syphilis and hiv through recieving and giving oral sex

hi doctor

3 months ago i got tested positive for syphilis. i got 2 treatment of peniclin injections. i was later informed after one month that the syphilis treatment had worked.

however 4 weeks ago i made a stupid mistake and recieved and performed oral sex and two ladies, this was unprotected. i later noticed that on the tip of my foreskin i had little slits and cuts. no blood was coming out but it was open. they were only visable if i looked closely. because i had syphilis does this make me virtually guaranteed to get hiv if either of these ladies were hiv positive? also when i brush my teeth my gums bleed. will this also cause me to get hiv when i performed oral sex on the ladies? the next day i examined my tongue but couldnt see any cuts, but on the tip of my tongue i noticed little red dots. i dont know how long they have been there for as i have never examined my tongue that closely.

two days after my exposure i suffered diarrea (diarrhea) which lasted about ten days, i have also suffered from a dry cough, this leads to difficulty in breathing after a meal which is somewhat relieved when i burp. my upper back and the back of my shoulder blades have been aching me as though i have been to the gym and lifted weights, however i have not been to the gym. my stools when i go to the toilet have been abit mixed. sometimes they are normal for 3 days and another 3 days they will go soft but no full diarrea (diarrhea). the colour will also change from very light brown to brown.i havent had a proper fever but sometimes i do feel the need to put on a jacket when i am indoors. i think anxiety is my big problem, i cant sleep at night worrying that the open cuts on my penis will lead me to get hiv, and the fact i had syphilis make me more likely.

[Edward W Hook, MD]

Welcome to our Forum.  Dr. Handsfield and I are doctors and have been engaged in diagnosis and management of persons with and at risk for STDs, including HIV for our entire careers.  I suspect that jimbobbm may have thought he was providing and answer on the HIV Prevention Community site which is separate from this site (but is also quite a good source of information).

Let's work through your concerns.  Your diagnosis of syphilis is associated with about a 3-fold increase risk for getting HIV if you were exposed to HIV at the same time that you acquired syphilis or before you were treated. Now, following your syphilis treatment, your risk for HIV is biologically no different than the risk of persons similarly exposed who did not get/have syphilis.  An open sore of any sort is thought to increase the risk of getting HIV if exposed but that increase in risk is low and lower if you are dealing with a simple, non-syphilitic sore than if you were dealing with syphilis.  

As far as your exposure is concerned however, with or without syphilis, cuts, sore gums, etc, you are at virtually no risk for HIV.  For starters, it is unlikely that your partners had HIV, few heterosexual women do, even if they are commercial sex workers.  Second, there is virtually no risk for HIV from oral sex.  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.  This includes by all of the people who had gum disease, etc.

Finally, as mentioned above, your symptoms came on earlier than would be expected for HIV and are non-specific and not suggestive of HIV.  Your statement that anxiety is likely to be part of the problem is, no doubt correct.  I hope that my comments are helpful to you in this way.

You need follow-up HIV testing at 3 months following your syphilis treatment.  As far as testing related to the exposures you describe above is concerned however, there is little to worry about.  I hope my comments are helpful to you. EWH

[cna341]

first i should mention that were not doctors here.if U want an doctor's opinion post on expert forum.but here we have people like teak who is a professional in case of HIV.
first as TEAK will tell you any way you have not put your self at any risk for HIV.because receiving and giving oral sex does not have any practical risk for HIV.and hiv is not going to transmit that way.
to your symptoms im sure that you have googled ars symptoms.and you know that it is impossible that they start sooner than(7 to 10)days.ars does NOT occur 2 days after exposure.
in adition the cuts on your foreskin are irrelevant in terms of HIV.

[jimbobbm]

sorry for the confusion, i thought mr hook and mr handsfield were doctors.

surely if i have a open sore on my foreskin and i insert this into someones mouth im putting myself at risk. if either of the girls had a cut or sore in her mouth then i would be open to hiv infection? is this right in what i am saying?

also the fact i had syphilis doesnt that make me more likely to catch hiv?

[jimbobbm]

thankyou for your reply dr hook. so the fact that i have been treated for syphilis means that i need not worry about the increased chances in getting hiv? i have the same risk as a person who does not have syphilis? even if i think one of the cuts on my penis was bought about by the shyphilis infection?

i also engaged in rimming one girl for about 30secs. is this classed the same as oral sex in terms risk %?

i have read elsewhere on the internet that open cuts and sores doesnt matter when it comes to recieving oral sex, as both male and female would need a vast amount of dripping blood present to constitute hiv infection from on another. do you agree with this?

[Edward W Hook, MD]

Let's not get into "what if" or "has it ever" questions. they are little help.

Rimming falls into the broad catergory of orla sex.  

ORal sex is not a risk for HIV, even if you have cuts of sore on your penis.

EWH

[jimbobbm]

sorry i forgot to mention that one of the girls had her tongue pierced. the ring was inside the piercing and there was no visible blood in her mouth.

this is why i asked does the person performing the act have to have alot of blood present to pass on the virus or can her tongue pierce be sufficient enough to pass on hiv ( even though the pierced hole was covered by the ring and no blood was visible)?

[Edward W Hook, MD]

Still no change in my assessment.  EWH

[jimbobbm]

sorry to bother you again dr hook, this is my last question.

is a stiff neck a early hiv symptom? a neck that feels abit heavy?

[Edward W Hook, MD]

This too is a non-specifc symptom which is more likely due to anxiety or some other process than HIV. Still no change in my assessment.  EWH