PEP Required? Its been 48 hours

Stupid, stupid, stupid me!  Was drunk and visited 2 prostitutes in the red light area in Mumbai (India).  Had unprotected oral sex on and off for a few hours.

But am freaking out for the following reasons:

1.  Prostitutes in this area have very high HIV infection rates.  In fact, they wanted to have sex without a condom (seems like the norm here), which makes me feel that they may already be infected.

2.  The second prostitute made me wash my penis with beer because she told me the first one had lots of ulcers in her mouth.  So now I have to assume that there was a good chance of blood in the mouth and some STD.

3.  I had a yeast infection on the head of my penis (was applying miconazole cream for about a week) and there was still some parts where it looked like the skin was peeling/red and not intact.

4.  I am not circumcized and my penis is still red/sore and it hurts from time to time at the tip probably due to the length of total exposure.

Normally I know PEP may not be recommended but do you feel my circumstances warrant it?  I read the following post:

http://www.thebody.com/Forums/AIDS/SafeSex/Archive/OralSex/Q206596.html

Am very scared!  Am I worrying unecessarily or is it a bad situation?   Do I need to test?

I know some people say you can't get hiv this way, no matter how much blood in the person's mouth, how many cuts you have, how long it lasts, etc.  But if that was the case, the risk would be 0 and not 1/20,000 like HHH has mentioned.  This means that 1/20,000 episodes or oral sex will result in one infection - yet no confirmed cases.  Does this mean the probablity is wrong, or people are getting infected this way and attributing it to something else?

Finally, if I am infected, how would I even go about documenting it so that people would believe that it could happen this way?

Thanks!

[joggen]

You didn't have a risk and don't need PEP if all you had was oral sex.

[voke]

Really no risk?

If the sex worker is HIV+, and it seems likely there is blood in the mouth due to the many ulcers.

TS's penis is still on a recovering from infection, if there is peeling and redness, it might be blood (open wound) too.

It seems to me it is kind of a blood-to-blood, except the "vector" is the mouth, instead of a needle etc. I understand that the virus has it tough in the mouth, but according to other sources like the forum he posted, there is a moderate risk.

A normal unprotected felliato is low risk, however, poor health conditions such as open wounds, bleeding gums, ulcers etc can increase the risk exponentially (although not to the extent of unprotected vagina sex). Do correct me if I am wrong.

[joggen]

You're wrong. There hasn't been a confirmed case of anybody catching HIV through oral sex.

[voke]

Perhaps we all need an update here? I'd like to believe ONLY what I am hearing here too...

http://aidsmap.com/cms1044877.asp [2009]
>Oral sex has been shown to be a less risky activity than these practices, but is definitely not risk free.
>You are at more risk of being infected with HIV from oral sex if you have cuts, sores or abrasions in the mouth or on the gums.
>Oral sex will therefore be more risky around the time of menstruation.
>Look after your mouth. The likelihood of oral HIV transmission increases if one has bleeding gums, ulcers, cuts or sores in the mouth. Don’t brush your teeth or floss before oral sex.


http://www.cdc.gov/hiv/resources/factsheets/oralsex.htm [2009] CDC factsheet
>numerous studies have demonstrated that oral sex can result in the transmission of HIV and other sexually transmitted diseases (STDs)
>Finally, several co-factors may increase the risk of HIV transmission through oral sex, including: oral ulcers, bleeding gums, genital sores, and the presence of other STDs. What is known is that HIV has been transmitted through fellatio, cunnilingus, and anilingus.

My Conclusion from these sources: Mouth conditions & any other open wounds is very important in the case of determining risk of Oral Sex.

[joggen]

by Emily_MHModerator , May 16, 2010 10:00AM
Let's all chill on the semantics, HIV backgrounds, etc etc.


On MedHelp, we follow the guidelines set by the Centers for Disease Control (CDC), test manufacturers, FDA, and our experts, Drs. HHH and Hook, and the experts in the HIV International Forum.

It is this forum's position that oral sex by itself does not require testing.

Lizzie, Teak, Vance, etc., all have some great quotes taken from our experts about the risks of oral sex and HIV, which I have included.  While one study may say one thing, and another says something else, there is no disagreement among our experts about HIV and oral sex.  Our forum experts are world-renowned, and have the ability to interpret situations and apply the science behind studies, etc., and they all agree on the risks (or non-risks) of oral sex for HIV.

If someone chooses to abstain from oral sex, or use a condom for oral sex (which is a good idea as other STDs can be transmitted via oral sex - see the STD community about that), or test after an oral sex encounter, that's a personal decision.  However, our stance remains the same.  There is no need for endless debate and insults about intelligence, education, backgrounds, etc.

Here are the quotes:

There is no debate (among experts) about the HIV risks associated with oral sex.  The risk is so low that almost nobody who cares for HIV infected patients has ever had a patient believed to have been infected that way.  Among experts, it's a semantic issue about using terms like "no risk" and "very low risk".  There is no difference between my or Dr. Hook's use of "low risk" and other experts' "no risk".
DR. HANSFIELD

"And oral sex is basically safe sex -- completely safe with respect to HIV and although not zero risk for other STDs, the chance of infection is far lower than for unprotected vaginal or anal sex.  Please educate yourself about the real risks.  If you stick with oral sex and condom-protected vaginal or anal sex, you have no HIV worries and very little worry about other STDs. "   DR HANSFIELD

"I am sure you can find lots of people who belive that HIV is transmitted by oral sex, but you will not find scientific data to support this unrealistic concern..."   DR HOOK
"HIV is not spread by touching, masturbation, oral sex or condom protected sex."- DR. HOOK

in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?  
I TOTALLY AGREE / DR GARCIA

Emily
MedHelp

[voke]

Thanks for reinforcing your stance.

[dibu]

Thanks for the feeback.  I really want to believe the forum view on this risk!  But, voke's feedback has some merit in that my exposure could have also been to blood and we need to use that as a factor when looking at risk.

In the moderator's note (provided kindly by joggen), it indicates that the CDC, HHH, etc. are the sources for their stance on oral sex being no risk.  But the CDC says it is a risk if there is blood in the mouth, as do other reliable sources (I am sure even HHH would agree with this).  Plus, I believe that the experts are basing their views on exposure to only saliva (which is what happens most of the time and carries no risk).  But exposure to blood is what is really worrying me and where the risk really lies.

So, we have to assume:

1.  The csw's were HIV positive (prevalence is 75% in this area)
2.  I was exposed to blood for long durations
3.  My skin was compromised (i.e. it wasn't as healthy as it could be) and I am not circumcised.

I don't think the supporting factors above could be any worse!  I mean, if anybody is a candidate for getting HIV from a bj, I would be right up there.  

Are the experts in the field of HIV saying that no matter what the circumstances or factors, how much blood you may be exposed to, etc. there is absolutely no way to become infected with HIV from getting a blowjob?

[Teak]

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