[Question #8795] Oral sex, risks, symptoms, should I have ever been worried??

39 months ago

Hello, I will state now that this will be perhaps overly verbose due to the nature of not wanting anything to be left to interpretation and to be as open and honest with you doctors as I can be since with holding any info would be counter intuitive.On Friday April 15th I met with a transexual (with penis) and gave him oral sex for 10-15 seconds. He had precum on his penis before I put my mouth on it but I believe I wiped / mixed it with too much saliva before hand (I spat on it for lubrication) since I was merely giving him a handjob before I made a lapse in judgement, something I never do. I licked his head and sucked it about little less than halfway into my mouth, never touching my gums (which bled due to brushing an hour before but it was just a drop or two). After that, there was no ejaculation in my mouth at all as he finished with just my hand. We did not have sex and he did not reciprocate giving me oral. They stated off handedly that they are healthy (or more so that they believe are healthy), I do not want to assume anyones status nor do I want to assume that this person is lying since they were very open and honest about being a transexual and the plights that brought and asked multiple times if that was ok. So I dont want to think anything less of this person.On a side note, the Tuesday after I did have unproteced vaginal sex with a woman who is 100% clean, I know that doesnt seem necessary to mention but I thought I'd do so to clear all my bases.After 2 days I got a bad stomach bug that I believe was only worsened by my anxiety and PTSD (this has happened before), and just yesterday I came down with a weird coldish feeling, no fever no nausea, no rash, but I did have minor sinus pressure and an occasional headache? (I was told ARS would be 10x worse than an average flu so I dont think this would be ARS?) but still the anxiety remains.

39 months ago

Now that that is out of the way my questions for you are

1. Did the duration of the oral sex put me at any less or any more of a risk than what is stated? (I've been told that the amount of time matters and doing it for such a short time is a 0% chance)

2. Did me covering the penis in my saliva 3 or so minutes before comitting to oral change those risks or odds

3. Do these symptoms and timing mean ARS or could they be something entirely different (to clarify the coldish feeling did not give me a fever my temp stayed the same I just felt hot and weird)

H. Hunter Handsfield, MD

39 months ago

The usual reason for blocking a user is that they continue to post anxiety driven questions, often about obviously low or zero risk exposures. That doesn't mean they are welcome to return with a new account. And these questions suggest you already know the answers, perhaps because of similar advice in the closed account. Hence very brief replies.

1) This counts as a very brief exposure, and even with prolonged prolonged oral sex events, HIV is rarely if ever transmitted.

2) Saliva rarely if ever transmits HIV.

3) Correct about ARS onset time; 2 days is much too soon. And your symptoms don't suggest ARS anyway.

If you would like to let me know your previous thread numbers, I may have additional advice -- up to you.

HHH, MD

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39 months ago

Thank you for your prompt response and I do understand why the brief response. I just want to clarify this is a different event entirely from my original. I wouldn't say its anxiety but its more wanting to talk to someone who knows much more than I and Google does.

My follow up questions

1. Does this mean I do not need to be tested?

2. My question is not if my saliva transfers it, its if my saliva on her penis due to gving a HJ before hand deactivates the virus, since some answers on this board has said that it does ,but I want to be sure. And to be extra clear it was pre cum not actual cum

My previous thread was

Question #6962 about 2 years ago

H. Hunter Handsfield, MD

39 months ago

Thanks for the additional information and your previous questions -- which also included 6952. You were not blocked from posting -- my mistake. I think your first thread was closed simply because you all the follow-up comments or questions included with each original question. Sorry I made the wrong assumptions.

1. An exposure of this very low risk doesn't need HIV testing. But of course you are free to be tested if the negative result would help you feel better; many anxious persons are more reassured by negative test results than by professional opinion, no matter how expert. So it's up to you.

2. There are no data on how much saliva exposure is required to inactivate HIV. I would guess that the presence of saliva in this situation makes no difference. There also are no data on HIV transmission risk via pre-ejaculate fluid (pre-cum) compared with semen -- although logically semen is higher risk for most exposures, simply because there's usually much more of it.

Given the nature of this exposure, and your past sexual history as noted in your previous questions, I would advise you to stop relying on casual statements or partner appearances, like "she said she is healthy" to judge whether or not a potential partner might have HIV or other STI. Ask directly! Nobody should be having sex with a new partner without first asking directly about HIV status. (Some have called this a "Do ask, do tell" strategy.) And then avoid risky sex with those who are positive and not on treatment, don't know, or seem evasive in their replies. Second, perhaps you should consider taking pre-exposure prophylaxis with anti-HIV drugs. Although this particular event was too low risk to need PrEP, in the past you caught chlamydia, which indicates a higher risk exposure, which in turn suggests that in the future you might be tempted to have riskier exposures again. You might look into PrEP "on demand", in which one only needs 3 doses of drug, one before and two more doses after a high risk exposure.

Let me know if anything else isn't clear.

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39 months ago

I do thank you for your understanding and quick answering of my questions Dr. As stated this was sadly a bad lapse in judgment in the heat of the moment and I do agree I should not take such statements at face value and I am currently in contact with this person to follow up on whether or not they ever had HIV to begin with. I personally will no longer be engaging in such acts like this one due to the mental and somewhat physical toll it has taken on me twice, but I do thank you for your advice!

My last question is a general one but knowing science I know the answer can change so apologies if it has not. I read on an older question that the risk of getting HIV through oral is one in 10,000 exposures (if the person is positive) has that changed? If so what has changed it and what makes the risk more or less?

Either way I do greatly appreciate your time and patience with me and I will hopefully not need to ask any more of these questions out of anxiety ever again. Thank you again and hope you have a wonderful day!

H. Hunter Handsfield, MD

39 months ago

The estimate of 1 in 10,000 is for the oral partner, performing oral sex on a male partner, and assumes ejaculation in the mouth. The estimate comes from CDC, and has not changed in several years. As a reminder of how low that risk really is, one in ten thousand is equivalent to giving BJs to infected men once daily for 27 years before virus transmission would be likely. And your risk is even lower, since he did not ejaculate in your mouth; and of course would be zero if he doesn't have HIV, or if he has it but is taking effective anti-HIV treatment.---

39 months ago

Hello, I wasn't sure if there another follow up here or not. I apologize if I left this open by accident.

I guess I can ask another general question. May I ask what exact symptoms there are and their severity? Since Google is so vauge that one can easily get anxious/confused by them

Is it true that most if not all infected men show symptoms while most women don't?

Finally for my own mind, do my symptoms of mild sinus pressure, runny nose go towards any sort of ARS? (I also get nauseous but that's only when I eat too much / or eat unhealthy)

Thank you for the final follow up and hope you have a good day.

H. Hunter Handsfield, MD

39 months ago

Indeed the intent was to close this thread. But no problem in briefly addressing these issues.

It's generally best to just ignore ARS symptoms, and to not search online. Most sites that list symptoms do just that: list every possible symptom, but say nothing about the usual patterns and combinations of symptoms, or which symptoms are more important than others. Typical symptoms are fever, sore throat, enlarged lymph nodes, and skin rash -- but most people with these have causes other than HIV. Nasal congestion, runny nose, and sinus symptoms usually are not present in ARS. And at least half of people with new HIV have no symptoms at all. For these reasons, symptoms almost never are useful in judging whether or not someone has HIV.

I am unaware of any data that symptoms are more common in men or women.

Thanks for the thanks. Going back to the title of your question, "Should I have even been worried?" Nope, not at all. Do your best to move on without worry!

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