Oral sex and HIV....again

[darksamy]

Dear Doctor,

I am a 25 years old man and I had a low risk encounter with another man about 4 weeks ago. I gave him an oral but he didn't ejaculate in my mouth. However I think that I might have been exposed to his pre-c**. As far as I remember I didn't have history of gum and mouth diseases. I've read essentially all related forums and I know that my risk is very low (1 in 10000) but I still have some concerns that I would appreciate if you can help me with:

1- Is 1 in 10000 a theoretical figure? I mean is it practically possible to contract HIV through only one-time oral sex? prior this incident I only had protected sex.

2- The lymph nodes under my jaw started to become a little swollen after about 2.5 weeks of exposure (confirmed by my doctor) and they are still swollen but I think not a large as before. All other nodes, armpits and groin area are not swollen. I didn't have any fever and sore throat but I had a very mild headache which could have been due to my sinus problems which is also bothering me with my ears now. my question is that is it possible that I am experiencing ARS? It's just that the timing is very concerning. Also only last night I woke up with a night sweat.

3- About ARS again, is it possible to have only one symptom? and more specifically only lymph nodes in under jaw area?

4- I am going to get tested at 4.5 weeks after exposure. How confident my results would be? and given the fact that I have OCD and Hypochondria with this whole issue, is it advisable to do a rapid test (regards to accuracy compared to ELISA)?

Thanks very much for your help and sorry for the long post.

[Edward W Hook, MD]

1.  False positive tests for HIV are very, very rare.
2.  No, the swollen glands in your neck do not change the risk of false positives one way or another.  EWH

[darksamy]

Thanks for your comments. I want to get tested today (5.5 weeks post exposure) and I have few question about testing which I hope that you can help:

1- What is the risk of getting false positive results in a common blood test? Specifically what is the risk in ELISA test and Western Blot?

2- I still have minor swollen lymph nodes on my neck (although much smaller in size compared to 3 weeks ago) and if based on your opinion, this is not necessarily due to HIV, it must be because of other viral infection. Is this going to change my results? in other words is it possible to get false positive results because of this?

Thanks for you help.

[Edward W Hook, MD]

If you have a negative test at 4 weeks, it greatly shifts the odds that you have HIV.  I think your risk is minimal and doesn't warrant concern.  If you are comfortable with my advice, wait till 6 weeks.  On the other hand, if your anxiety is debilitating, then a test at this time might help you to overcome the anxiety.  Your call.  EWH

[darksamy]

Thanks for your quick response. I know that thinking about ARS symptoms is a waste of time but it is also very difficult to not think about them when it is such an important issue. But again thanks for you help and I will try to not think about it. Just one more question, do it think it is better to do a 4 weeks test and then follow it up at 6 and 12 or should I just do the 6 and 12 weeks test?

[Edward W Hook, MD]

You have clearly read some of our earlier threads so I will go directly to your questions, all of which have been asked and answered repeatedly on this site.  The answers can readily be verified by looking at other threads:

1.  This is based on numerous epidemiologic studies. The results of all scientific studies lead to estimates as there is no absolute answer.  Some studies suggest that oral sex is a no risk exposure for HIV; we tend to be more conservative, stating that it is very, very low risk.
2 & 3.  You have seemed to missed our repeated statements that the symptoms of the ARS are TOTALLY non-specific and when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes. In contrast, over a given year, there is almost no one who has not had a viral illness, night sweats or both (sometimes on multiple occasions).  In addition, it is also important to realize that many persons who acquire HIV do not experience the ARS.  For a person to try to judge their HIV risk based on "ARS symptoms" is a waste of time.  Your swollen lymph node and night sweat may represent a community acquired, non-HIV viral infection but are most unlikely to be ARS.
4.  The results of rapid tests are as reliable as the more traditional tests sent to laboratories.  At 4 weeks post exposure, studies tell us that the results will detect 75-80% of all persons who had acquired infection.  At 6 weeks the figure is up to 95% and by 12 weeks virtually all infections that are going to occur will be detectable.  
Hope this helps.  EWH