Bangkok Prostitute HIV, Please Help?

Hi. Thank you anybody who takes time to read and respond to this, I am making myself ill with worry, to the extent I hate waking up in the morning. About 31 days ago I got very drunk and engaged in sex with two freelance workers in the RLD of Bangkok at about 6am.

-I was given unprotected fellatio by one or 10 seconds or so.
-I had protected sex with them both. (I was so drunk, as far I can remember it was protected though, although not absolutely certain)
-The main worry: I performed unprotected cunnilingus on one of them for about 40 seconds in the '69 position.'

I have read the hiv prevalence among Bangkok freelance workers is as high as 20%, which is very worrying.

I am wondering what my risk of transmission is? (I am 20 years old from UK, otherwise healthy, have average dental hygiene - I have several childhood fillings and my gums occasionally do bleed when brushing, but  when at home I brush teeth twice a day & use mouthwash and pass most dentist checkups without comment)

I am so worried, and want to know my risk? I have read some websites stating what they called a "low" (but I thought very high!) risk of 1-4% for cunnilingus. I have also read elsewhere risks are "almost negligable". CDC says it's also a possibility. I have come across the term "theoretical risk" a few times. Can anyone explain this phrase better to me? I know the risk is hard/impossible to quanitfy and percentages are merely a method to enable us to understand risks slightly better. However I am struggling to sleep despite feeling fatigued all day, and having nightmares about related things, and very miserable.

(also I have began to feel fatigued, in that I lack energy, let alone enthusiasm to do things. And find myself yawning all day. Is this a decent indicator of acute infection or could it perhaps be due to depression? I also have had a cold for a few days - but I do live in a rainy climate)

I would really appreciate it if anybody could reply with relevant information/experiences/anecdotes. Thank you very much.

[RainLover71]

You never had a risk from the oral sex but if you think it's a miniscule risk then it's up to you if you want to test but this forum says no risk.

[Teak]

No incident HIV infections among MSM who practice exclusively oral sex.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WePpC2072)??Balls JE, Evans JL, Dilley J, Osmond D, Shiboski S, Shiboski C, Klausner J, McFarland W, Greenspan D, Page-Shafer K?University of California, San Francisco, San Francisco, United States

Oral transmission of HIV, reality or fiction? An update
J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

AIDS: Volume 16(17) 22 November 2002 pp 2350-2352
Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan
Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:

Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117
Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.

There is no debate (among experts) about the HIV risks associated with oral sex. The risk is so low that almost nobody who cares for HIV infected patients has ever had a patient believed to have been infected that way. Among experts, it's a semantic issue about using terms like "no risk" and "very low risk". There is no difference between my or Dr. Hook's use of "low risk" and other experts' "no risk".
DR. HANSFIELD

"And oral sex is basically safe sex -- completely safe with respect to HIV and although not zero risk for other STDs, the chance of infection is far lower than for unprotected vaginal or anal sex. Please educate yourself about the real risks. If you stick with oral sex and condom-protected vaginal or anal sex, you have no HIV worries and very little worry about other STDs. " DR HANSFIELD

"I am sure you can find lots of people who believe that HIV is transmitted by oral sex, but you will not find scientific data to support this unrealistic concern..." DR HOOK

"HIV is not spread by touching, masturbation, oral sex or condom protected sex."- DR. HOOK

in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?
I TOTALLY AGREE / DR GARCIA
"HIV is not spread by masturbation, through oral sex, through kissing or other casual contact." Dr. Hook
"The observation on thousands and thousands of observations is that HIV is not spread by oral sex (of any sort)." DR HOOK
"I would not say your risk ,if he had HIV is "slim to none"- that's too high.  I would say they are effectively zero.  How much of his ejaculate or other genital  secretions you may have swallowed makes no difference.  EWH "
"As far as HIV is concerned, there is no known risk of getting HIV from performing oral sex on an infected partner, even if that person's genital secretions get into your eyes or if you swallow." Dr.Hook
HIV is not spread by oral sex, giving or receiving, even if sores, gum disease or blood is present
DR HOOK
The fact is that there are no cases in which HIV has been proven to be transmitted by oral sex, including fellatio..  EWH

[MadWithWorry]

Thank you for your reply. I am, however, struggling to reconcile this article with what's published on the CDC website.

Furthermore, I seem to be suffering from fatigue, that really started soon after day 28 and now (day 33). This is really worrying me as I have seen it is an acute sign?

[RainLover71]

Thats not an ARS symptom.

[Teak]

You never had an exposure.

[MadWithWorry]

Thank you for your replies! I really want to believe you, and I know it is a debated topic, however I am struggling to accept it in light of the official CDC line, and even the GB NHS line which says there's a "small risk".

I also swear lots of other sites said fatigue is a symptom, and I'm just knackered all the time in the past week?

[Teak]

by Emily_MHModerator,
And to clarify, it is this site's stance, based on studies and our own MedHelp experts (all of whom are world-renowned for their work in this field), that oral sex carries no risk for HIV.  
Emily

[RainLover71]

You will get some sites that say miniscule risk but this site says no risk.

[MadWithWorry]

I took 28 day course of PEP (truvada & Kaletra) from about 40 hours after exposure. How do you think this has helped my chances? Whilst it's hard to be specific could you say PEP has at least a 50% chance of succeeding?

[RainLover71]

What? You took nPEP for a no risk situation,that was 100% not required,you don't even require a test.

[LIZZIE LOU]

yep...nPEP kept your NO RISK at NO RISK !

[MadWithWorry]

So if we were to meet up face to face, you could honestly still look me in the eye and tell me that I have no risk of hiv?

[Teak]

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