Cut Lip DURING Oral Sex

While performing oral sex on a woman that I met in a bar in Thailand, she began thrusting her pelvis and--long story short--caused my lower lip to bump one of my upper teeth. This caused an abrasion on my lip. I use the word abrasion rather than cut because I could notice the taste of my blood on my tongue, but there was no profuse bleeding.

I asked the woman about this later and she said that I shouldn't worry because she always uses a condom (and indeed she had asked me if I had one--she had two of her own in her purse). She indicated that she had been checked within the last 8 months, but seemed vague about the date. The testing vagueness bothered me a bit, but she was adamant about the regular condom use.

Is this a PEP situation?

If not, would it be a PEP situation if you didn't know anything about her (in other words, based on the first paragraph alone)?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

In theory, having a fresh open cut that is exposed to a partner's genital secretions would elevate the risk of catching HIV, if the genital partner were infected.  However, to my knowledge there has never been a reported case of HIV transmission by cunnilingus (oral contact with female genitals), and surely over the 3 decades of the worldwide AIDS epidemic there must have been millions and millions of such exposures in the presence of cuts, nicks, oral bleeding, etc.  And in the absence of overt bleeding, probably your abrasion was not deep enough to materially affect the risk anyway.  So even if your partner had HIV, I would judge this event has carrying no measurable risk of transmission.

And it is unlikely your partner is infected.  Under 1% of Thai female sex workers these days have HIV (a lot lower than, say, 15-20 years ago).  So even with her vague reply, probably her most recent test was negative and therefore it seems unlikely she is infected; few people lie about their HIV status when asked directly.

So based on the information here, I definitely would not recommend PEP in this situation.  That said, PEP recommendations vary widely, based on local HIV rates.  For example, if it is known that sex workers in the bar where you met your partner have unusually high rates of HIV, it is conceivable a local clinic would recommend PEP.  I doubt it, but this is the best I can do from this distance.

Regards--  HHH, MD

[davek33444]

Doctor,

I think I am going for a DUO test at 4 and 6 weeks, just to be certain.

Now I've read that you say after 6 weeks, the DUO and the 3rd generation tests are pretty much equal from then on out... but wouldn't p24 be present even at like 8 weeks if the person was a late seroconverter?

Is it remotely possible that at 8 weeks, someone could turn positive afterward?

Thanks again

[H. Hunter Handsfield, M.D.]

The concept of "late seroconverter" is pretty much an urban myth.  Don't over-think it:  at 4-6 weeks after exposure (and beyond),EVERYBODY with a new HIV infection will have either p24 antigen, or HIV antobdy, or both detectable in blood.  With the modern HIV tests in current use, I have never heard of someone being negative at 8 weeks on either a DUO test or a stand-alone antibody test who later turned out to have HIV.

[davek33444]

Thanks! So when should I consider my test results conclusive?

[davek33444]

Oh and does the same about never seeing someone turn positive at 8 weeks also apply to 6 weeks?

This will be my final question.

[H. Hunter Handsfield, M.D.]

Read my comments above and concentrate.

This thread is over.