Oral Exposure Confusion

Dear Dr.,

My exposures with men have been limited to oral, rimming and kissing.  In the case of oral, there have been 5 occasions in total, none with ejaculation in the mouth -- probably all with pre-cum. After a recent exposure I had (within 3 days), my throat was sore and I clearly had swollen tonsils and white spots all over them.  I went to my doctor and he tested for mono -- including the full CBC to be more definitive (negative) and strep (negative).  He gave me an antibiotic and it all went away in 4 days.  I had a few chills (like you get with most infections), was tired....achy...but that was it.  Could that be ARS?  I thought maybe that would be a little soon after exposure....but who knows? I was just concerned when the obvious answers of strep and mono both showed negative. What got me worrying was another site that made mention of tonsils....I still have mine, which I guess is rare.  But they are lymph glands (I think), and I would guess are therefore susceptible to infection....I mean, "infections" are what tonsils do best!! But do they "attract" infections? Thus, I am worried--- could it be the tonsils were a route of infection for HIV?  Is that a significant increase in risk?  Has anyone looked at that? I've been so cautious about not having anal sex, and now I'm worried oral sex is even off limits!  And I must say.....even with these wonderful flavored condoms, I really don't know anyone that enjoys fellatio on latex...male or female!!  It's like tasting a balloon....I hope I have not placed myself at risk or need for more medical visits because of this....Is this an HIV or testing worry?  I speak of the oral, because I do believe most people don't see rimming and kissing as HIV risks?. Is that correct?  Would rimming be a risk for HIV as well? Most sites seem to imply no, but the tonsils thing has me worried.....at least my sex partners have been kept few, but it only takes one!

Thanks for the time and help Doctor.

[Edward W Hook, MD]

Welcome to our Forum.  Thanks for your well stated question.  Let's state with the issue of oral sex, then discuss tonsils and finally your sore throat.  Oral sex first.  The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  I would not worry about HIV from the exposures you describe.  

Tonsils.  Actually,. at present most people still have them.  The practice of taking out tonsils is far less common than it was 30 or 40 years ago.  Tonsils are essentially lymph nodes which help to fight infection. This is the reason they swell with sore throats.  They are not a "target" for infections and do not attract infection.  It sounds as though your tonsil swelling was an appropriate response to a sore throat (which was most likely caused by a virus (not HIV) since your strep tests were negative.  

Finally, your sore throat.  As above, most likely due to a plain old, "every day" virus of the sort we all get from time to time.  Nothing you have mentioned suggests there is reason for concern about HIV.  Finally, there are no data to suggest that rimming, like other kinds of oral sex puts you at risk for HIV.  On the other hand, unprotected oral sex of any can lead to acquisition of other sorts of infections, most often gonorrhea.  thus your condom use is something I would endorse and encourage, not because of HIV concerns but because of other STDs.

I hope my comments are helpful to you.  EWH