[Question #7742] Oral Exposure - HIV Question

52 months ago

Hi Doctors,

I'm a 27 year old Irish male that had protected vaginal sex, received unprotected fellatio and gave unprotected unprotected cunnilingus and analingus. The woman was 39, French with two children. She was born and raised in France and has been living in ireland for 15 years. She is of African ethnicity.

While performing oral on her, I had a split in my lip from it being dry. I had it for about a day at the time and it kept healing and re-splitting. I don't know her STI or HIV status.

About 2 or 3 days post exposure, I got a headache that lasted about a week and continues even know, on and off. Approx day 5 I had sinus or nasal congestion that's still present. As of today, 10 days post exposure, the right side of my next is extremely tense, I might have also felt an enlarged lymph node on the upper part of my neck.

My questions are:

Is there any meaningful risk of acquiring HIV from this exposure and would you even recommend testing as a result of this event?

2) Did the split in my bottom lip increase the risk at all?

3) Are all pregnant women tested for HIV? Her youngest child is approx 5/6 years old.

4) Are my symptoms at all indicative of ARS, as I'm now 10 days post exposure?

5) 4th generation tests are conclusive 6 weeks post exposure, but you say they're approx 99% after 4 weeks. Here, we have postal 4th gen tests, we take a fingerprick sample and send it to a lab. Is the window period longer if the sample is taken using a lancet on the finger vs blood from a vein.

Thank you fir your time and all you do for the community.

Edward W. Hook M.D.

52 months ago

Welcome to our Forum and thanks for your question. I happened to be on the site when your question arrives so you are receiving a reply somewhat sooner than is typical; any follow-up questions may take longer to respond as well. The exposure you describe is low risk. Most women do not have HIV and even if she did, the risk of your exposures is low. Even without condoms, if your vaginal exposure had been unprotected your risk for infection would b substantially less than 1 in 1000 (i.e. chances are 99.9% that you would NOT be infected) and with a condom the risk of infection goes down to virtually zero as long as the condom was worn throughout sex. HIV has not been proven to occur as the result of receipt of fellatio, cunnilingus or analingus with an infected partner. The cut on your lip does not change your risk meaningful either. Thus:

1. See above. Personally I would not feel the need for testing but testing is always a personal choice.

2. No the split lip does not change your risk

3. Testing for HIV during pregnancy is routine here in the U.S. and is recommended in most European countries. While I do not know specifically about recommendations in Ireland, I suspect she would have been tested.

4. No, three days is too early for the onset of the ARS. Further neither headache nor nasal congestion are typical elements of the ARS which is characterized by a severe sore throat, high fevers and muscle and joint aches.

5. No, the performance of a 4th generation test performed on a finger stick specimen should be equivalent to the performance of tests perfromed on a blood specimen from the vein

I hope this information is helpful. I would not worry. EWH

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52 months ago

Thank you for the very swift response, Dr Hook.

It no doubt put me at ease over the last couple of days, however our minds and anxiety are powerful things.

Just to repeat, I had fully protected vaginal sex (I am certain the condom was on properly and did not break), received an unprotected blowjob, and gave unprotected cunnilingus and rimming.

The reason I remain anxious is a rash has appeared on my back and neck today. The rash stings, hence how I noticced it, and physically it looks like a series of small pimples on normal looking skin, no redness other than the 'pimples'. It both burns and stings. I'm hoping this is as a result of my anxiety and may be linked to excess sweating due to the anxiety? I have no other symptoms, no headache anymore, no nasal congestion, no fever, no chills or aches and no swollen lymph nodes. The areas or burning and stinging are my back and the front and back of my neck, nothing on my stomach or chest.

1) You say that there is no evidence of HIV transmission from unprotected cunnulingus and analingus. Is this true the the reciever AND giver?

2) Is there any chance the rash is ARS given it appeared about 13.5 days after the sexual encounter?

3) I contacted the sexual partner, who said she had an abscess under her armpit three weeks ago so the doctor 'tested her for everything' via a blood test. Would such a test typically include a HIV one I wonder?

