Questions about ORAL

[anxious211]

I am a straight male, otherwise healthy in a mutually monogamous relationship. I met up with a friend (gay male) I've known for 4 years. It was my first such encounter. We engaged in mutual unprotected oral sex, however there was no ejaculation in either direction. I performed oral sex very briefly and don't believe/recall there was any pre-cum, in fact, it was hard for him to "get it up." He also anal fingered me for roughly 20 seconds. When I received oral, there was some spit involved and it was for longer, prob 3 minutes.

I have no reason to believe he has HIV, and in fact when asked, assures me he is "clean" and hasn't done anything risky since his last test a few months ago. He is quite promiscuous with other men, though he claims he always uses protection.

A day or two after, I developed a runny nose and fatigue. By about day 4/5, felt worse, developed a sore throat, sneezing, sinus issues. Had some blood in my snot, and went to an ENT. I also felt that my lymph nodes in the neck were swollen, and quite painful. The doc confirmed the swollen/painful lymph nodes, and after a nasal endoscopy said I had what looked like acute sinusitis, some pus on the back of my throat that's irritating my sinuses, and prescribed 10-day course of Levaquin. I have no fever.

1) Would use of cocaine (both sharing a dollar bill) and snorting it increase the likelihood of HIV transmission?

2) In various threads, you indicate effectively zero or "low risk", yet you indicate 1/10,000 or 1/20,000 chance of transmission...which implies that for the statistic, someone had to have been infected. Please clarify.

3) Do my symptoms warrant any concern of ARS? Should I be on the lookout?

4) Do you consider this a high-risk exposure and does it warrant testing? I have a regular partner and am abstaining from unprotected sex with her.

5) I generally have good dental hygiene, but a small gap between gum/tooth in on upper row of teeth. Does this change likelihood of transmission?

[Edward W Hook, MD]

.Welcome to the Forum.   You seem to have seen our prior comments so I suspect that much I say will be repetitive.  As you know, 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. This a dated figure which has not been borne out by scientific study.  An increasing number of experts, including us, state there is virtually 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.  This includes by all of the people who had gum disease, blood in the mouth, swallow, etc.  We no longer see a medical reason to recommend HIV testing for exposures of the sort you describe.  

1) Would use of cocaine (both sharing a dollar bill) and snorting it increase the likelihood of HIV transmission?
Not from the oral sex. there are a very, very few cases in which HIV has been spread by persons who shared devices for snorting cocaine and induced bleeding in the process. they are incredibly uncommon however.  

2) In various threads, you indicate effectively zero or "low risk", yet you indicate 1/10,000 or 1/20,000 chance of transmission...which implies that for the statistic, someone had to have been infected. Please clarify.
See above.  Those figures are purely theoretical.  

3) Do my symptoms warrant any concern of ARS? Should I be on the lookout?
No, your symptoms are those of a cold, not the ARS.

4) Do you consider this a high-risk exposure and does it warrant testing? I have a regular partner and am abstaining from unprotected sex with her.
See above.  I see no reason for testing or worrying that you might have caught HIV that you could give to your regular partner.  

5) I generally have good dental hygiene, but a small gap between gum/tooth in on upper row of teeth. Does this change likelihood of transmission?
No not at all.

If you are really nervous and want to be sure, the fastest way to resolve your concerns is to get your friend to test for HIV. If he is negative, you are not at risk at this time.  

Hope this helps.  EWH

[complex87]

you can't rely on hiv symptoms ... I've had the same thing

oral sex does not transmit oral sex

you never were affected ... however get an std test not hiv

[complex87]

oral sex does not transmit hiv *

[anxious211]

Thank you Doctor. I've done as you asked, and having my friend test.

In the mean time, I remain a bit anxious about my symptoms. My sore throat got worse, to the point of painful swallowing by day 8, though I've been feeling slightly better today (day 10). I have very-mild night sweats, but no fever whatsoever (I've been checking a couple of times a day). My lymph nodes in the neck are less painful than before, and I can't say I have any sort of rash. Maybe one or two red "pimple-like" red spots on my torso, but that's it. No real muscle aches or joint pain that I can notice.

Is it possible to have such atypical symptoms in the presence of ARS?

Would this be to soon to experience any symptoms of ARS?

Thanks again.

[Edward W Hook, MD]

These findings do not change my assessment.  The symptoms you describe are most likely a coincidence. EWH

[anxious211]

Doctor -- my friend tested for everything, including HIV and says everything came back negative and not to worry. Typically, this would be enough reassurance, but for additional pyschological reassurance, I went and tested today, via rapid fingerprick, exactly 35 days/5 weeks since the exposure. The results came back NEGATIVE.

Would you recommend additional testing given risk/exposure scenario?

Thank you again.

[Edward W Hook, MD]

Glad to hear this result.  You cannot get HIV from someone who does not have it.  I see no medical reason for you to pursue any further testing related to the exposure you mentioned.  EWH

[anxious211]

Hi Doc, so I had put this entire situation behind me, until a couple of days ago, when I got what seems like another cold. It started last Thursday, generally feeling unwell/tired, feeling of incoming chest cold. It progressed to really bad congestion, runny nose, sneezing, and by Sunday, developed a low grade fever, of about 99.5-99.8, aches, chills, etc. Today (Tues) I've started feeling slightly better, but still have a lingering low grade fever of about 98.8 to 99.2.

I'm not prone to colds so often, and the low-grade fever worries me. I've read that low-grade fevers are indicative of acute ARS, and I remain extremely anxious that my 5-week test missed a potential infection, despite reassurance from my friend that he was "clean."

Do any of these symptoms, over 6 weeks since potential oral exposure, worry you? And should I retest?

[anxious211]

I would also add that on Feb. 21, I did engage in entirely PROTECTED oral and vaginal sex with an asian CSW, who was VERY cautious and extremely careful...and indicated that she was clean. So I'm not entirely concerned with that exposure.

[Edward W Hook, MD]

Please, it is time for you to stop worrying.  Your recent cold does not suggest ARS.  Believe the test results you have for both you and your friend.  Similarly, HIV is not spread through protected sex.

Time for this thread to end. EWH

[anxious211]

Just wanted to let you know that to quell remaining anxiety, I went in today (50 days, or just over 7 weeks) and tested again via rapid fingerprick test. That was NEGATIVE.

Thanks again for your input Doctor.