hook.