[Question #8742] HIV Risk Primarily From Sexual Encounter

40 months ago

I've read your other recent threads and think I am HIV safe, but want to double check with you. I had a happy ending 8 weeks ago at a massage parlor. I started to have unprotected vaginal sex with the female parlor worker, but pulled out within seconds and wore a condom before continuing. Next I was given rough oral sex by the worker for about 10 minutes before reaching orgasm. When the oral sex ended, I noticed the edge ("rim")around the head of my penis was raw, but no bleeding from the raw areas probably caused by her teeth. During the oral sex event, she also agitated her fingers in my anus for about 10 minutes. She used a lubricant, but her hands may have been contaminated with her vaginal fluids or her mouth saliva. I got tested at 33 days after this event with the 4th gen HIV antigen/antibody test and was negative. Was this test result 98% certain? Should I retest to ensure I am HIV free?

H. Hunter Handsfield, MD

40 months ago

Welcome to the forum. Thank you for your confidence in our services.

Thanks too for reading other discussions with questions similar to your own. You have correctly analyzed the situation. It is logical to assume that the duration and vigor of an oral sex exposure (e.g. with mild trauma) might elevate the risk of HIV transmission. There are no data on this, but with no proved HIV transmissions oral to penis or by fingering, and the obvious fact that there must have been billions of events with the level of potential trauma you report, I would judge that the risk remains zero or close to it. Add to that the statistical fact that your partner is not likely to have HIV (probably under one chance in a thousand and certainly under a 1% chance). Finally, you are correct that a negative AgAb (4th generation) HIV test at 4+ weeks is around 98% reliable.

As you may have seen, sometimes I offer a probability calculation. Here we go, using risks on the high side: Let's say there's a relatively high chance of 1% your partner has HIV. Further let's estimate 1 in 10,000 transmission risk if she did. (CDC has estimated 1 in 20,000 for unprotected oral sex, mouth to penis: I'm doubling that because of the traumatic aspect.) And then there's the 2% chance your 33 day test missed a new infection. The chance you have HIV calculates at 0.01 x 0.0001 x 0.02 = 0.00000002. That's one chance in 50 million that you have HIV. I hope you would agree that's zero for all practical purposes. (And if we use a more likely estimate for the chance your partner has HIV, your risk would be still 10 times lower, one chance in 500 million.)

So do you need additional testing? If personally I were in your situation, I wouldn't feel the need. But I'm not you, and some persons are more reassured by a conclusive test result than by professional opinion, no matter how expert or no matter how believable it seems. So if you're going to lie awake worrying and wondering, by all means have another test 6 weeks or more after the event. If you do it, of course you can expect another negative result.

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

HHH, MD

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40 months ago

Thank you for your reassurance with the terrific odds of being HIV free from the sexual encounter 8 weeks ago. I wanted to ask you my original questions because my primary care doctor told me to get retested when I saw him for my annual general check up. He said my 4th gen HIV test at 33 days was "too early" and that I should wait 3 months before retaking it just to be sure. Today, at Day 62, I took retook the HIV test and awaiting the results to send my doctor. When I get that conclusive result, I look forward to joining the thousands of inquiries you have received in you forums over 17+ years with similar questions who wound up not infected with HIV from their encounters described to you.

By the way, you mentioned in one of your other threads about donating to your organization. If I wanted to do that too, will this organization start sending mail to my home (which I want to avoid)? Thanks again for providing such a valuable service to the public for so many years.

H. Hunter Handsfield, MD

40 months ago

Thanks for the follow-up information. Sorry to hear your PCP is among the many who do not understand the current HIV tests. Three months to conclusive results is old news: 6 weeks definitely is conclusive for the AgAb (4th generation) HIV blood tests. (Officially, CDC says 45 days, but rounding it down to 6 weeks -- 42 days -- is equally valid.)

ASHA is a highly responsible organization, the nation's primary nongovernmental resource for STI/HIV prevention and other aspects of sexual health. Dr. Hook and I both are former members of the Board of Directors. I can guarantee they will respect your privacy. (What would be your recommendation and policy if you were in charge of an outfit that cares about sexual health? ;-) Visit the website and scroll around a bit; I think you'll be positively impressed: www.ashasexualhealth.org.

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40 months ago

Dear Dr. Handsfield: I am impressed after visiting the ASHA website and learned that the organization is starting its second century of service. Even the charity rating organization "Charity Watch" confers an "A" rating to ASHA for its ability to use its funds wisely. And yes, I made a donation to ASHA.

And yes, my HIV 4th gen test results came back today-- negative. Thank you.

H. Hunter Handsfield, MD

40 months ago

Congratulations on the test result -- glad to hear it, but of course not surprised!

Thanks for supporting ASHA. It's history is quite interesting, and can be interpreted as a microcosm of changing societal attitudes toward sex. It started as the American Social Hygiene Association, when "social hygiene" was a euphemism for moralistic, misogynistic, anti-prostitution programs. It's heart probably was in the right place as a reflection of societal attitudes, but many of those beliefs are now recognized for what they were. The last ~50 years have been honorable, but not so much before that. (Hygiene became Health around that time, and Social was replaced with Sexual about a decade ago.) Today ASHA is a superior agency in all respects.

That completes the two follow-up exchanges included with each question and so ends this thread. It sounds like the discussion has been helpful -- if so, I'm glad. Take care and stay safe.

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