This was an exceedingly low risk exposure for HIV. The risk of HIV transmission by oral sex is zero or close to it. CDC has calculated that if the penile partner has HIV, the average transmission risk to his oral partner is 1 in 10,000. For the penile partner if the oral one is infected, it was estimated at 1 chance in 20,000. Those figures are equivalent to giving or receiving BJs with infected partners once daily for 27 years (penile to oral) to 55 years (oral to penis) before transmission might be likely. And you have been assured there is little chance your partner had HIV. All the details of the exposure you describe probably lower the risk still further, or at least do not raise the risk. As for gonorrhea and chlamydia, those risks were also extremely low -- and you are correct in your assumption that your "itchy/scratchy" throat started too soon:  no infection can start to cause symptoms sooner than 24-36  hours after exposure.

Those comments cover question 1. As for your symptoms 12 days later, undoubtedly they are entirely unrelated to the exposure event. Acute HIV conceivably could cause such minor, brief symptoms -- but so can innumerable other viruses or allergic events that are far more common.

From a medical or risk perspective, you don't need testing for HIV or any STD. On the other hand, many people nervous enough to come to a forum like this are more reassured by negative test results than by professional advice, no matter how expert. (I don't take it personally!) If you're going to lay awake worrying, get tested -- a throat swab for gonorrhea, urine for gonorrha/chlamydia, and blood tests after a few weeks for syphilis and HIV. Or contact your partner and arrange for both of you to be tested, especially for HIV:  if both negative at this time, you'll both be assured neither could have infected the other. (Maybe you'll learn he's just as nervous about the event as you are.) But be clear:  I recommend you consider testing strictly for the reassurance you may gain from the negative results -- not because there is any realistic chance you were infected. At a personal level, if somehow I were in your circumstance, I would not seek testing myself.

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

HHH, MD

2 questions, one related to new symptoms and me getting worried.

1) Are g/c tests 5 days later conclusive? I decided to get a throat swab and urine sample with negative results. Following on, since I was living the country the day after the test, I was given a prescription for doxycycline to treat the potential infection, today is day five of treatment but results just came yesterday night, should I stop it?

2) I am deeply worried about a low grade fever I developed late last night (10 days after the event). Most of the time it's been stable at 99.5 with occasional spikes to 100.4 and for a few minutes even 100.4. This is the only symptom I have, no sore throat, no tiredness (more on that below), no rash. But also no signs of respiratory illness like cough, sneezing or runny nose (I have gotten a handful nose tickling as if to sneeze, but have not done it once). I am worried about timing :(
Details: yesterday I slept 5 hours, non-continuous, I was drained. I went playing soccer for 80 min (which I hadn't done in years), ended really tired (not like sick, just being out of shape), after the fact I even decided to go for a 2 hour walk (I have been doing so for 1 month non-stop), bottom line, I was extremely tired by EOD (walk finished around 10pm). Fever started 1am. Could this be more related to the stress I put on my body, fever has not gone yet (16 hrs).
I contacted this person I met with, he claims no need to worry, tested in January and only met 1 guy before me for just oral with the other guy being clean (I know at this point we are playing he said / I said). Also said never had any flu like symptoms since last negative. I have no reason to think he is lying on purpose.

Final note, some cousin of mine and her husband have come up with a cold-like illness yesterday: stuffed nose and low-grade fever. Was sitting next to them on the 24th and 25th, could I just have caught something?

In a strictly medical sense, should I get worried about HIV because of the fever, or is your initial assessment the same? I also have a stable relationship with a woman, and do unprotected oral and protected vaginal. Can I keep on on those activities?

2) Any of a hundred medical conditions could cause such symptoms. Based on the virtually zero chance of HIV from the exposure described, you can be confident it's not HIV. Given the current pandemic, the main thing to be concerned about is COVID-19; you should see a health care provider about getting tested for it. And of course this could also be the cause of the symptoms you mention for your friend and her husband -- and the timing is right for your exposure to them 4-5 days ago. They also should be tested. With the COVID-19 pandemic, colds and influenza are less common than they used to be:  the precautions against coronavirus (masking, social distancing) are even more effective in preventing colds and flu. All three of you should be tested.

In any case, no STD causes symptoms like yours, and they're also too long after the sexual exposure. Although I hope you don't have COVID, it's a good possibility. Good luck.

I hope you are having (had) a great new year's eve.

1) When you say symptoms are too late for STD's that means all but HIV, right, as 10 days is correct timing for ARS? But for what I understand in your answer, you are confident into not even thinking about it due to how low risk the (potential if any) exposure was.

2) About antibiotics,  I meant to say I was given a 7 day course, but since tests were negative, my question was if I should have stopped then by then (day 5), I now finished the course.

3) Finally, about my fever, 36 hours after onset (yesterday noon) it was mostly gone, and all day long my main symptom was actually a runny nose, which made me have to blow my nose frequently and felt a lot of postnasal drip, a few (5-10) sneezes during the day also happened. Around 48 hours after onset, low grade came back again topping at 99.5, when I woke up today (less than 60 hrs) it was totally gone and been fine all day with just a little nasal fluid and thicker mucus. I guess this all seems to further confirm this is not ARS (even though as noted in 1) you were always sure). But I think that would further rule it out, correct?

So for this scenario, I guess I can keep my mind away of it and enjoy the new year with no worries or anxieties.

1) That the timing is consistent with a new HIV infection doesn't mean HIV is the cause. I continue to be confident it is not.

2) Understood about the antibiotic treatment. Thanks. It remains true that doxycycline was unnecessary, but it has done you no harm.

3) Fever from ARS typically lasts a week or two, and HIV doesn't cause nasal congetion, mucus, or runny nose. However, these symptoms reinforce my concern above about COVID-19. I do hope you'll get tested for it. But still no worries about HIV. (Perhaps you'll be interested to know that in the 15 years Dr. Hook and I have been moderating this an an earlier, similar forum, with thousands of questions from people worried about HIV exposures, symptoms, etc, not one has turned out to have acquired HIV. With the low risk exposure you had, you won't be the first. If and when that happens, I'm sure it will be from a standard high risk exposure, like unprotected anal sex with an infected partner.)

That concludes this thread. I hope the discussion has been helpful. Happy new year!