[Question #7501] oral sex hiv risk

3 months ago

I'm a 23 year old straight female.

I am scared that I might have contracted HIV after unprotected oral sex. It was a one time encounter at a party while drunk. We kissed and performed unprotected oral sex on each other. He fingered me as well. He didn't ejaculate into my mouth but I did swallow some pre-ejaculate. We finished by mutually masturbating. I also want to note, I asked if he was "clean" and he said yes, and the last time he had sex was around a month before me with a girl from a dating app. He's a white, British straight male, doesn't inject drugs, as far as I'm aware. The same applies to me. I have a bad habit of chewing the inside of my bottom lip, and sometimes I get sore gums- I am wondering if this makes me higher risk?

I went to the clinic a week later to get tested as I started to feel itchy down there, I was very anxious that I ended up with herpes or something, even though I didn't have any blisters. The nurse told me she thinks I have a yeast infection so I took treatment for it and it pretty much went away, although I'm still a bit itchy sometimes. I tested negative for chlamydia and gonorrhea twice since the encounter.

Fast forward 3 weeks (a month after potential exposure) I did a home STI test including a finger prick test for HIV, which all came back negative. However the last few days I've been really achy, with a slight headache and random body pains.

I know that there's a window period of around 6 weeks for the test I took, so I will take another after that point. But I'm very worried I've contracted HIV, it's making me miserable and I can't focus on my work. 

What do you think my chances of being HIV+ are?

Thank you.

3 months ago
Somethings I forgot to mention! So sorry...

I'm in the UK- I don't know if that makes much of a difference to how we are tested.

My symptoms are mainly body aches, they feel almost like they're in my bones. It's shooting pains that come and go and can be in any part of my body. It's quite mild but unpleasant. I also have quite a tickle throat but no cough. 

Thanks so much. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome to the forum. Thanks for your confidence in our services.

The news is good:  there is little chance of HIV from the events you describe. First, the a straight male in the UK has HIV is very low. Even if this partner is very sexually active with many female partners, the odds he has HIV probably are no higher than 1 chance in a thousand. Second and equally important, oral sex is very low risk for HIV transmission. A US Centers for Disease Control and Prevention (CDC) estimate was that if the penile partner has HIV, the risk to an oral partner from fellatio is in the range of 1 chance in 10,000. That's equivalent to giving BJs to infected partners once daily for 27 years before transmission might be likely. And even that estimate presupposed receiving ejaculate in the mouth. So even if your partner has HIV, there is little chance you were infected.

I'm not surprised at your diagnosis of yeast infection, which is the most common cause of new vulvar itching. I'm glad to hear you tested negative for gonorrhea and chlamydia. But did that testing include an throat swab? You were at no risk at all for genital infeciton, which is rarely if ever transmitted by cunnilingus.

Re HIV testing and symptoms:  Your negative fingerstick test ~1 mo. after exposure is highly reassuring; it would pick up 90-95% of newly acquired infections. Although not quite conclusive for infection, it is 100% conclusive in regard to your symptoms:  Nobody can have symptoms due to new HIV for more than a few and have negative testing. And honestly, the symptoms you describe do not suggest HIV anyway, as well as coming on too late (new HIV symptoms start 7-14 days after infection).

Considering all these factors, there is no realistic chance at all you have HIV -- certainly well under 1 chance in several million. If you would like to be 100% certain, have an AgAb ("duo", "4th generation") HIV test 6 weeks after the event. The negative result will be conclusive. If you would like even more comprehensive reassurance about other STIs, you could have a syphliis blood test at 6 weeks, and a throat swab for gonorrhea and chlamydia if not already done. But in the meantime, stay mellow:  I ave entirely confident all these will be negative.

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

3 months ago
Hello Dr. Handsfield! 

Thanks so much for your reply. 

Just to confirm, I did have an oral throat swab for chlamydia and gonorrhea at one month after the event, that thankfully did come back negative. So I am not too worried in regards to that.

Unfortunately, my supposed HIV symptoms started a few days after my finger prick test. It started on the 16th Dec as a pain in my right glute, going down to my leg. Since then it has progressed slightly every day, deep aches in random parts of my body! 
and unfortunately in the last hour I've my throat has become a bit sore and I'm feeling like the lymph nodes in my throat are enlarged... It's possible I'm hyper-fixating due to anxiety, which is what my parents believe. 

I do believe I will struggle to calm down until I get a new fingerprick test so I will be sure to take your advice and do that. Unfortunately due to COVID-19 all that is available to me currently is the STI home testing kit. I did try and call in to go to a NHS GUM clinic however they're not convinced I am at risk and told me to order the free home kit instead, which I understand. The test includes oral & genital chlamydia and gonorrhea, HIV, syphilis and hepatitis B&C.

I'm quite reassured about the other STIs but unfortunately I will remain nervous about HIV until I receive another negative result... but thank you Dr, I really appreciate your quick response. 

Merry Christmas!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Nothing in these additional comments changes my opinion and advice about HIV. You do not have it. The GUM clinic is exactly right: of course they are "not convinced" you are at risk, because you were not -- or such low risk that you can ignore it. You really didn't even need HIV testing on account of these events. Believe it and do your best to stop worrying A final AgAb test will be negative and conclusive. (Perhaps it will also help you to know this:  In the 15 years Dr. Hook and I have been moderating this and a preceding similar forum, with thousands of questions from persons worried about HIV after a potential exposure, not one has turned out to have caught HIV. I'm sure you won't be the first. If and when that finally happens, undoubtedly it will be from a truly high risk event -- which yours was not. As this implies, I also agree with your parents about the cause of your symptoms!

I'm glad to hear of your negaive oral gonorrhea/chlamydia test. It wasn't clear form your orifinal question whether you might have only had genital testing.

Threads are closed after two follow-up comments and replies, so you have one coming. In case you might like to report a final HIV test result, I suggest no furhter comments until then. In the meantime, stay mellow. There is no chance you have HIV. OK?