It's been almost 7 months since my last question and forgive me if this is repetitive but in researching some more recent questions by other users I am wondering if any data has changed and would very much like your risk assessment and what if any testing might be needed.

I gave unprotected cunniglingus to a CSW two days ago with female ejaculation and received unprotected fellatio.  It was strictly oral sex for the two of us nothing more.

What are my risks for STI's including HIV and others.  Do you suggest any initial testing and/or testing down the road.

Sorry to bother with another question but concerned.  I noticed some language that there may be some cases though rare of HIV transmission to the giver so curious how concerned I should be.

Thank you.

The data have not changed and I don't know what "language" you saw that concerns you. To my and Dr. Hook's knowledge, there have been no reported cases of HIV infection that apparently were acquired by cunnilingus, by either the oral or the vaginal partner; or by fellatio from the oral to penile partner. That's not to say it can never happen, but we can be confident it is exceedingly rare. One estimate calculated and published by CDC is a possible risk of one chance in 20,000 exposures, if the other partner is infected. That would be equivalent to performing cunnilingus or receiving a BJ with infected partners once daily for 55 years before transmission might be likely. Given mutual oral sex, you were exposed both ways, so perhaps the risk would be double, i.e. one chance in 10,000. And this is if your partner has HIV -- and in the US, on average probably around one in a thousand female CSWs has HIV.

Other STI risks are higher but still low. The most important is gonorrhea if your partner had an oral infection. Herpes, nongonococcal urethritis, and syphilis also are potentially transmissible -- but the chance is low for all these for any single exposure.

So you really shouldn't be seriously concerned at all, and for sure not about HIV. We generally never recommend HIV/STI testing after any single encounter unless the risk is a lot higher than you describe here -- for example, if one partner has known infection. But some anxious persons are more reassured by negative test results than by professional opinion, no matter how expert. If you'll sleep better having had negative testing, of course you are free to be tested. In that case, I would recommend only urine for gonorrhea and chlamydia, valid any time more than 3-4 days after the event; and blood tests for syphilis and HIV 6 weeks afterward.

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

HHH, MD

I may have misinterpreted the language I was referring to.  In another thread, I had seen Dr. Hook reference this line: There are a handful of cases in which HIV may have been acquired from cunnilingus.  That was what I was referring to.  But in re-reading it maybe the key words "may have" show it may not be proven but it slightly concerned me. 

For my clarity, if I was your patient and with the events described, would you recommend testing for any STI's referenced above or do you believe the risk is low enough to not warrant testing.  Assuming I was not anxious about the event.

Finally, though its only been 3 days since the event, would any symptons present themself and when would they typically appear which I should be on the lookout for and if such symptons occur maybe then testing should be done.

Welcome your thoughts and again many thanks!

We generally recommend against HIV/STI testing after any single exposure unless the risk is particularly high, like sex with a known infected partner, and for sure not with patently low risk events of the sort you experienced. Smarter to just test routinely from time to time, e.g. once every few months or annually, depending on the frequency of exposure. If it has been a while since you had testing, perhaps this is a good time, when it's on your mind -- but not because of this particular event.

The only potential symptoms from this event would be urethral discharge or painful urination, which could start from 2 days (gonorrhea) to 2 weeks after exposure (NGU); or penile blisters/sores (herpes), usually within a week. Syphilis chancre (penile sore) up to 6 weeks. If you feel you must be tested for the anticipated reassurance of negative results, have a urine gonorrhea/chlamydia test any time 3-4 days after exposure and syphilis (and maybe HIV) blood tests at 6 weeks. But if somehow I were in your situation, I definitely would not be tested, assuming no symptoms of the sort just mentioned; and I would continue unprotected sex with my wife without worry.

Does the fact that I had contact with vaginal fluid in the mouth change any of the risk here for HIV or other STD's?  And though I don't believe I had any cuts or sores in my mouth, many months ago I had a biopsy done on my inner lip and it never healed 100% so that too is giving me pause.  Its now been about 5 days and no STD symptons we have been discussing below though I understand its still early on.  I understand this is my final question and I do appreciate all of your insight and guidance.

You are serious over thinking all this. You were at little or no risk, period. Do your best to move on without further worry.

That concludes this thread. I hope the discussion has been helpful. Bet wishes and stay safe.