[Question #7463] HIV risks from oral sex

2 months ago
Dear doctors,

I am a man currently living in Melbourne. On 11/30/2020, I had a date with a man. We kissed for a while, we both performed really brief (Around 1-2 mins) oral sex with each other. I had bleeding gum the night before due to the use of dental floss and it was around 20 hrs before I performed the BJ, I also had 2 tiny cuts on my pubic area due to shaving that night. After reading through some of your answers, I understand even with the presence of the cuts in my pubic area and with the contact with his saliva, there would be no risk for HIV, so I mainly focus on the exposure which I performed oral sex on him. He did not cum in my mouth, I clearly saw some precum at the tip of his penis. My concerns are:

1). I only performed oral sex on him in less than one minute, and I tasted his precum. After approximately 20hrs from flossing, would the cuts in my mouth increase my risk of getting HIV?

2). It has been 10 days now and I do not have any symptoms of any STIs, I want to take a 4th generation duo Ag/Ab test 15 days after the exposure, and I called the clinic and they said results after 14 days shall be accurate. Do you think a 4th generation duo test after 15 days would be accurate? What about the same test after 22 days? Since I want to have it done before Christmas, 12/22  would be the last day I can get tested.

3). Based on my situation, Would you suggest any HIV test at all? Can I move on without testing for HIV?

I have been chatting with this guy for 2 weeks and we met after I finished all my exams. He always claimed that he wants a monogamous relationship and he's not into hookups. He first mentioned that he wants to have unprotected anal sex and suggests that we both get tested before engaging that. However, he didn't manage to get tested due to his work shifts and he forgot to call. I'm not sure if he was hiding his status on purpose.

I sincerely appreciate your answers and I hope you all stay safe and healthy. Thank you very much!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
Welcome to the forum. Thanks for your confidence in our services. Thanks too for reading our responses to other questions similar to your own.

The bottom line is that you are at no measurable risk of HIV from the exposure described. Here are my responses to your specific questions with more detail.

1) The US Centers for Disease Control and Prevention (CDC) has published estimates of HIV transmission risk. For fellatio (penile-oral exposure) the estimate for the receptive (oral) partner is 1 in 10,000, if the penile partner has HIV. That's equivalent to giving BJs to infected men daily for 27 years before transmission is likely. And even this estimate assumes ejaculation in the mouth and probably a more prolonged event than you had. Would cuts in the mouth elevate that risk? I suppose so -- but starting at such a low risk, it probably doesn't make a big difference. That said, there are clear cases in which people acquired HIV by such contact (unlike oral to penile transmission, for which there are no reliable reports of transmission). I'll further add that you don't know your partner has HIV; the above figures are only for contact with known infected partners not taking anti-HIV drugs.

2) Despite advice from "the clinic" (more about which below), at 14 days the AgAb test is not conclusive; it will pick up many but not all new infections by that time. According to a review endorsed by CDC, it would detect around 80% of infections at 3 weeks; 28 days is required for 98-99% reliability and 6 weeks for 100%.

3) From a strictly medical perspective, the risk is low enough that testing is optional. However, probably you should be tested. Many (most?) people with concerns like yours are more reassured by negative testing than by professional opinion based on probability and statistics, no matter how expert the source. (We don't take it personally!) If you're otherwise going to keep worrying, of course get tested.

I'm not sure whether "this guy" your Nov. 30 partner or someone else. If the same partner, both of you can be tested for HIV now -- if both negative, then neither of you was at risk from the other on Nov. 30.

Australia's federally supported sexual health centres are, collectively, the world's best STI/HIV clinic network, and the Melbourne SHC is the best of the best. While i might disagree with the assessment you had about AgAb test reliability (if you called the Melbourne SHC), that might just be one person's (mis)understanding. You really could not go wrong by visiting the clinic and following their advice.

And final advice:  No male should ever have sex with another man without first discussing their mutual HIV status -- and avoid sex (especially unprotected anal sex) with those who are positive and not on treatment, don't know, or seem evasive about it. Most people tell the truth when asked directly. Think how much less worried you would be if you had been assured your partner doesn't have it.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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2 months ago
Dear Dr. Hansfield,

I really appreciate your assessment of my case and your advice.

I was talking about the same guy I met in person on Nov. 30, and he's the only person I had sexual contact with in 2020. The problem is that I am not able to get tested with him now because I became not interested in him at all after the date and ignored him for a few days while he remained very attracted to me. We ended up blocking each other because he said I ruined all the feelings he had for me. 

The place we agreed to get tested is MSHC, their booking system is a bit unfriendly to people work in shifts like him, (e.g. you need to call them at a certain time to book for the time you want), that's why he failed to get an appointment after he first called and I was the one actually went there and got a full STIs testing on Dec. 04, all results came back negative. 

I still have some questions and hope I can have your advice.

1). I also read some of your posts on MedHelp, you gave the same advice to people with similar situations as me that it is such a low risk of getting HIV from giving BJs and one has to do it daily for 27 years then it might happen. Since there was even no ejaculation (only a small amount of precum)in my mouth and the risk is being so low, could I simply assume that I'm not at any risk of HIV and other STIs (tested on Dec.04)?

2). Since there are clear cases of transmission from fellatio, Do you know how many cases are being reported each year? Or there are only a few cases throughout the history of HIV.

3). I understand why you suggest me to get tested to have peace of mind. Can I expect a negative result after 6 weeks? 

Thank you very much for your time and I look forward to hearing from you soon. Have a great day, stay safe and healthy!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
1) Some STDs are higher risk from oral sex than HIV is. The single greatest risk is for oral gonorrhea, but still a low chance for any single exposure.

2) No public health agencies collect routine data on route of infection, so nobody has numerical data on numbers of HIV cases acquired by fellatio. As discussed above, the number obviously is extremely low.

3) Of course you can expect a negative HIV result if you choose to be tested.

Thanks for the thanks!
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2 months ago
Dear Dr. Handsfield,

Sorry for the spelling of your name in my last post.

I managed to ask the guy I had oral sex with, he said he is negative. As you mentioned in other peoples' questions, people rarely lie about their status, I feel a bit reassured. The most important thing is that you analyzed my case from a medical perspective and with all the risks being extremely low, I decided to get tested just for peace of mind and then move on from this completely. 

There is one last question that I would like to ask you about. Before asking questions directly to you on here, I posted my case on MedHelp, the experts on there gave me a very conclusive answer which oral sex is "NO RISK" for HIV and no information I could add in my case to make it a risk for HIV since I didn't have unprotected anal or vaginal sex. I understand the experts on MedHelp do not offer medical advice on the forum, and they also mentioned that when doctors say the risk is extremely low in terms of getting HIV from oral sex, in reality, it basically means there is no risk. It sometimes confuses me that the word choices from doctors and what they really mean in reality. Since you previously answered questions on MedHelp so I assume you should know why the experts on MedHelp always gave conclusive answers to people who have similar events like me.  What would be your comments on their statements? Thank you very much.

I really appreciate that you answered my questions in a really detailed way and I now am able to let go of my unnecessary anxiety. Wish you all the very best, stay safe, and take good care.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
I haven't participated on MedHelp for over a decade, and in that time have never been on the site. I have no insight about the quality of advce MedHelp now provides or where they derive their information. All I can say is that many highly reliable sources might well characterize an extremely low risk as zero. Depending on the context, sometimes we do also do this, although we usually try to include qualifying statements like "for all practical purposes", "no measurable" risk, etc.

That concludes this thread. Tanks for the thanks; I'm glad the discussion has been helpful to you.
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