Unprotected Oral Again

About two weeks ago I received unprotected oral from a femal stripper. No doubt the biggest mistake of my life. I did return to speak with the stripper and found out she had a child two months prior to our our interaction and was hiv negative then and still claimed to be. Everything I have read on the internet (including here) states I am at zero to negligible risk for any std's including hiv and syphyllis. To date I have experienced no signs of std's such as discharge, painful urination or sores. My concern is that there is just so much contradictory information available online. I am seriously involved with a woman and am terrified of passing something on to her. Please let me know what your take on my risk level is. I have had protected sex with my significant other and am now truly horrified of the possibilities. Thank you for your time.

[H. Hunter Handsfield, M.D.]

There is no "contradictory information online" about the HIV transmission risks of oral sex, as long as you pay attention to the source.  Stick with professionally run (and professionally moderated) sites.  Testimony from individuals about their horror stories is the worst possible source of information about any health problem, including HIV.

Quickly considering the factors: HIV testing is automatic in all pregnant women in the US, so undoubtedly your stripper friend indeed is HIV negative.  If she had it, the chance you would have caught it has been calculated at 1 in 20,000 -- which is equivalent to a BJ by an infected person once a day for 57 years before transmission occurs.  (Some experts believe it never occurs.)  And since the stripper clearly doesn't have HIV, your risk is truly zero.

You're fine.  From a risk assessment perspective, you don't need HIV testing.  You only need it if this reassurance is insufficient and a negative test result will further calm your nerves.  And there is no reason to not have unprotected sex with your partner.

Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

Also no serious risk of other STDs. The stripper will have been tested for syphilis, chlamyida, and gonorrhea, in addition to HIV; and almost all STDs acquired from oral sex would have caused symptoms within 2 weeks.  So besides HIV, there is no realistic risk of any other STD.

[gr0372]

You deal with a lot of anxious people so I apologize for the follow up but I am one of those anxiety/guilt ridden individuals. Even just seeing that others have made similar mistakes has made me feel better. You will not hear anything but a thanks from me after this. I take your mentioning that there is no reason not to have unprotected sex with my partner as a wonderful statement. I do plan on getting an std panel done for my own sanity and to ensure that I will not be that guy who got struck by lightning. What is your assessment of the reliability of the DNA PCR test when taken 3-4 weeks from possible exposure?

[H. Hunter Handsfield, M.D.]

Do not have a PCR test.  They are not made (nor approved by FDA) for use in situations like this.  Just have an antibody test.  At 3-4 weeks after exposure, the antibody tests will pick up around 80-90% of infections, and by waiting just another couple of weeks will be 100% reliable.  By contrast, the PCR test has a propensity to give false positive results.  Think what you'll go through for a week if that happens, while additional testing is done to show that you don't really have HIV.

If you were my patient and any HIV test turned up positive, my first tack in counseling you about the result would be to look you in the eye and say "OK, let's talk about your real risks. Because you didn't get it during the oral sex event you describe."  Looked at another way, if you have HIV, it would probably be because your significant other has it.

But do what you wish.  I won't have any further comments.

[gr0372]

Thanks for your help and advice.