One Second of Insertive Oral with Massage Lady

[Philly07]

Hi Doctors,

Thank you for taking the time to answer my question.

I had a sensual massage a few weeks ago.  I am married but have not had sex with my wife in over a year due to marital problems.  During the massage, the woman started touching my penis and then inserted it into her mouth.  I immediately stopped her.  I did not want to engage in any sexual activity at all.  It may have been in her mouth for a second or two at most.  I have not had any other risk in 10 years.

I am paranoid about this incident.  I have no idea about her oral health or anything else.  Afterward, I asked her if she was healthy and she said yes.  There was a bit of a language barrier.  

What is my risk for HIV?  What if she had gum problems or some small amount of blood in her mouth?  There was nothing noticeable.  Should I test?

If something suddenly changes with my wife, should I feel comfortable sleeping with her?  I do not want to infect her if there is any real possibility I was at risk from this incident.  

Thank you.

Philly07

[Philly07]

I looked at my test results a little more closely and, despite the fact that I ordered a p24 ANTIGEN test, they gave me an HIV antibody test with a Western Blot that included a P24 antibody test, so I guess it isn't "conclusive".  However, since it was over 28 days from the event (which it seems would have picked up most infections by that point), and you (and the knowledgeable folks over at AIDS Meds) said it was zero risk anyway, I will take that as a negative and move on.

[Philly07]

To no one's surprise (except for maybe mine), I just received by HIV Antibody/p24 test results and they are negative/non-reactive.  

I know the worried that run to this site cannot be the easiest to deal with Dr. Hook, but your advice did calm me a bit when I needed it.  Thank you very much.

[Philly07]

I will believe them.  Thank you Dr.

[Edward W Hook, MD]

You are over reacting and I think that the statement you quote is taken out of context.  To summarize what I have said earlier- the exposure you describe was virtually no risk for HIV and, when considered in terms of the time frame since your exposure, when you get the negative results that I am confident you will receive, you need to believe them  The 4th generation type tests have been rigorously studied and then evaluated by regulatory agencies including the U.S. FDA.  

I think it is time for this thread to end.  Your results will be negative. Please believe them.  EWH

[Philly07]

Hi Dr,  Can you tell me what the chances of a false positive test result is for the ELISA antibody and p24?  I read something on the HIV International Forum where the doctor said that false positives with the DUO or combo tests happen "far more often than people think." (he said that in response to someone who had a false positive).  I think a positive result would give me a heart attack.  I am only half kidding about that.

I took the test for peace of mind, but that comment gave me pause.  Thanks.

[Philly07]

Since I want to get this 100% off my mind asap, I took p24 and antibody tests today.  I should have the results within 72 hours.

Now that the blood is actually out of my arm, I am very nervous, despite the very calming advice you gave me, Dr. Hook.  I wasn't very nervous before, but just felt like the testing would completely rid me of the thought.

I will post the results when I have them.

[Philly07]

Thank you Dr. Hook.

[Edward W Hook, MD]

Yes, thisis the same as a 4th generation test. EWH

[Philly07]

Hi Dr. Hook,  One last question.  I just found that I can order an antibody and p24 test (though they are put through as separate orders) online and go to a testing center around the corner.  They are charged as 2 separate tests.

Is that effectively the same as getting a "4th generation" test (since I would be tested for the antigen and antibodies)?

[Philly07]

Thanks doctor.  Because I am a bit of a worrier, I will test at some point.  I guess I will try to find a 4th generation test.  If not, I will wait to take a regular antibody test.  They offer them at the local health department.

[Edward W Hook, MD]

If you must test, a "4th generation" (combination p24 antigen/HIV antibody) test would be most desirable.  It has a lower rate of false positives and is designed for diagnosis.  PCR is not. EWH

[Philly07]

Hi Dr. Hook,

One follow up question.

If I wanted to get an HIV test, is the DNA PCR after 28 days a good test to take?  I read about the possibility of false positives and that is scary to me.  I don't want to wait a few more weeks for an antibody test.   Is the risk of a false positive with that test high?

I know I have virtually no risk, but sometimes my brain gets the best of me.

Thank you.

[Edward W Hook, MD]

Glad to help. Take care. EWH

[Philly07]

Thank you very much for getting back to me, Dr. Hook.  I read too much internet and saw way too many misinformed "insertive oral sex is risky" type comments and made myself concerned.  Thanks for bringing sanity to the whole thing.

[Edward W Hook, MD]

When I said no risk of HIV from persons ue to oral sex, that includes persons with blood in the mouth, gum disease or sores in the mouth.  No risk at all from oral sex.  EWH

[Philly07]

Hi Dr. Hook, when you have a chance, can you please let me know how much blood would possibly have to be in a woman's mouth before there was any concern for transmission?  I am assuming just having gingivitis (of course I have no idea of she did) or the woman just having brushed her teeth and having a small amount of blood as a result of that is not enough.  I have been told before that you would have to have the kind of obvious bleeding that only a punch in the mouth could provide.  Do you agree with that?

[Philly07]

Thank you so much for the prompt response, Dr. Hook.  So, no crazy scenarios my mind can cook up such as blood in the saliva or a soaring viral load would change the fact that this is a no risk event?

[Edward W Hook, MD]

Welcome to our Forum.  There is zero risk of having gotten HIV from the brief exposure you describe and the risk of other STDs, both because of the brief duration of your exposure and the statistically low risk of transmission from oral sex is probably less tan 1 in a million.  I would not worry about risk of any STD, including HIV from the event you describe and would not let it curtail any future sexual activity you may choose to pursue.  There is really no medical reason for testing related to this exposure.  EWH