Valid Concern?

I posted this question in the wrong forum yesterday, so I apologize to anyone who's had to read it twice.

Thank-you for all your work on this forum, Doctor.

I'm notoriously anxious about my health, Doctor.  I dislike taking tests.  They tend to make me anxious, rather than reassuring me.  That said, I'll take them if they're necessary. So, I'm wondering if you think an HIV test is necessary.

I'm a 36 year old heterosexual male.  In the past three years (since my last HIV test), I've had unprotected oral sex with four women, one of whom was a CSW at a massage parlour.  I've had no unprotected intercourse.  I know that oral is an extremely low risk activity for HIV, but with four instances, do you think testing is warranted?

I'm concerned because I recently developed angular cheilitis.  It's clearing up relatively quickly with an anti-fungal cream and my doctor tells me it's a common condition.  I also have a white-grey film on my tongue, but I think I've had that for many years.  I've been to the dentist several times in the last few months and he hasn't mentioned anything amiss.  I'm missing a molar on one side of my mouth and perhaps this has contributed to the angular cheilitis.  I've read that missing teeth can be a cause.

Thanks for your time, Doctor.  There's no quick-testing where I live, so I don't want to be anxious for two weeks waiting for lab results if the testing wasn't warranted in the fist place.  I will take the test, though, if it's necessary.

[Edward W Hook, MD]

You do not need testing on the basis of your symptoms.  Your risks are tiny and neither angular cheilitis not discoloration of your tongue suggest HIV infection.  Similarly, the exposures you describe are very low.  With four oral exposures, your risk is now less than 4/10,000 - tiny.  I should also tell you that in our discussions with each other, neither Dr, Handsfield nor I have ever seen someone who acquired HIV infection solely from oral sex.  

Now, about testing.  Please remember that the purpose of testing is only to reassure you and, in the very unlikely event that an infection is discovered, to allow you to take steps to keep yourself healthy.  There is nothing about being tested that increases your risk- knowledge is power!.

Hop this helps.  EWH

[neilg2008]

I should add a couple of things (don't know if they're relavent or not).  I'm a smoker, so that may have contributed to the discoloration of my tongue.

Also...I've been very fortunate and not had a serious cold or flu in years.  Certainly nothing that resembles ARS.

Thanks.

[neilg2008]

Thank-you, Doctor.

That's reassuring.  My main concern is angular cheilitis.  Many websites associate this condition with HIV.  Are you suggesting that association is exaggerated?

Thank-you again.

[Edward W Hook, MD]

Absolutely.  EWH