Help for a worried doctor!

I have a huge amount of respect for your posts and your direct down-to-earth advice. As a practising chest physician, I have lost objectivity and would appreciate your help. Regarding risks of insertive oral sex, most of you posts indicate that the risk of HIV is zero for practical purposes. One post, however, you stated that the risk was small but not zero.

Since a family bereavement I am undergoing treatment for health anxiety and stopping the practice of getting unnecessary medical tests is a crucial part of my therapy.

Stupidly I had a blind date which went quite far a couple of days ago. We hit it off and snogged a few times. She also gave me unprotected oral sex twice, about 5-10 mins each time. I am as sure as I can be that there was no blood in her mouth or open sores on my penis. I got freaked out that she said that she had worked as an escort for 3 months sometime last year, always using protection for vaginal sex but not always for giving blowjobs.

Please reassure me that I dont need to worry about HIV! I really was doing well with my health anxiety and dont want to ruin everything by starting a series of tests.

Thanks in advance.

[H. Hunter Handsfield, M.D.]

Please read numerous other threads using the search terms "STD transmission risk", "HIV transmission risk", "oral sex", and "fellatio".  Not coincidentally, searching "HIV anxiety" will bring up much of the same information.  As far as the seeming uncertainty you cite ("zero risk" vs "small but not zero", I'm sure you understand there are few absolutes in biology or medicine.  Depending on context of a patient's question, you might tell one person to completely disregard a particular diagnosis as a possibility for a given set of respiratory symtpoms and clinical circumstances, you might leave the door open a bit for another another with similar symptoms.

Here are some bulleted comments on the risk of acquring STD/HIV by receiving fellatio (with apology to the non-professionals for some terms the questioner will understand).

HIV risk:  near zero but probably not truly zero; no definitely documented cases.

Chlamydia risk:  Same.

Gonorrhea, some risk but lower than for vaginal or anal sex; but no quantitative estimates have been made.  Almost always causes obvious symptoms (purulent discharge, dysuria); absence of symptoms within a week is a virtual guarantee of no gonorrhea.

Nonchlamydial nongonococcal urethritis (NGU):  It occurs, but zero data exist on per-exposure risk; probably less than 1 in 100.  Variable (mostly unknown) causes, but probably no long term consequences and probably no risk to future sex partners.  If no symptoms (discharge [usually mucoid or cloudy, not overtly purulent], dysuria), don't worry about it.

Herpes due to HSV-1:  Although 50% of the population, and presumably 50% of commercial sex workers, have oral herpes, the large majority are distant childhood infections without recurrent cold sores.  In that circustance, asymptomatic viral shedding is uncommon.  Unless the partner has an overt oral herpes oubreak--which a partner could easily observe--the risk is very low.  But not zero.

Syphilis:  Theoretical small risk, primarily in settings with high background rates of syphilis (which does not include heterosexual female sex workers, especially expensive ones [ie, "escorts"]).

Other STDs: No signficant risks I can think of.

Take home message:  In the absence of symptoms, neither STD nor HIV testing is indicated on the basis of the encounter you describe.

Good luck-- HHH, MD

[Imdumb]

Relax doctor. I am sure you only want DR.HHH's advice, but in the mean time rest assured that there is not an HIV risk in getting oral sex. Saliva does not carry the virus. That is why sharing a drinking glass and kissing are not risks. If salvia carried the virus, there would be millions more infected. It simply doesn't happen.

[Willl]

Without visible blood, the saliva contact you had is referred to by the CDC as a neglible risk even if she had HIV.

PEP would not be warranted by the CDC guidelines and therefore neither would testing.

[Willl]

I also found out something you might be interested in as well as others on this forum, and possibly raks if he decided to get tested for some reason anyway.

We have discussed Home Access testing before, and I believe you said you were not aware of exactly what generation test they are using. I found out from Home Access that they use "the updated first generation ELISA". I know a lot of people come to this site and mention buying their test and also inquire about the window period. Would this information lower the approx. 95% accuracy of a 6 week test you sometimes give? Or would the difference for this updated first generation test be negligible?

[Docrak]

Thanks. I still hope that Dr HHH will answer my original question - hope not to let this thread "go off on tangents" before the original question is addressed. No offence intended!

[Willl]

I wouldn't worry about that. He always answers the original question. He is more likely to delete any follow up posts if they are not relevant.

[monkeyflower]

Wow, this has certainly been a popular topic recently! While you wait for Dr. Handsfield's response, you might read the thread "Going on Two Month Roller Coaster" for some of his thoughts on the oral HIV subject. In the meantime, I can tell you that you have nothing to worry about. Testing is completely unwarranted for such a low risk exposure.

[JohnnyV]

If this same doctor had asked the question but said he had two small depressions in his penis that look a little like sores, how much higher would the risk go for all categories?

J

[H. Hunter Handsfield, M.D.]

I can't speculate from such a vague description and not knowing the diagnosis. But probably not much difference.

HHH, MD

[JohnnyV]

Do sores or scabs that may have come off expose the insertive partner in fellatio to a high risk of HIV?

[Willl]

The source is still only saliva. If those types of sores made that much difference, then we should have had a documented case of HIV trasmission by this route.

[Willl]

I was responding to your first question. I always seem to post 5 seconds too late.