[Question #8800] Oral and Testing
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39 months ago
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Thank you for the service that you offer with this forum. I have read many replies and have had some reassurance but want to ask for more clarification.
My case in brief: I'm a male in my mid-30s and around two months ago, I visited a massage parlor in Dubai, and at some point, the female Indian "masseuse" gave me unprotected oral sex. I am unfamiliar with her HIV or other STI status and assuming the worst has led to an anxious two months. The oral exposure lasted for approximately 30 seconds and when I felt that I was close to ejaculating, I asked her to stop and managed to hold my orgasm. I ejaculated a few minutes later onto my torso. She also used her body in the massage and gave me a handjob at the end but I am not concerned about those no-risk exposures. Afterward, I showered and left with no other exposure. On day 7, I got a full STD pack test: HIV, Syphilis, Herpes, and chlamydia blood tests, & urine bacteria culture test (I believe for chlamydia and gonorrhea). All were negative. On day 27, I had a urinalysis and urine bacteria culture test (not specifically testing for STIs). No bacteria growth was found. On day 33, I had a 4th gen combo HIV test. It was negative.
My questions:
1. What is the risk for HIV infection from this one-time encounter? I know the risk has been calculated at 1 per 20000 but is there a basis for this estimate? I have read on this forum that there have been no proven documented cases of mouth-penile HIV transmission - is this still the case in 2022?
2. Given the low-risk encounter and HIV-negative test on day 33, can I consider this result conclusive and move on? Do you suggest another test at 6 weeks? Given my current work location, this would mean traveling to get the test done.
3. Is the urine bacteria culture conclusive at 27 days, even though the lab was not looking for STIs specifically? I have had no penis discharge or pain while urination.
4. Do I need to get tested again for Syphilis, Herpes, or other STDs? I have not seen any wart
My case in brief: I'm a male in my mid-30s and around two months ago, I visited a massage parlor in Dubai, and at some point, the female Indian "masseuse" gave me unprotected oral sex. I am unfamiliar with her HIV or other STI status and assuming the worst has led to an anxious two months. The oral exposure lasted for approximately 30 seconds and when I felt that I was close to ejaculating, I asked her to stop and managed to hold my orgasm. I ejaculated a few minutes later onto my torso. She also used her body in the massage and gave me a handjob at the end but I am not concerned about those no-risk exposures. Afterward, I showered and left with no other exposure. On day 7, I got a full STD pack test: HIV, Syphilis, Herpes, and chlamydia blood tests, & urine bacteria culture test (I believe for chlamydia and gonorrhea). All were negative. On day 27, I had a urinalysis and urine bacteria culture test (not specifically testing for STIs). No bacteria growth was found. On day 33, I had a 4th gen combo HIV test. It was negative.
My questions:
1. What is the risk for HIV infection from this one-time encounter? I know the risk has been calculated at 1 per 20000 but is there a basis for this estimate? I have read on this forum that there have been no proven documented cases of mouth-penile HIV transmission - is this still the case in 2022?
2. Given the low-risk encounter and HIV-negative test on day 33, can I consider this result conclusive and move on? Do you suggest another test at 6 weeks? Given my current work location, this would mean traveling to get the test done.
3. Is the urine bacteria culture conclusive at 27 days, even though the lab was not looking for STIs specifically? I have had no penis discharge or pain while urination.
4. Do I need to get tested again for Syphilis, Herpes, or other STDs? I have not seen any wart
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39 months ago
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I reached my limit so I will add other questions in the follow-up comments after the initial response. Thank you
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39 months ago
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I forgot to mention that since the exposure, I may have had swollen lymph nodes in my neck and armpits (about 4 weeks after exposure), but no other significant ARS symptoms. When are swollen lymph nodes a symptom of HIV infection?
Also, since the exposure, I have had protected vaginal sex with my partner 4 times at various intervals, but no other exposures such as oral or anal. Each time, I pulled out before I ejaculated into the condom. She has recently developed a sore throat and has diarrhea. I am very worried that I might have passed on HIV to her. Is this possible?
Thank you again.
Also, since the exposure, I have had protected vaginal sex with my partner 4 times at various intervals, but no other exposures such as oral or anal. Each time, I pulled out before I ejaculated into the condom. She has recently developed a sore throat and has diarrhea. I am very worried that I might have passed on HIV to her. Is this possible?
