I gave him oral but before he finished I switched to hands so he didn’t ejaculate in my mouth rather on himself but I did taste some precum. My main concern is that I brushed my teeth about 2 hours beforehand and I have gingivitis so my gums tend to bleed. Since two hours passed I can assume my gums weren’t ACTIVELY bleeding but instead had cuts that were still in the beginning stage of healing. Would these cuts in my gum increase my risk of infection significantly? 

All in all what would be your assessment of my risk and recommendations for testing if at all? 

I was planning to test 24 days post exposure with RNA. Would this be conclusive? 

You don't mention HIV in particular, but that seems to be your main concern (based largely on your mention of RNA testing). You really aren't at significant risk for HIV:  testing is optional, certainly not required in this situation. First, in the US and other industrialized countries, the chance any particular straight male has HIV is under one in a thousand, so it is very unlikely your partner is infected. Second, oral sex is very low risk for HIV, regardless of gingivitis, tooth brushing, etc. Several years ago, CDC calculated that the risk of HIV from oral sex is roughly one chance in 10,000 for the oral partner, if the penile partner has HIV. That's equivalent to giving BJs to infected men once daily for 27 years before infection might be likely. Might gingivitis increase the risk? Sure -- but gingivitis and other oral inflammatory conditions are very common, so there must have been billions of oral sex exposures by persons with such oral health problems -- and still almost no known cases of HIV acquired by oral sex.

So as I said, testing for HIV is optional in this situation. But assuming you go ahead with that plan, an RNA test at 24 days would be highly reassuring but not quite conclusive -- probably it would be ~95% reliable. For conclusive testing, have an antigen-antibody (AgAb, "4th generation) HIV blood test at 6 weeks. You could also do that test instead of RNA at 24 days:  it also would be ~95% conclusive at that time, and its a lot less expensive than RNA testing.

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

HHH, MD

So the cuts in my gums wouldn’t make my exposure a significant risk? Like I said I had brushed my teeth 2 hours before so I’m not sure if they had begun to heal or not but the actual cut was still visible. And wouldnt the lack of ejaculation in my mouth lower the risk as well? All in all what do you think of the risk? 

And I managed to go into test before your reply so I took RNA 23 days post exposure and I will be getting my results tomorrow. Now depending on those results would it really be necessary to test again at 6 weeks to be conclusive? 

Sorry if anything doesn’t make sense I’m just really nervous waiting for my results. Thank you for your help. 

You can definitely expect a negative result of your RNA test. Let's hold off on further comments until you have the result; I'll be happy comment again at that time.

4. When and what test would you recommend next if any?

Again I want to repeat my test was 4th gen AG/AB and NOT RNA like I had planned. So I’m not sure how much that changes the impact of the results. 

2. Yes, penile to oral transmission has occurred, but it rare.

3,4. For the reasons already discussed, I consider your current test results conclusive. But if you feel you need to have a test result that by itself that is 100% reliable, disregarding the other aspects of risk calculation, have another AgAb (4th generation) blood test at 6 weeks.

RNA testing is not the main or most accurate test for HIV following any particular exposure. The AgAb tests are more reliable.

That completes the two follow-up exchanges included with each question and so ends this thread. Do your best to move on without worry! I hope the discussion has allowed you to do that.