Safety Question

Hello, doctor.

I am a gay man. I have been in a monogamous relationship with my partner for four years. Because we were both tested for common STDs and HIV, we agreed that we would make our relationship exclusive so that we could have sex without condoms.

About four weeks ago, I was dragged to a club with a few friends of mine and drank quite a bit more than I really intended. I will not bore you with further exposition: I ended up giving oral sex to another male whose status was unknown to me. When he ejaculated, I swallowed some of his semen and the rest went onto my face and over my eyes. Some of the semen got into my eyes and made them sting.

A couple of weeks after the event, I developed a sore throat that's come and gone for the last two weeks. My temperature seems to have been elevated occasionally, usually 99.2 or 99.3, but I've never seen it break 100F, so maybe this is normal. At one point I had muscle ache exclusively in my gluteal muscles, but I thought that maybe this was due to poor posture affecting circulation. That particular muscle ache only lasted a day or so and then went away. I've had an ulcer in my mouth in the last few days that may have been due to stress from this event and from an interview I had recently. The nodes in my neck feel a little enlarged and tender, but I don't think I can judge with much accuracy since I have allergies.

I intend to get tested at six weeks. The clinic here in Dallas does a free test that includes a third generation ELISA, a PCR, and a syphilis test. In the meantime, I have been avoiding anal sex with my partner so that he is not put at any risk whatsoever.

My question is: is it safe to continue having sex with him before the test? I can tell him about this event if I must. I am certain that he will both understand and forgive me. Yet the revelation would cause him great pain, and I would prefer to simply erase this accident and move on.

I greatly appreciate your advice and consideration.

[Edward W Hook, MD]

Welcome to our Forum.  I'll provide some information which I hope you'll find helpful.

You do not know if your partner at the club had HIV or other STDs.  Most people, even in such settings do not have infection. Further, the majority of sexual exposures to infected partners do not lead to infection (either with HIV or other STDs). thus your risk of infection is rather low. Not zero but low.

As far as HIV is concerned, there is no known risk of getting HIV from performing oral sex on an infected partner, even if that person's genital secretions get into your eyes or if you swallow.  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 exposure you describe.  

So, what about other STDs.  Again unlikely. Facts behind my reasoning are:
1.  Again the "efficiency" of STD transmission through oral sex is low.
2.  Most oral STDs are asymptomatic, making your sore throat and swollen nodes unlikely to be due to an STD.
3. The timing is wrong. If you were to acquire a symptomatic STD from your exposure I would have expected it to occur within a week or at most two of exposure, not 3 weeks after the event.  It is more likely to be some other viral, non-STD sore throat that you acquired in your activities of daily living.  

Based on this reasoning, I see little reason for abstinence at this time although with kissing you could give him whatever non-STD, community acquired virus that is causing your current sore throat.  

if you choose to test, at any time more than 4 weeks following exposure the combination of a negative PCR and a negative antibody test provides definitive evidence that you did not get HIV.

I hope these comments are helpful. EWH

[silly_boy19]

Thanks for the advice, Doctor. I've resumed having sex with my partner, and I've also scheduled an HIV test just to rid myself of any lingering worries. I'm a little nervous about getting tested, though. I know the nervousness isn't rational; I'm definitely going to go and intellectually I expect a negative result based on your assurances. I guess I'm just having some trouble reconciling reason with feeling.