HCV Transmission Over Unprotected Oral Sex

[anxietyattack2008]

Perhaps this may have been asked before. How likely HCV can be transmitted via unprotected oral sex? I had recently made a very stupid mistake by performing oral sex to a female prostitute (cunninglingus) as well as receiving unprotected oral sex from her. I only performed cunninglingus shortly less than 2 minutes. Followed by protected virginal sex. I still regret it which put myself in unbearable anxiety for 3 months not just worrying about HIV, but also Herpes and Hepatitis. The exposure was on 06/19/08. On the same day during night time, I had a pretty bad sore inner lips and tongue which lasted for 2~3 days. Perhaps I used too much mouth wash before and after the exposure which I had spit off some skins later. Only about 4th of July, I have developed chronic diarrheas for months now. The stools are sometime normal but could often loose. I also have dry mouth only during night time while asleep. I have abdominal pain on both the left and right but not sure if they're upper or lower quadrant. In addition, I also have migraine / headaches over for 3 weeks now, but it just came and gone in the scale of mild. I had Hepatitis A,B and C antibody test on July 22nd which is only 5 weeks after the exposure, perhaps is too soon to be meaningful. The Hepatitis A & B were igM tests. I also have HIV results of both Antibody and DNA PCR in the Negatives for 10 weeks now. My questions are:

1. Statistically wise, how likely can HCV transmitted over unprotected oral sex?
2. Do the symptoms I described can be HCV related? I don't have any fever, vomiting, losing weights, cola color urines or clay color stools.
3. How soon should I be tested again for HCV for antibody? I can't afford to do DNA PCR with Labcorp for $700.00!!
4. How long should I wait to be tested again for HCV to be considered conclusive?

Thank you so much in helping me out.

[H. Hunter Handsfield, M.D.]

Not working late at all -- I am between sessions at a scientific meeting in Italy.

[anxietyattack2008]

Wow....that was a super quick response. Thank you so much, which I can't believe you are even working late on a Friday night. Once again, Thank You. God Bless You and Dr. Hook.

[H. Hunter Handsfield, M.D.]

You probably are somewhat protected against HAV and HBV from the incomplete vaccination series.  Since you are so concerned about these infections (I still don't know why but it doesn't matter), see a provider about completing and/or restarting your immunizations.

The last detail about the sexual exposure makes no difference.  In general, all STDs are much harder to transmit than you seem to think. That is why they are STDs.  If they were so easy to transmit, then nonsexual transmission routes would be common.

That's all for this thread.

[anxietyattack2008]

Sorry, one more detail I forgot to provide. We didn't finish the protected vaginal sex which she has to give me a hand job afterward with condom off to finish it off. I was worried that she has touched her Virgina with some residual fluid on her hand while performing the hand job with condom off. Perhaps some level of increased risk over still zero risk....Sorry for being paranoid in obsessing with details....

[anxietyattack2008]

Thank you so much for your help as well as Dr. Hook earlier on my concerns about potential exposure to HIV. Now I am better understanding that HCV may not be effectively transmitted through the route of oral sex. Since you mentioned that you won't even advice me to be tested for any forms of Hepatitis, which I assumed that I shouldn't be worry too much about HBV also. I have one last question to bug you then I will say goodbye and not to come back for another six months which I hope I won't have to ask more HIV or STD questions with this huge lesson learned.....no more CSW for me.......

I had vaccines done for both Hepatitis A and B roughly about 1997. I could remembered it was something like the 0,1,6 schedule. However, I missed the 3rd dose which I had to wait 6 months for it which I really regret it now. Do I still have some level of protections against HBV and HAV even the fact that I may have very low risk of exposure via unprotected oral sex? Or am I at risk of HBV given my history and exposure????

BTW, again thank you so much for your words and Dr. Hook which always calms me down. I will have to manage to talk to my PHP about it because he is our family Doctor.......

Also many thanks to Dr. Hook, He was right that I shouldn't be worry that I have 10 weeks of ELISA HIV test in NEGATIVE.

[H. Hunter Handsfield, M.D.]

Contrary to popular opinion these days, HCV really isn't an STD in the usual sense.  Recent data documents that it sometimes is transmitted sexually among men who have sex with men, but that probably is exclusively through anal sex with blood exposure.  Heterosexual transmission has never been clearly documented and if it occurs, it is rare.  Oral sex has never been known (or even suspected) as a transmission route.  Based on your exposure history and symptoms, had you come to my STD clinic, we would have counseled against testing for any forum of hepatitis based on the exposure you describe (and would have refused to test you for HCV).  To the specific questions:

1) No data are available, but probably you were at zero risk for HCV.

2) Your symptoms don't suggest hepatitis of any kind.

3,4) Because it isn't an STD, I don't try to keep current in HCV diagnosis. If you insist on additional testing, probably an antibody test at around 3 months would be OK.  Don't decide yourself or by online searching or forums, and do not use a lab directly or an online testing service.  See a personal health care provider about your symptoms and exposure, then follow his or her advice.

Finally, please note the MedHelp rule about a maximum of 2 new questions every 6 months on the moderated forums (you had another question a couple of months ago).  See "Terms of Use" at the bottom of the page.

Regards--  HHH, MD