HIV - Prevention Expert Forum
Possible Exposure
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Possible Exposure

Hey Doctors,

I would like to start off by thanking you for taking my question. I am worried over an exposure I originally felt was low to no risk. I went on two dates with a guy and each night we engaged in deep, open mouth kissing. I know during both instances there was an exchange of saliva and we kissed periodically throughout both nights. My concern is that the first night my throat was a bit scratchy. On the second night I had a full sore throat. So, I kissed him with both a scratchy throat on the first night and a regular sore throat on the second. In order to calm my nerves I asked him his status a few days later. He just got quiet and didnt respond so I can only assume he is positive. Would deep kissing an hiv positive guy while having a sore throat be a risk? Do I need to get tested? We also kissed each others necks, cheeks, bodies and engaged in genital touching. I did feel his pre-cum on my fingers but wiped it off. Are any of these exposures a cause for concern? I have read that even canker sores and other blemishes in the mouth are not a cause for alarm but have never heard of a sore throat. Any advice you can give me would be appreciated. Thanks again. Patrick
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Welcome to the HIV forum.  I'm glad you used your name at the end; until then, I couldn't tell  whether you were male or female.  The risks of HIV are far higher, as you undoubtedly know, among men who have sex with men (MSM) than straight men and women.

I agree that your partner's evasiveness when asked his HIV status suggests he likely is infected.  In the future, I would advise you to ask that before getting involved, even at the kissing or other no-risk level, e.g. mutual masturbation, frottage (body rubbing), etc.  Not because kissing or these other actitivies are risky; they are not.  But because one thing can rapidly lead to another, and intentions for safe sex often go out the window in the heat of the moment.  Therefore, among MSM frank exchange of HIV/STD status is imperative before any physical contact, not after it gets underway.  And of course the corollary is that you won't go ahead with any contact -- and absolutely not with unprotected anal sex -- with those who are positive, don't know, or, like your partner, are evasive about it.  Take that lesson to heart, and you'll go a lifetime at low risk for HIV.  Ignore it and there's a good chance HIV is in your future.

OK, lecture over.  The fact is that HIV has never been known to be transmitted by kissing.  That's not to say it is impossible.  But in the 30 years of the known HIV/AIDS epidemic, few if any HIV/AIDS experts have ever seen an infected gay/bi man (or any other patient) whose only possible exposure was kissing.  The same is true of genital touching, body rubbing, etc. It just doesn't happen.  Among other things, saliva inactivates HIV.  The presence of a sore throat at the time of the exposure is not likely to make any measurable difference in risk.  Just think about it:  at any one time, millions of people have sore throats. Thus, over the years there must have been millions of kisses when one person or the other had a sore throat.  And still no mouth-to-mouth HIV transmission. So logic tells you that even with a sore throat, kissing carries little if any risk.

Here is a thread you might want to look at, explaining why HIV and other STDs are (and are not) transmitted in certain ways.  Start reading with the follow-up comments that start December 14:  http://www.medhelp.org/posts/show/1119533

I hope this helps put things in perspective for you.  Stay safe--  HHH, MD
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Dr. Handsfield,

Thank you so much for taking the time out of your busy schedule to provide me with your expert knowledge. I am definitely reassured by your assessment of the situation and will be putting this behind me. My last remaining question is if you believe testing is warranted after this episode. Although your post makes it quite clear that this is an extremely low risk situation (probably as close to no risk as you can get), I would still appreciate your advice on testing. Once again, thank you so much for your expertise.
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This may surprise you, but my view is that testing usually is not warranted after the large majority of exposure episodes, even unprotected genital sex with high risk partners.  Of course there are exceptions, e.g. unprotected anal or vaginal sex with a partner known to have HIV.  But for the most part, the smarter approach is for sexually active people (outside mutually monogamous relationships that really are monogamous) is to have a test at regular intervals, without worrying so much about individual events.  For the gay man having frequent sex with multiple anonymous partners, every 3 months or even every 2 months wouldn't be too often.  For most people, every 1-2 years might make sense.
If the events described here are typical of your sexual lifestyle and that style doesn't change, an HIV test every 2-3 years might be about right.

Of course risk assessment per se isn't the only consideration.  People who are frightened usually are better off being tested, since verbal reassurance doesn't quite cut it. But only each individual -- this includes you -- can decide what it best for them.

So from a purely risk assessment perspective, you don't need testing.  But you're free to do it if you wish. We don't hold hands on this forum.  
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
University of Alabama at Birmingham
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