[Question #8224] Oral Sex and HIV risk

47 months ago

Hello Dr. Hook,

I recently had an encounter with a new man of unknown status. The infamous oral sex. Vaginal sex was protected but the oral was not. I'm going to ask him about testing today but wanted to get your expert opinion on the encounter. As I was giving him oral sex, I stopped to give him a hand job. He ejaculated from the hand job and his fluids were still on his penis when I started giving him oral sex again immediately after he'd ejaculated. My oral hygiene is very good but I do occasionally have bleeding gums. With all of this considered, is this a risk event that warrants testing? Technically the fluids were exposed to air and it was a short limited exposure. Thoughts?

Edward W. Hook M.D.

47 months ago

Welcome to our firm and thanks for your question. Thanks as well for your confidence in our service. I’ll be glad to comment.

The encounter you described was no risk for HIV. Before we even begin to discuss the specifics, let me remind you that less than 1% of heterosexual men are HIV infected. When you combine that with the low risk of HIV from this partner with the as described in the explanation below, your exposure was virtually no risk.

Condom protected genital sex is safe sex as long as the condom is worn throughout the exposure. With respect to oral sex, oral sex on an infected partner is very, very low risk, occurring less than once and every 10,000 and that is a conservative estimate of exposure risk. Gum disease an oral lesions make no difference.

Likewise, you are a risk for other, mucosal STI‘s is relatively rare. STI‘s are inefficiently describe transmitted through oral sex and the likelihood that your infection is quite low. Depending on your level of anxiety, you may choose to pursue oral testing for mucosal

From my perspective, the event you described was no risk. It would be great if your partner would agree to risk undertake HIV testing, as well as testing for other more common bacterial STIS although his likelihood of being infected is very low. His results will likely be negative. Irrespective, your risk of HIV infection from the exposure you described could be measured as one in millions. I hope the evaluation I have describedIs helpful to you. If you have additional questions or any part of my response is unclear please, do not hesitate to follow up at this response with up to to follow up questions.

EWH

---

47 months ago

Yes. This is very helpful. I typically consider oral sex, safe sex but with recent developments surrounding proven cases of HIV transmission by oral sex, I figured it wouldn't hurt to ask. I am unclear about the references you make to mucosa testing. Could you elaborate?

Edward W. Hook M.D.

47 months ago

When I referred to mucosal STIs I am referring to infections caused by Gonorrhea or chlamydia. EWH ---

46 months ago

It's been 2 weeks since the event with a man of unknown status. I truly believed that this was a no risk event until my boyfriend got sick 2 days ago. I have not been sick at all but now I'm worried.

I'm hoping that this is just my guilt getting the best of me. How soon after infection can someone infection a new person? Immediately? Since he's sick now, do you recommend testing eventhough oral sex is supposed to be low/no risk? I feel terrible.

Edward W. Hook M.D.

46 months ago

You don’t describe what sort of symptoms your boyfriend is experiencing however my assessment of the risk related to the encounter you described is unchanged. This was a very, very low risk encounter. Also, I remember that you were going to ask your casual partner to get tested. Did that happen?

Irrespective, your boyfriend’s current illness is far, far more likely to be coincidental than directly related to the exposure you described. If you would like to provide a little bit more information, I may have an additional comment or two in my final response. EWH

---

46 months ago

Thank you Dr. Hook. He's complaining that he doesn't feel well in general and he has a sore throat. No body aches, no fever yet. But he took medicine that could be suppressing those symptoms. My casual partner and I did talk and we are supposed to login to our respective medical apps to show each other recent results but I've not seen him due to our schedules conflicting. I can add that my anxiety is further fueled by his willingness to want unprotected vaginal sex with me before we had this important conversation. Makes me wonder how often he does that and also, if my boyfriend is truly sick with some more common illness, it seems that I would be sick too but I'm not. I appreciate you opinion on this. Thank you.

Edward W. Hook M.D.

46 months ago

Thanks for the additional information. It is not at all uncommon for one member of a partnership to experience symptoms or feel ill when the other does not. Again the risk for any infection is very low. I would add that when STIs infect the throat, they are almost always asymptomatic.

I would not worry. EWH

---

46 months ago

I hadn't considered other STIs. When is the soonest I can take a 4th generation HIV test? Right now it would show antigen if present right? Or do I have to wait until day 28? Needless to say, I want to go get a test asap. Eventhough I agree that this is low risk. I know I'm out of follow ups now but I appreciate you help! :-)

Edward W. Hook M.D.

46 months ago

Good questions. You cannot transmit HIV to a partner if you have a negative test so a test at this time will provide useful and, I’m sure, reassuring information. Likewise you could test for other STIs at this time and expect no problem, you’re far busier than me---

46 months ago

Ok. If it will be helpful for others suffering through anxiety and worry, I can provide my results here when I get them. Assuming it's good news!

Edward W. Hook M.D.

46 months ago

Thank you for offering to share your results. I will leave the thread open for you to provide your results but there will be no further replies. Take care. I am confident your tests will be negative. EWH---

46 months ago

Dr. Hook,

I know I'm all out of replies and happy to contribute towards a new question if necessary. It's been 7 days and I'm still waiting on test results. Usually, my regular doctor has results in 24 hours. This time, she wasn't available so I went to a new women's health clinic. They did say it could be a week before they received results but I thought surely that wouldn't be the case. Well now I'm wishing I had just waited on my own Dr. At this point.

If test results take an excessive period of time like this, is there a realistic cause for concern?

Edward W. Hook M.D.

46 months ago

I’m sorry that you are having difficulty getting your test results. The prolonged period between testing and the availability of results is far more likely a reflection of an administrator problem where the testing is performed than any indication that your test is positive.

This thread has gone on for far beyond our standard three replies. The thread will now be closed. Please don’t worry. I remain confident that your test will show that you were not infected. EWH

---