how low is low risk???

[chris1983]

Doc.  I first have to say you do great work!

30 days ago i received unprotected oral sex from a random male.
The only thing I know about him is that he said he was hiv neg.  About 12 days or so after the incident I noticed some glands around my body that were noticeable and then out of the blue a hard core "head cold."  Or, what I thought was a head cold, lots of green and yellow phelm from coughing and when I blew my nose and mild sore throat when I woke up.  This lasted about a week and I saw my Dr. who gave me zithromax.  I took it for 5 days and on the 5th day noticed my tongue was all whacked out with white coating and bright red random spots.  This is when I got freaked out and started feeling by body and noticed that glands in my groin and armpits were very noticeable and protruding.  My groin to down the inner thigh has lots of protruding things.....

We all see the conflicting data about oral.  In your experience have you ever had someone test positive due to insertive oral sex.  I m starting to get really scared.  A lot of people seem to think oral is no risk, but that is starting to seem hard to believe.  I want and need your professional.

[H. Hunter Handsfield, M.D.]

Just look rationally at the odds.  It is said the risk of acquiring HIV from a single episode of receiving fellatio from an HIV-infected partner is around 1 chance in 10,000.  By itself, that translates into a daily BJ by an infected partner for 27 years before you would expect to catch the infection.  And your partner says he doesn't have HIV!  But let's say there is a 1% chance he is infected, either because he is lying or he was in the window period the last time he was infected.  That makes your chance of having caught HIV 0.01 x 0.0001 = 0.000001.  That's one in a million.  And that, my friend, is 37 times less likely than the chance you will die someday of a lightning strike (if you live in North America.

There are no 'conflicting data' about the low risk of oral transmission of HIV.  There are only conflicting nonscientific opinions and advice.  No, I have never seen someone with HIV acquired by receiving oral sex.  But since there might be only 10 or fewer people in the entire US (and maybe none!) who acquired their HIV infections that way, of course I would not expect to ever see such a person.

Your symptoms are irrelevant to these calculations, since all of them can be due to many conditions that have nothing to do with HIV.  Some of your symptoms do not suggest HIV at all (cough, head cold, coated tongue), although enlarged lymph nodes could be due to HIV.  However, most people who believe their lymph nodes are enlarged are wrong.  That's a notorious difficult symptom for self-assessment.

Bottom line:  See a health professional and follow his or her advice.  You can be HIV tested for self-assurance.  You can expect a negative result.

Good luck--  HHH, MD

[chris1983]

I understand that info and thank you for reiterating it to me, as that is important.  You state that unprotected oral is 1/10,000 with an infected person and that there are roughly 10 people in the US who received hiv from oral or maybe insertive oral, and I greatly respect your work and knowledge.  I just wonder when you read the sf study that stated 8 of 122 men transmitted hiv from oral or an australian study at states betweet 3-8% of hiv transmission is believed to be from oral.  What is the proof of the 1/10000 or is it just though?
Thanks!

[H. Hunter Handsfield, M.D.]

All data on oral sex transmission risk are flawed.  Some would say they are little more than a guess, and some experts believe the risk from receiving oral sex is zero, and chalk up the reports of rare cases as reflecting misinformation given by infected people who claim oral sex as the source.  I have no idea whether 10 cases is the right number - I picked a low number out of the blue just to make the point that it is rare enough that of course I have never seen a case personally.

Most of the oral sex acquired cases are the receptive (oral) partner.  There clearly is some risk there. I am unaware of any data from Australia or elsewhere that attribute 3-8% of cases in people receiving fellatio.

In any case, all such data depend on infected people's personal histories.  Some are lying--they have other risks they don't admit.  Others assume a particular exposure was the source of their infection, when in fact they caught it somewhere else.  Others believe they have new infection but in fact were infected a long before the oral sex event.  Others simply forget other, higher risk events, sometimes because they were high or drunk at the time.  And so on.

All things considered, even though the data from CDC supporting the 1 in 10,000 estimate also are flawed, most experts consider that to be the ballpark figure.  And many consider it a high estimate.

[bitethebullet]

The figure that you state 8 out of 122 is a study that showed receptive oral sex to be a risk.  And the figure that the doctor is quoting from the CDC is not for insertive oral sex it is for receptive oral sex( 1 out of 10000).  The figure that the CDC states for insertive oral sex is .5 out of 10000 or 1 out of 20000. and the way they came out with that figure was on assumtions that it was the least risky not that they had any actual cases.  There was a study in spain between couples where one was poz and the other neg and over 19000 instances of oral sex and not one positive result afterwards.

[monkeyflower]

Also, that 8 out of 122 study is flawed. I looked it up, and apparently everyone also had other possible exposures, including receptive anal sex. I guess the take-home message is that people aren't perfect. We readily lie, exaggerate, evade, and minimize things and events as needed...

[Alexandr]

Doc, your calculation is flawed too. Firstly, even with a 1:10000 likelihood, you do NOT have to do it 10000 times to get infected. I.e., for the first time the chances are 1 in 10000 indeed, but they increase with every next time... Having said that, 1 in 10000 is not that low: it is higher than winning the lotto and yet someone wins it nearly every week! So, how can you say that the risk is zero or nearly zero, when much less likely events (lotto is only one example) take place all the time?

[H. Hunter Handsfield, M.D.]

You miss the point entirely.  The accuracy of the specific numbers, or of my calculation of the odds, isn't the issue.  I use such guesstimates as ways to illustrate that the risk is extremely low - or in the case of receiving oral sex, maybe zero (with few or no proved cases of transmission).  It doesn't matter whether the actual risk comes to bear at real levels after 5, 20, 27, or 50 years.  It is negligible, that's the point.

But no ongoing discussion, please; it's a bit of a thread jump off chris1983's question and my response to him.