Thank you again.
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Edward W. Hook M.D.
39 months ago
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Welcome to our forum and thanks for your questions. I’ll be glad to comment. In general receipt of oral sex is amongst the lowest risk penetrative sexual encounters one can participate in. Acquisition of STI‘s from receipt of oral sex is relatively uncommon and there are no proven instances in which HIV has been acquired through receipt of oral sex. Furthermore, context is important, and the STI rates in Dubai, even among commercial sex workers, is low. With this background let me provide specific answers to your questions:
1. The one and 20,000 risk for HIV acquisition estimate is just that, an estimate, and they conservative one at that. I am not aware of any proven cases in which HIV has been proven to be acquired through receipt of oral sex.
2. Although technically your HIV test results for ruling out acquisition of HIV would not be conclusive until 42 days following your exposure, given the circumstances and the lack of evidence that HIV is acquired through receipt of oral sex, I would not be concerned and we’re are you and I would not feel the need for further testing.
3. Your seven day STI test results were conclusive and did not need to be route repeated, perhaps with the exception of Syphilis testing. I see no reason for further testing for gonorrhea, chlamydia, etc. With regard to Syphilis, acquisition of syphilis is quite rare following oral sex but it does occur. The incubation period for development of a positive syphilis blood test is between four and six weeks. I would encourage you to have a repeat syphilis blood test at some point more than 4 to 6 weeks following your encounter just to be absolutely sure that you did not acquire Syphilis (which I believe is most unlikely).
4. See above. We specifically recommend against blood tests for herpes as these tests are notoriously unreliable and give both false negative and false positive results. Since you have not developed lesions suggestive of herpes in the interval since your encounter, I would advise you not to worry further and to not have blood testing for herpes performed.
With regard to your follow on questions, swollen lymph nodes are a notoriously nonspecific finding and if a blood test for HIV is negative at the time swollen the notes are detected, one can be sure that those swollen lymph nodes are not due to HIV.
I see no reason for you to be concerned about exposure of your partner to HIV.
I hope this information is helpful to you. As you know you have for up to follow ups which can be used for clarification. Take care. EWH
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39 months ago
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Thank you for your reply Dr Hook This is very helpful and reassuring.
I have a few follow-up questions.
1. More than 7 weeks have passed since the exposure, so if I were to get tested again for HIV, would you suggest a NAT PCR or just a 4th gen test? How accurate are results at 33 days? Have you ever seen a false negative HIV 4th gen at 4-5 weeks?
2. Thank you for your reassurance that I shouldn't be concerned about my partner getting HIV. Is your assessment due to the low-risk exposure, negative 4th gen at 33 days, or that the sex was protected? In general, is there any danger of HIV exposure when condoms are used for vaginal sex? I'm concerned about her symptoms, hence the follow-up questions. Does the same apply to possible infection for syphilis (I won't be able to get tested for another few weeks or so)?
3. are there any other STDs that I should get tested for, following this exposure?
I have a few follow-up questions.
1. More than 7 weeks have passed since the exposure, so if I were to get tested again for HIV, would you suggest a NAT PCR or just a 4th gen test? How accurate are results at 33 days? Have you ever seen a false negative HIV 4th gen at 4-5 weeks?
2. Thank you for your reassurance that I shouldn't be concerned about my partner getting HIV. Is your assessment due to the low-risk exposure, negative 4th gen at 33 days, or that the sex was protected? In general, is there any danger of HIV exposure when condoms are used for vaginal sex? I'm concerned about her symptoms, hence the follow-up questions. Does the same apply to possible infection for syphilis (I won't be able to get tested for another few weeks or so)?
3. are there any other STDs that I should get tested for, following this exposure?
Thanks
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Edward W. Hook M.D.
39 months ago
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Thanks for your follow-ups. Straight to my replies:
1. 4th generation, combination HIV antigen/antibody tests are entirely conclusive at any time more than 6 weeks following an exposure. There is no need for a PCR test. Personally, I have never seen or even directly heard of a false negative 4th generation HIV test occurring at any time after 4 weeks.
