[Question #7975] MSM Oral - HIV risk and worries

50 months ago

Good afternoon,

I have a few worries about HIV which I’d like to get some clarity on.

Over the past month, I have engaged in unprotected oral (giving and receiving) and rimming and fingering with two separate MSM partners. No insertive anal sex.

Both partners have informed me that they are on PReP. The first partner last tested in February and was negative - he said I was the first contact he had since this test apart from his regular partner (who is also on PReP. The second partner tested a few days before our encounter and also tested negative. The second partner said he hasn’t had any other sexual contact since January 29th and I was the first contact since his test.

24 days after the first encounter and 18 days after the second encounter, I went to my local clinic for a full panel of tests (including a duo HIV test) which all came back negative. I also started taking PReP following the appointment.

My worry is that I could have caught HIV from either of these incidents and started taking PReP too soon after these events now if I was to test it would give me a false negative.

I’ve also noticed a few red blotches on my skin, both on either shoulder, which I’m now paranoid about.

Should I be worrying about either of these encounters regarding HIV?
Do these tests after those incidents give any indication or status?
Should I worry about how soon after I started PReP and, if I caught HIV, I could become resistant to the drugs and get false results?
Should I be worried about the blotches on my skin in relation to these events?

I know that PreP will protect me (and those partners) from HIV, but I’m just very worried that all the timings are off.

Edward W. Hook M.D.

50 months ago

Welcome to our Forum and thanks for your questions. I'll be glad to comment. We get questions regularly about the possibility of acquiring HIV at about the time persons start PrEP. The fact is, except for persons who have many high risk partners, these possibility is extraordinarily rare. From the sound of things, your encounters do not fall into this category. Your partners are on PrEP and have been tested relatively recently and the sex acts you engaged in were very low risk for infection even in the unlikely situation that one of your recent partners had HIV.

There are no proven cases in which a person has acquired HIV from receipt of oral sex from an infected partner or to my knowledge, from rimming. Mutual masturbation is also a no risk activity. That leaves performing fellatio on an HIV infected partner. Among penetrative sex acts this is amongst the lowest risk sorts of exposures. The calculated risk of acquiring oral sex from performing fellatio on an infected partner is substantially less than 1 infection per 10,000 sex acts. In other words, even if your part had HIV and was untreated, there is a 99.99% chance you would NOT be infected. I would not worry if I were you. In response to your specific questions:

Should I be worrying about either of these encounters regarding HIV.

I would not worry.

2. Do these tests after those incidents give any indication or status?

These tests were taken too early to give reliable results. Results of 4th generation, combination HIV antigen/antibody tests are more than 99% conclusive at 4 weeks and completely conclusive any time more than 6 weeks after an exposure.

3. Should I worry about how soon after I started PReP and, if I caught HIV, I could become resistant to the drugs and get false results?

This is very very unlikely, as I mentioned above. I would not worry.

4. Should I be worried about the blotches on my skin in relation to these events?

No. If the blotches persist you may want to see a dermatologist but I am confident that they do not reflect HIV infection in you.

Hope this helps. EWH

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50 months ago

Thanks Dr.

Just to clarify, given that both partners are negative and on PreP, there's no risk of HIV here? I'm taking comfort in the fact that I have been their last partner since their negative tests and they have both been taking PreP for quite some time.

Would you recommend re-testing given these situations? Or should I just continue to take my PreP with the confidence that I haven't had an exposure?

Edward W. Hook M.D.

50 months ago

You are correct, I see no risk for HIV here. In your situation I see no need for for additional testing. related to the two encounters you describe. I would just continue taking your PrEP. EWH---

50 months ago

Thanks, Doctor Hook! Appreciate it.

I had a silly question about the redness on my body - in terms of HIV rash, I imagine they're typically quite widespread. Also, the red marks I have disappear/fade when pressed /stretch. Would a HIV rash disappear/fade when spread/stretched?

Edward W. Hook M.D.

50 months ago

that is not a silly question. The rash of recently acquired HIV is typ8ically widespread and can be faint, blanching (going away) when pressure is applied (i.e. when it is spread or stretched.) Also, as an FYI, when the rash is positive, tests for HIV are always positive as the rash is a manifestation of high virus levels and the interaction between antibodies and the virus. Hope this helps.

As I suspect you know, we provide up to three responses for each question. This is my 3rd reply so the thread will be closed shortly. Please don't worry or overthink this. You have not acquired HIV from the encounters you described. Of this I am confident. EWH.

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50 months ago

Sorry doctor that comment has completely terrified me! The marks I have are blanching when stretched and fading. I know you typically do not reply after the third but I’m now petrified. Do they typically come with other symptoms? As the marks are the only ones I’m having. I was hoping that would be more reassuring

Edward W. Hook M.D.

50 months ago

Please do not panic. Persons with recently acquired HIV DO NOT have an isolated rash without other prominent symptoms, including HIGH fever, sore throat, and severe muscle aches and joint pains. A isolated skin rash is a non-specific consideration which raises NO concerns for recently acquired HIV.

I worry that you may be looking for information on the internet. Bad idea! Statements on the internet are unfiltered without any way to provide context or situational considerations. Much of what is seen there is out of date, taken out of context, or just plain incorrect.

This will end this thread. EWH

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