HIV risk, oral unprotected no ejaculation

[lars490]

Hi Doctor,

Just wanted a quick assessment on my risk for peace of mind, though I realize this question is quite redundant.  About 3 weeks ago I had an encounter with a transsexual escort.  We performed oral sex on each other where she put a condom on me but didn't wear one herself, not sure why.  She did not ejaculate in my mouth though there may have been a dab of precum at some point.  Later I performed anal sex on her for about a minute with a condom and then stopped.  

Prior to the meeting I had a bit of a sore throat developing, possibly some swollen gums, maybe a canker sore but to my knowledge no bleeding was going on.  What stays in my mind from that night is that the head of her penis hit the back of my throat a few times, and given that I had a sore throat developing I was wondering if that increases my risk.  

The next day my sore throat was worse and I developed a low grade fever and body aches later in the day.  After two weeks my groin area was hurting.  I don't feel any lumps or swollen anything, just pain that seems to change location form inside my groin to my inner thigh.  The last few days I've been feeling pain in my armpits but no noticeable lumps (possible from pressing the area) and the sore throat hasn't fully gone away, comes and goes.  Didn't have any real noticeable fever but have a possible rash on my chest and left shoulder, though is more itchy than visible...slightly pink.  

Anyway,  I was resign to the fact that my risk was nil until the groin thing appeared.  I haven't had sex with my girlfriend in 3 weeks for fear surrounding this encounter.  Do you think it is reasonable to put this behind me and stop worrying or should I get a test?  I got tested once before and the whole experience was quite punishing.  Is it responsible for me to just move on and forget this?

Thank you!

[H. Hunter Handsfield, M.D.]

Welcome to the HIV forum.

Your initial instincts were correct and "the groin thing" makes no difference.  Your symptoms, neither the groin pain nor discomfort in your armpits nor the not-sure-you-can-see-it rash, really do not suggest a new HIV infection.  And you seem to already know that the risk of HIV from oral sex is estimated in the range of 1 in 10,000 for the oral partner, if the penile partner has HIV -- and that's generally considered to apply only when there is ejaculation in the mouth.  (1 in 10,000 in equivalent to giving a ** once daily to HIV infected people for 5 years).

Yes, I believe it is "reasonable to put this behind me and stop worrying" and from a medical or risk assessment perspective you do not need HIV testing.  However, most people nervous enough to ask questions on this forum would benefit from the additional assurance from a negative test, in addition to our reassurance.  If that applies to you, feel free to be tested for peace of mind.  But don't lose sleep over it in the meantime; there is no reason for a "punishing" experience.  You can expect a negative result.

Finally, I can sense a follow-up question coming if I don't say this overtly:  While I never guarantee someone isn't infected or that it is safe to continue sex with a regular partner, if I were in your situation, knowing what I know, I would comfortablly continue unprotected sex with my wife.

I hope this helps.  Best wishes--  HHH, MD

[lars490]

Thank you for the quick reply doctor.  This helps quite a bit.  One tidbit I left out is that I followed up with the transsexual the next day via email as a possible client and asked her HIV status.  She said she was negative for HIV and everything else.  Given that and everything I've read on your forum and this reply I feel I can move on from this without getting tested.  Though, If my anxieties persist I will consider it.

Thanks again!

[H. Hunter Handsfield, M.D.]

I agree.  Most people are truthful about their HIV status when asked directly.

[lars490]

Great, just one final remark/question and I'm done!  You didn't mention the persistent sore throat, which I take as probably another irrelevant symptom as far as HIV is concerned.  It started slightly before the encounter and has been getting worse and better since.  I was on a 10 course of amoxicillin which seemed to be working until a few days ago.  I finished the course today and the sore throat is not completely gone.  It feels a little lower in my throat now with some external muscle pain as if I was straining my neck (which I may have done, don't know).  My question is, could this be related to another STD or would the amoxicillin have taken care of gonorrhea or anything else?  I was tested negative for strep so not sure why I'm still having issues.  Should I get on a stronger antibiotic?  I really appreciate your patience and detailed comments thus far.  Thank you!

[H. Hunter Handsfield, M.D.]

There is nothing about your sore throat that makes me any more concerned about HIV or any other STD.  Sore throat (by itself) is not a symptom of either HIV or other STD.  Most sore throats are not due to bacterial infections, so I certainly would not recommend an antibiotic.  You should follow up with your personal health care provider if the discomfort continues.

[lars490]

Well, thanks very much.  Your posts really help me stay rational, though as you suggest, I may need to get a test for peace of mind since I can't seem to let this go completely and have spent countless hours on these threads.  Tomorrow will be 4 weeks and I think I've read that this is a pretty reliable time frame 95% or something.  Anyway, thanks again for this outstanding service!

[lars490]

Hi Doc, I'm not sure if this thread is over but I went to the doctor today for my sore throat and lymph nodes and groin pain.  She said there was definitely one node in my neck that was swollen and possibly one or two in my armpit but she wasn't too sure.  She checked my groin and said she felt a couple of small lymph nodes but said they might just be normal and not swollen.  They certainly don't look swollen.  I talked to her about my HIV concerns and she said she doesn't "feel" like this is indicative of HIV but that there was some risk.  My temp was 99.3 at the doctor's office.  I don't know how to process all of this and thought I'd come back from any last bit of reassurance.  I am pretty scared right now and have to wait out the weekend before I can get a test but I guess I'm going to have to get one.  Does any of this change anything you said earlier?  Can I trust a quick swab test? Thank you!

[H. Hunter Handsfield, M.D.]

I'm not sure what "swab test" you're talking about?  If from the throat, it's probably for strep, but maybe also for gonorrhea.  Your doc did the test -- ask her!

I stand by my original reply.  I cannot rule out HIV, but I have given you my best assessment that the chance is very low.  But your doc is now in charge.  If she recommends HIV testing, you should do it.

Let us know what turns up.  But try to relax over the weekend.  I don't anticipate bad news.

[lars490]

Thanks doc.  Just to clarify I was asking about a rapid HIV test where they swab saliva.  I was planning to go to a clinic on Monday to get this done.  My dr. did not specifically recommend testing and she didn't seem overly knowledgeable about HIV in general, just kind of confirmed that the risk was small despite my symptoms.  I guess I was just checking to see if these events changed your opinion.  I'm sorry, just trying to get through the weekend I suppose.  I'm trying to stay rational and not give in to every little symptom that shows up.  

[lars490]

I got tested today via oraquick method.  Results are negative after 31 days.  I think I've read that you estimate this as 90 - 95% accurate?  Do I need to follow up in 2 months or since my risk was so low, just accept this?  Either way, thanks for all your patience and reassurances.  

[H. Hunter Handsfield, M.D.]

Just like all the other similar questions:  Statistically, your chance of having HIV was very low to start.  With a negative test at 1 month, it's now 90% lower than that.  From a strict risk assessment perspective, you don't need further testing.  But if you're nervous because it takes another 2-4 weeks for tests to reach 99% reliability, you might want to be retested.  If it were me, I would not feel the need.  But it's your choice.

That's all for this thread.  Take care and stay safe.