4) Is your view that testing is not necessary from a medical viewpoint (removing my own personal anxieties) still valid?

52 months ago

I would just like to add that I've had the burning and stinging on my upper arms too and on my armpits. On my arm pits, I can actually see that my sweat glands are raised and by feeling them, that they are the source of the pain.

52 months ago

Sorry Doctor,

Just to add on a fifth question.

5) Would you resume unprotected sex with regular (tested partner) without worry if my only exposure since my last test was the one outlined above?

Edward W. Hook M.D.

52 months ago

I'm sorry you continue to worry. I hope that my further replies will help you with this.

1) You say that there is no evidence of HIV transmission from unprotected cunnulingus and analingus. Is this true the the reciever AND giver?

Correct.

2) Is there any chance the rash is ARS given it appeared about 13.5 days after the sexual encounter?

The timing is in the realm of where ARS rashes occur but the rash you describe sounds nothing like the rash of ARS which tends to be generalized and is not uncomfortable.

I doubt that testing for an abscess would include testing for HIV unless there was some other indication.

4) Is your view that testing is not necessary from a medical viewpoint (removing my own personal anxieties) still valid?

I continue to see no medical or scientific reason for testing. If you are really worried about your rash however and it were due to HIV, an HIV test would be positive at this time.

5) Would you resume unprotected sex with regular (tested partner) without worry if my only exposure since my last test was the one outlined above?

I see no reason to hesitate to have unprotected sex with your regular partner on the basis of anything you have described.

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52 months ago

Hi Doctor Hook,

I am glad to report that the 'rash' only lasted for approx 48 hours and it seemed to result from sweat. I am currently 16 days post exposure.

I am back with a different concern however. Since yesterday, I feel like I have muscle fatigue and some joint and muscle pain.

My forearms are painful as is my right elbow and left knee. Other joints aren't too bad and my neck remains tight. I'm hoping it's a combination of lifting a couple of heavy buckets and walking 10+ miles a day and a slightly impacted sleep schedule due to my anxiety.

I have no fever, no swollen lymph nodes (that are obvious, anyway), no sore throat and no rash.

1) Since there are no proven transmissions from receptive fellatio or giving cunnilingus and rimming, was my exposure truly no risk for HIV?

2) Does the above change your views on whether it's ok or not to resume unprotected sex with my regular partner?

3) Does it change your opinion that testing really is not necessary scientifically or medically?

4) How reliable would an INSTI third generation rapid test be 28 days post exposure?

52 months ago

5) Would joint and muscle pain ever be the only symptom of ARS?

52 months ago

The muscle pain is in my arms and legs - not severe, I can still carry out day to day tasks etc

Edward W. Hook M.D.

52 months ago

As per Forum Guidelines we typically provide just three responses to each client's questions. Your thread was not closed earlier so I will provide brief additional responses before closing the thread.

1) Since there are no proven transmissions from receptive fellatio or giving cunnilingus and rimming, was my exposure truly no risk for HIV?

Correct.

2) Does the above change your views on whether it's ok or not to resume unprotected sex with my regular partner?

No, I still see no reason related to this exposure to hesitate to resume unprotected sex with your regular partner.

3) Does it change your opinion that testing really is not necessary scientifically or medically?

My opinion is unchanged

4) How reliable would an INSTI third generation rapid test be 28 days post exposure?

At day 28 a 3rd generation test will detect over 50% of recent infections but not all. On the other hand, a 4th generation test taken at 28 days is more than 99% conclusive.

5) Would joint and muscle pain ever be the only symptom of ARS?

Muscle and joint discomfort are part of the ARS but are typically accompanied by additions symptoms such as high fever or a severe sore throat. Further, isolated muscle and joint pains are non-specific findings which can be caused by lots of other things, including every day, community acquired viral infections. I should add that when symptoms are present, 4th generation tests are typically positive, no matter how long after the exposure.

This concludes this thread. I hope my comments are helpful. Please don't worry. EWH

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