At risk because of this...

[vida12]

Hello Dr.

I am a 35 yr old male who tested negative for HIV two months ago. A week ago I only recieved  a blow job from a female of unknown status. I did not see any blood on her nor my pennis had any cuts at the moment. After the incident I  washed it and urinated.

Do I need to get tested because of this? I read some of the comments about my chances but they are confusing to me. Has there been any documented cases of somebody getting HIV by insertive fellatio? What are my chances of getting HIV from this?

A week has gone by and my anxiety is driving my nuts. I itch all over my body and have soar throat?

Was I at risk?

Thank you for all that you do in educating people like myself.

[H. Hunter Handsfield, M.D.]

That has to end this thread.  If you want to continue the discussion, please take it over to the community forum.

[Thomas96]

After reading this site for a while and looking at this link I would probably say that they both are very similiar.  I was always under the assumtion that kissing and insertive oral could possibly be a risk under extenuating circumstances such as severe bleeding in the infected persons mouth and that is why they said extremly low risk.  as far as I know there are no proved cases of hiv from insertive oral and one questionable case from deep kissing(but there were a lot of extenuating circumstances ie bleeding, gum disease etc...) given this and the probably millions of ** that occur everyday for the last 25 years of hiv I would say not to worry about either of these modes of transmission for hiv.

[badday103]

Sorry, probably shouldnt have jumped in because now I am confused.  I was more quoting from the Johns Hopkins site.  I couldnt find the original where the doctor said he actually looked into where the CDC came up with these numbers but even though the original numbers were based off actual people the oral part was a guess( at least according to the Dr.)  He actually tells his patients that are hiv infected that they could perform unprotected oral on their partners without worrying about infecting them.  With the exception of a rare case report( I have actually also found a few for kissing and other non exposures so I dont trust them) have there been any confirmed cases via this route?  I have enclosed the link to the site I mentioned above.  I respect that there just might be a difference of opinion but I am not sure if I just misunderstood that 1 in 2000 that you mentioned kind of rattled me.

http://www.hopkins-hivguide.org/q_a/patient/hiv_transmission_and_prevention/risk_with_oral_sex.html?contentInstanceId=445087&siteId=7151

[H. Hunter Handsfield, M.D.]

That isn't quite true.  The number was calculated based on histories of infected people and the types and frequencies of sexual practices they had participated.  The data have been published.

That said, that method of ascertainment has big problems and the number has to be looked at as approximate at best.  The San Francisco health department position that fellatio carries no risk for the insertive partner (assuming an infected oral partner) might be correct, but it is equally imprecise.

But all experts agree the risk is low enough so that individual oral sex events can generally be ignored as signficant HIV risk.  To put it in perspective, what if the CDC estimate of 1 in 20,000 is off by tenfold and the real risk is 1 in 2.000?  Even that is equivalent to receiving a ** daily by infected partners for 5+ years and maybe never getting infected.

Sexually active persons should avoid oral sex with partners known to have HIV or to be at especially high risk, such as anonymous gay/bi men.  At the same time, people who have the occasional oral sex episode with people of fairly low HIV status (e.g., heterosexual partners in most industrialized countries) can pretty much ignore the risk of HIV.

Thanks for your comment.  A good opportunity to address this important issue.

[badday103]

Actually the 1 in 20k estimate is basically just a guess that the CDC made they ASSUMED that it was 100 times less likely than insertive vaginal sex.  There have still been no documented cases ever which says a ton.  The san fran city clinic web site and hopkins web site both list this risk the same as kissing "Zero".  

[H. Hunter Handsfield, M.D.]

You are re-asking the same questions as before, with different wording.  I don't see how I can provide any stronger reassurance than I did in my original reply.

[vida12]

Hi Dr. HHH

I read the article and also many of the threads on this same issue. Is my assumption of very low risk to zero risk accurate? I dont want to go crazy over this and move on.

Again just by my knowledge on the subject I want to be able to do the right thing? I have not have any intercourse in quite sometime now and the only "sex" that I seldomly practice is oral sex (insertive fellatio) with females that to my understanding are in good health. Will my current way of viewing this issue considers me as a "safe sex" type of person?

Again, I have not yet encounter any documented cases of such transmission. Have there been any?

And  from your expert opinion my exposure does not require testing? Correct

Just wanted again some peace of mind and move on.

Thanks

[H. Hunter Handsfield, M.D.]

Well, yes and no.  Of course the risk is not uniform for all exposures.  But in general, from the information provided by questioners on the forum, it is not possible to judge whether the risk might be higher or lower than usual, so the only possible response is to give the average risks.  For any particular person, the risk might be higher or, equally likely, lower.  When we're talking about such rare events as HIV transmission by fellatio, it really doesn't matter one way or the other.

Thanks for the comment about the Google Knol article.  Many of the things I said there were derived from the experiences of responding to questions on this forum.

[jackal2]

I apologise for intruding on a thread, but I believe that my query is relevant to all users. I have read elsewhere that the risk estimates per exposure (e.g. 1 per 20,000) is a statistical estimate that really can't be applied to any one specific blowjob. These types of statistical estimates give some idea of relative risk, not actual risk, for a specific coupling.

Is the above correct?

On another point I have found the following article by Dr Hansfield. It gives an easy to follow outline of HIV/STD transmission.

http://knol.google.com/k/hunter-handsfield/safe-sex/nAi5F17X/WdH0tg#

[H. Hunter Handsfield, M.D.]

To my knowledge, HIV rates are very low in Puerto Rican women.  Test at 6 weeks or longer after the event.  

[vida12]

Dr. HHH

Thank you for your prompt response. I had no other risks by the way and the woman that perform the act lives in Puerto Rico, so I am assuming that your previous statement stands?

I did read some of the threads and yes a lot of similar worries. By the way if I choose to test, do I need to wait 3 months or can I test now?

Best wishes and thank you again

[H. Hunter Handsfield, M.D.]

The risk of catching HIV from any single epsiode of receiving oral sex is in the range of 1 in 20,000 exposures, and that's if the oral partner has HIV -- which is very unlikely for a woman in North America or Europe.  Some experts believe such transmission carries no risk at all.  Based on risk assessment and symptoms, you don't need HIV testing.  However, if you will sleep better from the psychological reassurance of a negative HIV test result, go ahead and do it.  But if positive, it will be from some other exposure that you haven't described.

For more detailed information, you can review the forum as sugested above ( "...please review other threads in our archives for questions similar to yours and Dr. Handsfield's [and Dr. Hook's] replies.")  HIV risk from oral sex is probably the single most common topic discussed; pick just about any 10 threads at random.  

Best wishes--  HHH, MD