Existing Chlamydia Infection. Risk of HIV from Insertive Oral Sex?

Today, I received the results from a chlamydia test--positive. I believe this to have been acquired from a sexual encounter with a friend in June.

Last week, I visited an Asian massage parlor. I had protected vaginal intercourse, she licked my anus, and inserted a finger into my anus. She also performed oral sex on me without a condom. It is the latter circumstance that is the subject of my inquiry.

Question: With my chlamydia infection, how likely is it that I could have contracted HIV from this insertive oral sex? I don't know anything about the sexual health of the "masseuse."

I'm very worried about this. Frankly, it's a bit cathartic to write it down, but the anxiety about a possible infection remains.

[Edward W Hook, MD]

Welcome to our Forum.  The presence of urethral chlamydial infection does not significantly increase your risk for HIV acquisition.  If your partner had HIV (unlikely) and IF you have unprotected vaginal sex with her) you did not), there MIGHT be a SLIGHT increase in risk of getting HIV however, since HIV is effectively not transmitted through oral sex, the presence of chlamydial infection does not change your risk.  I would not worry.

HOWEVER, your experience does illustrate something important.  You note that you use protective measures with the commercial sex worker but not your friend. Friend or not, many people with STDs (including HIV) do not know they are infected. Thus I would urge you to always use condoms regularly outside of regular relationships in which you know that your partner is not infected.

I hope my comment is helpful. EWH

[serenesis]

Dr. Hook, it has been four weeks since my encounter with the CSW. Although my initial recollection was that I was wearing an intact condom for the duration of the penetrative sex, my anxiety over the whole thing has been raising doubt that either the condom might have broken (I didn't check it) or slipped off.

That said, I am a pragmatist and see little value in wondering about such things at this point. Further, I am fully aware that my first recollection is *probably* the most accurate.

I just have a quick follow-up for you:

I went in to a clinic for an OraQuick oral swab test on Monday, which would have been 25 days post potential exposure. That test was negative. I am well aware that a test is not conclusive until between 6-12 weeks. Still, should this test at 25 days be encouraging?

In the past few days, I have developed some fatigue and moderate lower back pain. The fatigue is nothing abnormal, however the lower back pain (which feels like a strained or sprained muscle) is more concerning. As a 25 year old, lower back pain is not something I've had much experience with. Is this something indicative of ARS? Onset was about 26 days after the exposure.

Thanks in advance for your help. Your answers are informative and your demeanor comforting.

[Edward W Hook, MD]

Your test results are quite encouraging to say the least.  You were at about 4 weeks since exposure at the time of testing and at that time your test would have detected 90% of recent infections. This, combined with the fact that your exosure was oral which is essentially a no risk exposure (a slipping condom that did nto come off completely would still offer complete protection) combine to prove that you did not get HIV.  

Your symptoms are not suggestive of ARS.  Peole wiht ARS are really more sick than what you descirbe with fevers, widespread muscle aches, sore throat and skin rash.

You really need not worry.  EWH