[Question #965] Oral Sex and need for PEP

50 months ago
Dear Dr. -- I am very worried because I am married and have recently quit my job in favor of a new job overseas in a country that will require an HIV test upon entry. Yesterday, I scheduled a massage with an escort. She was much more aggressive than I expected. She rubbed my penis on her vagina for about 30 seconds. More troubling, perhaps, is that she put herself in position for oral sex and allowed me to lick her vagina for about 30 seconds. She was quite wet. I spit as soon as we were done, but I may have swallowed a small amount of vaginal fluid. I have a minor gum issue from a few days ago -- No active bleeding, but still sore and tender. I went to the ER and they administered a dose of PEP and gave me a prescription for a month. However, i went to the pharmacy and the cost of PEP will be more than $2500 (my insurance doesn't cover). I don't know what to do, how worried I should be, or if I should still just fork over the money (with a credit card) before the 72-hour PEP window expires. I'm at 24 hours right now as I send this question. I found info about oral sex HIV risks online, but it's a couple of years old.  I don't know what the scientific literature looks like now. Based on my description of the event, can you offer a percent chance that I could have contracted HIV and would you advise (as the ER doctor did) doing a month of PEP? Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago
Welcome to the Forum.  I will be pleased to comment. If you were my patient I would not have prescribed PEP for you and would have told you not to worry.  Most commercial sex workers do not have HIV and even if your partner did, there are no proven cases in which men have acquired HIV from either receipt of oral sex or from performing oral sex on a an infected female sex partner.  Your chance of getting HIV from the exposures you describe is less than 1 in 100,000 (0.001%).  It is not something to worry about.  EWH
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50 months ago
Thanks, doctor! I'll avoid PEP. Very quick follow ups: Do you recommend I get tested for HIV at all? Also, there's a clinic near me that says it has a new rapid test with accurate results only 15-days after exposure/incident (as opposed to the normal 3-month window). Does such a test even exist? Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago

Glad to help.  If there was no penetration other than receipt of oral sex (even briefly) then there is no known risk for HIV.  there are no instances in which someone has gotten HIV from receipt of oral sex from an infected person. 

As for tests, many services will tell you that using PCR-type tests they can detect HIV infection reliably as soon as two weeks after exposure and this MAY be true but the data on this are modest.  The studies of PCR type tests are not nearly as extensive as studies of other methods.  This sort of testing is expensive compared to recommended testing and has not been studied as well as other methods.  The so called DUO tests which test for both HIV antigen and HIV antibodies reliably detect all infections at 4 weeks following infection and are most widely recommended.  EWH

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50 months ago
Thanks! Your most recent response suggests some confusion regarding my original question. I was worried about GIVING her oral (with a wet vagina...), not receiving. Does this change any of your advice or the percentage you mentioned? That'll be my last question. Thanks! 
Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago
You are right, I was mistaken but my advice remains the same.  There are no cases that I am aware of when anyone has gotten HOV from performing oral sex on an infected female partner.  Take care.  EWH
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