Brief vaginal insertion and cunnilingus

[kristover]

Hello Doctor:

I am not very sexually active (2 women in 15 months including this encounter) I’m a white male, 34 in Tampa, FL and was recently with white women of 29, one time (who claims that I have nothing to worry about). I penetrated her for approximately 5 seconds, 10 seconds max, unprotected, and then a condom was used. Prior to that I did unprotected cunnilingus on her for two or three minutes, which from what I have read is very low risk. I have very good oral hygiene and did not notice any abnormalities on her.

1. How much risk is involved with such a short unprotected vaginal penetration?

2. With only vaginal fluids (no visible blood) and excellent oral hygiene should I even think twice about any transmission of HIV?

3. If I choose to get tested should I wait the full 12 weeks in this case?

4. Should I continue wish my usual sexual partner without cause for worry?

5. Would it be a good idea to get her commit to a mail in test (Express HIV-1)?

6. Is there an early results test that I can count on to a fairly high percentage of accuracy? Meaning an HIV test that I can take within days or weeks of the encounter that could provide peace of my to a fairly high percentage rate?


Thank you for your time

[Edward W Hook, MD]

I presume from your note that the partner you did not mention is a regular partner about whom you do not have any concern.   Overall your risk of a single brief encounter with an American, white woman of unknown HIV status is very, very low.  The reasons I say this are as follows:

A.  She said you had nothing to worry about.  while you did not elaborate on why she said this, most people do tell the truth..
B. On a statistical basis, a white woman living in the U.S. has a less than 1 in 1000 chance of having HIV and if she is not an IV drug user, the risk is lower still.
C.  The risk of a single unprotected exposure to an HIV infected partner (remember, odds are your partner was not infected) is also less than 1 infection per 1000 exposures.  There are no studies to tell us how the duration of infection changes this estimate but common sense tells us the shorter the exposure, the lower the risk.
D.  Thus putting the odds stated in B and C together, on a statistical basis your risk of getting HIV from the exposure you describe is less than 1 in a million.

Now, on to your questions:
1.  See B above - very low.
2.  The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.
3.  In your situation, a test at 4 weeks, which will detect over 95% of infections acquired 4 weeks earlier, should be taken as evidence that you did not get infected through your exposure of concern and give you complete confidence that you did not get HIV from the exposure you mentioned.
4.  You really have little to worry about.
5.  If you can get her to get tested, she will get her result in about a week.  I anticipate the result would be negative.  You cannot get HIV from an uninfected person, thereby providing you with complete confidence you did not get HIV.
6.  See above.  A standard HIV blood test at 4 weeks should be sufficient.

Hope this helps.  EWH

[Edward W Hook, MD]

You can test for gonorrhea nad other STDs any time more than 2 days following your expsoure.  If you have gonorrhea it could increase your risk, about 2-3 fold (i.e. from a 1 in 10,000 chance for oral sex to a 1 in 3-5,000 chance, still relatively low(), IF your partner was infected, something which is unlikely.

Please try not to worry too much about this- your risk is low.  EWH

[kristover]

Doctor,

Could you also tell how much the risk of HIV transmission is increased if a gonorrhea infection occurs as well?

How soon after the encounter can I test for gonorrhea, and if treated for it will that increase the time frame for the HIV test?

Sorry to add more questions, I didn't think of these until now. Like most people on here I get quite worried about this.

Thank you once again.

[kristover]

Thank you for clarifying

[Edward W Hook, MD]

Given the relatively low risk nature of your encounter and the fact that a four week test would be expected to detect more than 95% of infections acquired 4 weeks earlier, a single tet at 4 weeks should suffice and there is little to be gained by further testing.  EWH

[kristover]

Sorry forgot to add -

That being said should that make my 4 week conclusive?

Everything else I get checked regularly.

[kristover]

Immediate testing and 4 week testing?
My other partner definitely is no risk.

[Edward W Hook, MD]

There is there in your history or description to cause me to recommend immediate testing to further sort things out.  On the other hand, you describe unprotected sex with two partners.  Thus you qualify for periodic HIV/STD "screening (testing in the absence of symptoms) because you have had multiple partners over a period of less than a year.  As a matter of personal protection, we recommend annual testing for anyone who has had two or more sex partners in the past year (we consider this to be health maintenance- we also recommend you get your blood pressure and cholesterol checked regularly).  I think testing is a rasonable thing to do.  EWH

[kristover]

Thank you Dr. Hook

Just one more thing to clarify for me and I'll have no more questions.

I believe that you’re saying with my very low risk encounter and a 4 week negative test, I should consider that totally conclusive?

Other than my own edification would you even recommend a test?

Thank you for all your experience and help.

[Edward W Hook, MD]

I have little direct expeience with Home Access testing but if it is FDA approved, it's performance should be similar to other, clinic based tests.  the clinic based tests however, in most instnaces will give results quicker and with less expense to you.  EWH

[kristover]

Thank you Doctor

Sounds like I should go about my daily life, even if I had a brief exposure.

When you say a standard blood test, would that include the FDA approved Home Access Express HIV-1 mail in test that gives you results the next business day, or should I get tested at a testing clinic?

Thank you