[Question #9794] Risk Assessment for HIV

29 months ago

Hi Doctor. I am a heterosexual man in Taiwan. I had my exposure on 2/4 , I received the oral sex with a CSW, but not sure if it was unprotected. The CSW said she had put on the condom on my penis already, yet I am worried she lied to me. I also receive anilingus. When she did the oral sex, she had iced and hot water IN HER MOUTH alternatively. The last exposure was she rubbed my penis with public hair.NO penetration in vagina at all. (100% sure)

After 25 days my throat did not feel well for (one day), recovered 20 minutes later after I took just one pill of Panadol, I also had nasal drip and coughing with sputum and then all recovered in less than 5 days. No fever, no rash, no severe muscle aches, no diarrhea, and no swollen glands . I need your opinions to make me reassure . Maybe I don’t need testing at all. Thanks

H. Hunter Handsfield, MD

29 months ago

Welcome back to the forum. Thanks for your past questions (a couple of years ago) and your continuing confidence in our services.

You're of course the only one who can know whether a condom was used: you were there and I wasn't! However, I do not understand why a CSW would say she applied a condom when that actually didn't happen; or how you would not know just by having your eyes open and/or how the exposure felt. And I don't understand why hot and cold water could make any difference in condom integrity (assuming that's why you mention it). It also seems you may have the common misunderstanding that unobserved or even microscopic defects in the condom increase the chance of HIV or STD transmission. They do not. If a condom doesn't break wide open, protection is complete.

In any case, this was a completely safe exposure in regard to HIV. Even with no condom, if your partner has HIV, the chance you were infected is nil. There has never been even a single case of confirmed HIV transmission oral to penis. A calculation by CDC, based on how people think they were infected (which often is wrong), is a risk of one chance in 20,000 if the oral partner has untreated HIV. That's equivalent to receiving BJs by infected (and untreated) partners once daily for 55 years before infection might be likely. And there is no risk from penile contact with the pubic area, and little or no risk known from analingus.

Finally, your symptoms: they came on too late to be due to acute HIV infection, the symptoms of which always starts within 2 weeks of catching the virus. And your symptoms are wrong: acute HIV doesn't cause nasal drip or congestion, cough, or sputum production. You had a cold, COVID, or influenza.

Therefore I agree with your concluding statement: you do not need to be tested for HIV. Of course you're free to be tested if you wish, but only for the reassurance of a negative result -- not because there is any significant risk.

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

HHH, MD

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29 months ago

Thank you Dr. Handsfield, actually I understand that I am at extremely low risk fo rHIV infection. However, I do need the opinions from experts like you to make me reassure and move forward.

Now with these comments I believe I can move forward and focus on my personal life goal. Really appreciate your comments and help~~~

H. Hunter Handsfield, MD

28 months ago

That's exactly the response I was hoping you would have. Thanks for the thanks.---