[Question #8560] HIV risk after unprotected oral MSM
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42 months ago
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Hi doctors HHH / E. Hook,12/11 I engaged in unprotected reciprocal oral sex with another male, I performed oral sex on him for about a couple of minutes only and could definitely taste a small amount of precum, which I tried to get out of my mouth asap. No ejaculation on mouth. Asked about STI status and replied he was all neg, as well as showed me some tests 11/29 showing that, EXCEPT for 1 thing: Gram Stain Urethral (POCT) WBC (Gram Stain) 50/HPF and Gram Negative Intracellular Diplococi: Present (C&G Urine negative); but also showed he completed a course of Doxyxycline 100mg and mentioned any possible infection was out of his system. For peace of mind I went to have both urine and throat swab for G&C 5 days later, both negative. Interestingly enough, PCP suggested a blood test for HIV although: a) I was not worried as per only oral contact, b) )I knew it was too soon for a test anyways, but went with it, negative. On 01/01 late night (exactly 21 days after encounter) I couldn't get to sleep due a lot of burping/acidity (no stomach cramps) a few minutes later I vomited and a couple hours later I (think, as I had no thermometer available) developed a low grade fever (got a little cold and shivered, but barely noticeable as opposed to any other times I have a fever). Woke up feeling tired and experienced fatigue and a little bit of muscle ache over the day (can be explained by sleep deprivation from said night and new year's eve before and jumping/running the day before after being in overall bad shape) experienced diarrhea once (next time that same day diarrhea was gone) and felt better after taking magaldrate/dimethicone , tiredness continued through the day and am almost positive had really low grade fever (no chills but felt itchy eyes and after taking paracetamol later at night -I only had it once- I barely sweated). During the same week my dad also had stomach unwellness, so I attributed everything to gastroenteritis. I was back to full capacity in <24 hrs.
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42 months ago
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However, this weekend (1/28) my stable female partner developed some weird sickness where she only felt tired and with a little bit of muscle ache, no fever or sore throat (although she took OTC cold meds) nor respiratory symptoms, just fatigued. This is after having sex several times so it can be 2-3 weeks after being with me.
Finally, I developed a cold sore today (I have had them since a kid, but flares every couple of years).
So, since I got some random illness 3 weeks after my encounter, she got a different random illness 2-3 weeks after being with me, and me having a cold sore now; is there a chance I could have gotten HIV and spread it to her so both got ARS?
His neg tests with gram negative positive got me worried on him potentially just gotten HIV as well, showed neg but be highly contagious due to a recent infection. He also mentioned the encounter after which he got said tests was oral only as well.
Do yo feel I may be overthinking this?
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Edward W. Hook M.D.
42 months ago
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Welcome to the forum and thanks for your detailed description of the events of concern. My sense is that logically you will agree with me that your risk for acquisition of HRV or any other STI from the encounter you describe is very, very low.
The mild illness did you describe soon after January 1 is not particularly suggestive of the symptoms associated with recently acquired HIV. Those symptoms tend to be quite severe with a very high fever, severe sore throat, and severe muscle or joint aches. Similarly, your Regular partner’s rather mild flu like symptoms are far more suggestive of a regular, every day viral illness or even perhaps COVID-19 them recently acquired HIV. I do think you are overthinking this. On the other hand, I completely understand if you would like to prove to yourself that you did not acquire HIV from the exposure you described. If your symptoms had been due to recently acquired HIV, a fourth generation combination HIV antigen/antibody test would be positive at this time.
As an FYI, the laboratory report that your casual partner shared with you showing high numbers of white blood cells and gram-negative diplococci is diagnostic of gonorrhea. Having tested for the infection subsequently however you can be comfortable that you did not acquire his infection during your casual encounter.
Bottom line, the information you provided suggests that the symptoms you have described both in yourself and, more recently, in your regular partner, are due to something other than HIV or an STI acquired in the encounter you described. As I said above, if you wish to prove to yourself that you were not infected with HIV, I would recommend a test at this time. The results will be entirely conclusive. I am confident that you not infected during the encounter you described.
I hope this information shuffle to you. If any part of my responses unclear, or there for the questions, please don’t hesitate to use your up to two follow-ups for clarification. Please don’t worry. EWH
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42 months ago
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Thank you doctor.
Just out of curiosity, why would urine for casual partner throw neg for gonorrhea but swab did not. However, yes, I am not worried at all as he showed both a complete course of antibiotic and I also tested neg.
My main concern stems from knowing that if he got Gonorrhea recently, it is a rule of thumb to discard other STIs (I am unsure how long after exposure he tested, but he mentioned he had urinary symptoms hence the test, I would suppose then test were done soon after exposure, where HIV is not fully ruled out).
Additionally, 2 more details about my regular partner's flu-like illness: It only lasted for 2 days, and he had already tested positive for covid twice before (Jan 21 and May 21) and is now fully vaccinated (no booster). I also thought covid was likely, but unsure if previous positives + vaccine would make it harder to reinfect.
My last question on ARS: You mention my symptoms were not suggestive for it, what about timing (3 weeks) and duration (less than 24 hrs or 48 for my female partner).
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Edward W. Hook M.D.
42 months ago
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There are several possible explanations for a positive Gram stain and a negative test, including having taken antibiotics which made the organisms seen on the Gram stain visible but no longer capable of being detected with standard tests. In addition, urine tests may be just slightly less sensitive than a swab specimen.
You are correct, that if your partner had acquired gonorrhea around two weeks earlier and had acquired HIV at the same time, his HIV test could still be negative. However, virtually little or no HIV transmission occurs when people have negative tests.
---Regarding your ( and your partner’s) symptoms, not only were they less severe than is typical for the ARS but they occurred towards the end of the time window when the ARS occurs and their duration was shorter than its typical for the ARS which more typically causes five about five days of considerably more severe symptoms. If your symptoms however we’re due to the IRS, virtually any test for HIV performed following the onset of symptoms would be positive.
I understand your continuing concern. Nonetheless, I remain confident that you did not acquire HIV from the encounter you describe, much less transmitted it to you regular partner. If you wish to prove this to yourself, then by all means go and test. EWH