2 acts of cunnilingus..

[reallyworried75]

Good day, i have posted in the International forum as well but i would really like Dr HHH to ***** this situation,

2 weeks ago went to the rugby, met up with a white girl... cut a long story short, we ended up in the car @ a club giving each other oral sex. i went down on her for about a minute, she went down on me for about 30 seconds. She finished me off with a handjob.

She wanted to go further, but i refused as i didnt have protection.  

2 weeks down the line, i feel a little run down, fatigue, not sure if its maybe the anxiety and stressing of all of this, knowing that i stay in the HIV capital of the world, however it is more prevalent in the black population..

I asked her the next day if she knew her status and when last she got tested, she first took offence to the question, and then answered she was negative and was tested in March.  But i have a feeling she just said this to get me off her back.

I had a similar incident in April, protected sex, but unprotected oral both ways.

My questions:

1. Does the fact that this girl was willing to go all the way WITHOUT protection put me @ more of a risk in terms of her maybe being positive?

2. Is it neccessary to test over these 2 incidents of cunnilingus, or would it purely be for peace of mind? these are the only 2 incidents since my last test which was a year ago. (nov 2010)

3. Does it make a difference whether the vaginal fuid that enters your mouth, stays there for a while, or gets spat out/swallowed immediately?

4. Lets assume that this girl was HIV +, and had an extremely high viral load, does it change my situation at all?

5. I have been reading articles on the web where they suggest that if you have your tonsils, you are at more of a risk, as the tonsils provide a good entry point for the virus? is there truth in this or not?

6. What STD's should i be tested for with this incident?

7. Can i continue normal sexual activities with my girlfriend?

Thank you Dr.

[Edward W Hook, MD]

Last answer.  I have told you that your exposure was no risk.  That being the case, there was no need for testing.  There still is not.  Further testing will give the same results.  

This thread is over. EWH

[reallyworried75]

Hi Dr Hook,

I had another 2 rapid finger prick tests this morning. This is now at 6 weeks, 1 day. Both were negative.

Do i need to test out at 8 weeks, or can my results now be deemed as conclusively negative?

Thank you.

[reallyworried75]

Thank you so much for your help Dr Hook,

Keep well..

[Edward W Hook, MD]

At this time tests taken at 4 weeks woul etect over 90% of recent HIV infections.  Given your virtually no risk exposure to start with, there really is no need for further testing. EWH

[reallyworried75]

Thank you Dr,

i wish we had expertise of yours and Dr H's level here in SA.

Just thought i would let you know, that due to the anxiety i have been having over this, i bit the bullet this morning, and went to a clinic and had 2 rapid tests done, the one where they prick your finger. Both are negative, this is a huge amount of relief, however i know 4 weeks is too soon...

in all likeiliness, what is the chance of a 4 week negative changing @ 6 weeks? Given my low/no risk exposure, should i even go for a 6 week test?

this will truly be my last question Dr, i promise

[reallyworried75]

Thank you Dr,

i wish we had expertise of yours and Dr H's level here in SA.

Just thought i would let you know, that due to the anxiety i have been having over this, i bit the bullet this morning, and went to a clinic and had 2 rapid tests done, the one where they prick your finger. Both are negative, this is a huge amount of relief, however i know 4 weeks is too soon...

in all likeiliness, what is the chance of a 4 week negative changing @ 6 weeks? Given my low/no risk exposure, should i even go for a 6 week test?

this will truly be my last question Dr, i promise.

[Edward W Hook, MD]

You are right- your anxiety is in overdrive.  Syphilis transmission through oral sex is vanishingly rare and when it occurs it has been described primarily among men who have sex with other men.  Further, the azithromycin woul likely have prevented syphilis if it were present.  You can have a doctor look at it if you wish but I would not worry.  This will be the last answer as part of this thread. EWH

[reallyworried75]

sorry, typo... he prescribed me a 3 day course of zithromax, im not sure what strength it was..