2. Condoms are highly although not quite perfect protection against HIV when used throughout sexual encounters. Perhaps slightly less protective against syphilis which is both more infectious than HIV and which may cause infectious lesions on parts of the genitals not protected by condoms. That said, the risk of syphilis in an exposure of the sort you described is miniscule and not something I would spend a lot of time worrying about. Repeat testing, like repeat testing for HIV will largely be for the reassurance it provides and will be conclusive when performed.
3. No, not in my opinion
EWH
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39 months ago
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Hello Dr Hook.
I didn't really want to come back to this forum, but anxiety has been getting the better of me in recent days. I've recently (around 7 weeks after exposure) developed swollen lymph nodes in my neck, jaw, armpit (this one is painful, others are not painful) and groin. I don't have any other 'symptoms' but as I can't get tested again for another 2 months or so given my work location, I'm freaking out. So based on your extensive years of experience, I'm hoping you can help with some follow-up questions.
1. What is the likelihood that I'm experiencing HIV symptoms around 6-7 weeks after exposure (as most agencies say symptoms typically appear 2-4 weeks after exposure)? How often are swollen lymph nodes the only symptom of HIV infection? Is it normal for them to flare up suddenly and then subside at certain body locations?
2. I know that HIV-2 is rare, but given that my exposure was with an Indian woman who may have had clients from India or West Africa, how likely is it that I might have contracted HIV-2? I understand that most duo 4th gen tests don't pick up HIV-2 antigens only antibodies - is this true? How likely is it that HIV-2 symptoms are delayed until 6-7 weeks after infection, and that both HIV-1 and HIV-2 antibodies were negative 33 days after exposure? What are the risk percentages of becoming infected with HIV-2 from insertive oral sex (unprotected)?
3. Could these swollen lymph nodes be symptoms of syphilis? Testing is not really possible right now, so should I take doxy as a precaution? I may or may not have a chancre (it's very small and I'm not very familiar with what it should look like)?
Thank you again and sorry for having to come back here
I didn't really want to come back to this forum, but anxiety has been getting the better of me in recent days. I've recently (around 7 weeks after exposure) developed swollen lymph nodes in my neck, jaw, armpit (this one is painful, others are not painful) and groin. I don't have any other 'symptoms' but as I can't get tested again for another 2 months or so given my work location, I'm freaking out. So based on your extensive years of experience, I'm hoping you can help with some follow-up questions.
1. What is the likelihood that I'm experiencing HIV symptoms around 6-7 weeks after exposure (as most agencies say symptoms typically appear 2-4 weeks after exposure)? How often are swollen lymph nodes the only symptom of HIV infection? Is it normal for them to flare up suddenly and then subside at certain body locations?
2. I know that HIV-2 is rare, but given that my exposure was with an Indian woman who may have had clients from India or West Africa, how likely is it that I might have contracted HIV-2? I understand that most duo 4th gen tests don't pick up HIV-2 antigens only antibodies - is this true? How likely is it that HIV-2 symptoms are delayed until 6-7 weeks after infection, and that both HIV-1 and HIV-2 antibodies were negative 33 days after exposure? What are the risk percentages of becoming infected with HIV-2 from insertive oral sex (unprotected)?
3. Could these swollen lymph nodes be symptoms of syphilis? Testing is not really possible right now, so should I take doxy as a precaution? I may or may not have a chancre (it's very small and I'm not very familiar with what it should look like)?
Thank you again and sorry for having to come back here
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Edward W. Hook M.D.
39 months ago
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As you know, we provide up to three responses to each client’s questions. This is my 3rd response. The thread will be closed shortly after this response.
1. As I’ve already said, lymph node swelling is notoriously nonspecific. You’ve proven you did not acquire HIV. If the swelling continues or progresses, you should be evaluated by a trained clinician without concern that your symptoms are due to HIV. When lymph nodes are swollen due to HIV, there are rarely uncomfortable.
2. You are correct that HIV-2 is quite rare. Further, your negative test for HIV-2 antibodies at 33 days is strong evidence that you did not acquire infection from your virtually no risk exposure. As I’ve already told you, there are no proven cases in which anyone has acquired HIV of any sort from receipt of oral sex or masturbation.
3. Your symptoms are not suggestive of syphilis.
Hope this helps. Please don’t worry about HIV or other STIs from the exposure you described. End of thread. Take care. EWH
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