[reallyworried75]

thank you for all the replies Dr..

i noticed a small red dot on my penis head yesterday, just bigger than a pin head.

this has spun my anxiety into overdrive.. its exactly 3.5 weeks since my encounter.

could this be syphilis? is it possible it could be anything else? should i be concerned?

3 days after my exposure, i was @ the doc for the flu, and he prescribed a day course of zithromax to prevent a secondary complication from the flu.

if i got syphilis, would that course of zithromax 3 days after exposure, have sorted the syphilis out?

im sorry for all the questions... just worried , i will pay again if i have too, to get your assesment.

[Edward W Hook, MD]

Your assumption is most likely incorrect.  The only STDs which would warrant being tested for are NGU and gonorrhea, either of your throat or penis.  

Fatigue is not a symptom of any STD and is a non-specific symptom.

I suspect anxiety is your major problem. EWH

[reallyworried75]

Thank you Doctor,

assuming i have contracted an STD from this exposure, pls tell me which STD to test for.

i am certain i have contracted nothing from her giving me a blow job, as i have no symptoms that would suggest that ie: pain while urinating, penile discharge etc.

so if i did contract something, it would be from performing oral sex on her.

i am asking as i have been suffering from extreme fatigue for the past week, no other symptoms.

i plan on seeing my doc this week.

Thank you..

[Edward W Hook, MD]

1 in 10,000 means that on average there will be one infection transmitted for every 10,000 acts of oral intercourse with an infected person (i.e one exposure per day for over 30 years).  EWH

[reallyworried75]

Hi Dr Hook, pls could you kindly respond.

Thank you

[reallyworried75]

thank you for your replies Dr.

just a quick one, i am from South Africa, dont know if you saw that, i'm assuming it makes no difference?

When they say 1 in 10,000... does that mean for 10,000 exposures with a known hiv+ person, there is one chance of infection? what does it relate too in real terms? ie: 1 in a million, 1 in 2 million?

[Edward W Hook, MD]

Welcome to our Forum. I will be answering your question - I suspect they will be quite similar to what you will hear on the International Forum.  The events you describe are rather low risk for STDs and virtually no risk for HIV.  Your partner sounds to be rather low risk and most heterosexual women who do not use IV drugs do not have HIV and here in North America fewer than 1 in 10,000 have HIV- I suspect the situation is similar in Australia.  I also would tend to believe her comment about being testing.  her response was rather specific and this increases her credibility.,  With this as background, let’s work through your questions:

1. Does the fact that this girl was willing to go all the way WITHOUT protection put me @ more of a risk in terms of her maybe being positive?

No.  while this is not a particularly wise practice and does increase her risk for STDs somewhat, if she knows of this risk she may take better precautions about regular checkups as well.  It certainly is not an assurance that she in infected with anything

2. Is it neccessary to test over these 2 incidents of cunnilingus, or would it purely be for peace of mind? these are the only 2 incidents since my last test which was a year ago. (nov 2010) .

It sounds like you are in need of peace of mind.  As for evaluation of risk, the overall risk of infection is rather low, probably less than 1% that you had gotten anything from your most recent encounter and lower now that 2 weeks have passed and there are not clear cut symptoms.  As for the encounter over a year ago, close to no risk.  

3. Does it make a difference whether the vaginal fuid that enters your mouth, stays there for a while, or gets spat out/swallowed immediately?

While the duration of exposure may have some biological impact on risk, that impact is small and probably not significant. As you can imagine, this has not been studied.  

4. Lets assume that this girl was HIV +, and had an extremely high viral load, does it change my situation at all?

No.  There are no documented, scientifically believable cases in which HIV have been documented to have been transmitted by giving or receiving oral sex.  

5. I have been reading articles on the web where they suggest that if you have your tonsils, you are at more of a risk, as the tonsils provide a good entry point for the virus? is there truth in this or not?

These articles are theoretical in nature and overstated.  

6. What STD's should i be tested for with this incident?

See above.  Your risk is low but only  you can be completely sure with testing.

7. Can i continue normal sexual activities with my girlfriend?

see above. How much risk do you want to take. Clearly the safest approach is to get tested however the overall risk is quite small.

Hope these comments help. EWH