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HIV from Bloody Oral During Acute HBV
Hi Doctors,
Thank you for this forum and for your help. I know that the common wisdom is that oral is not a risk for HIV, but I have a situation, which I think may pose an HIV through oral worst case scenario. I got some advice on the Health Forums, for which I'm very grateful, but wanted to ask you about my particular set of circumstances.
I've copied my original question below.
On Friday, May 17th, I received unprotected oral from someone whom I believe to be a higher risk for HIV (African American, CSW from a very rough part of town - not an escort). I mention this without bias. My understanding is that statistically it matters. I understand that the general consensus is that oral carries no risk of HIV but there are a couple items which I think might make things different in my particular case. I'm not implying that my situation is special or unique. I just think I screwed up big time.
1.) Though I did not bleed (I checked for scratches and cuts), I am uncircumcised.
2.) She did bleed some. There were visible streaks of blood on the head of my penis. Not copious amounts, but enough to see without strain.
3.) On Sunday, May 19th, I was diagnosed by an ER doc, and subsequently by a specialist with Acute HBV. Didn't know I had it. I noticed my urine was very dark that Sunday and went in to get checked. I'm right in the middle of hopefully clearing the infection.
I'd like to know, based on these factors and my partner's characteristics, how elevated is my risk of having contracted HIV.
Thank you for this forum and for your help. I know that the common wisdom is that oral is not a risk for HIV, but I have a situation, which I think may pose an HIV through oral worst case scenario. I got some advice on the Health Forums, for which I'm very grateful, but wanted to ask you about my particular set of circumstances.
I've copied my original question below.
On Friday, May 17th, I received unprotected oral from someone whom I believe to be a higher risk for HIV (African American, CSW from a very rough part of town - not an escort). I mention this without bias. My understanding is that statistically it matters. I understand that the general consensus is that oral carries no risk of HIV but there are a couple items which I think might make things different in my particular case. I'm not implying that my situation is special or unique. I just think I screwed up big time.
1.) Though I did not bleed (I checked for scratches and cuts), I am uncircumcised.
2.) She did bleed some. There were visible streaks of blood on the head of my penis. Not copious amounts, but enough to see without strain.
3.) On Sunday, May 19th, I was diagnosed by an ER doc, and subsequently by a specialist with Acute HBV. Didn't know I had it. I noticed my urine was very dark that Sunday and went in to get checked. I'm right in the middle of hopefully clearing the infection.
I'd like to know, based on these factors and my partner's characteristics, how elevated is my risk of having contracted HIV.
Thanks again doctor. I'll return in 4-6 weeks to post my results. Until then, please take care.
MEDICAL PROFESSIONAL
By the way, the CDC's STD/HIV phone hotline is run by contract to the lowest bidder. The phone rep probably was not actually with CDC, but probably a low-paid, minimally educated person who was following a script. CDC's hotline is pretty good for some things, but not for more sophisticated medical issues.
MEDICAL PROFESSIONAL
1) Correct.
2) There are no medical conditions known to interfere with HIV antibody test reliability, with the theoretical (but unproved) possibility of advanced life-threatening conditions like overwhelming sepsis, terminal cancer, etc. There is no known effect from other acute viral infections like hepatitis B.
3) PCR testing can give reassuring results in the time frame you suggest, but you still would need an antibody test after 4 weeks, so PCR doesn't actually reduce the time to a definitive answer. And it's quite expensive and probably not covered in this situation by most health insurance policies. For these reasons, it's generally reserved for much higher risk situations than yours. But it's something you could discuss with your doctor. Peraonally, I certainly wouldn't do it if somehow I were in your shoes.
Thanks for the thanks. Take care.
2) There are no medical conditions known to interfere with HIV antibody test reliability, with the theoretical (but unproved) possibility of advanced life-threatening conditions like overwhelming sepsis, terminal cancer, etc. There is no known effect from other acute viral infections like hepatitis B.
3) PCR testing can give reassuring results in the time frame you suggest, but you still would need an antibody test after 4 weeks, so PCR doesn't actually reduce the time to a definitive answer. And it's quite expensive and probably not covered in this situation by most health insurance policies. For these reasons, it's generally reserved for much higher risk situations than yours. But it's something you could discuss with your doctor. Peraonally, I certainly wouldn't do it if somehow I were in your shoes.
Thanks for the thanks. Take care.
Thank you doctor for such a detailed response to my question. I'm very grateful for your time and expertise.
You're correct, the specialist that confirmed my HBV diagnosis had me tested for HIV (1/2). The results came back negative.
If you don't mind doctor, I have 3 follow-up questions:
1.) As I read your response, I understand that you're saying, that the fact that I was in the middle of an a Acute HBV infection does not raise the risk of acquiring HIV during the oral episode on May 17th. Is that correct?
2.) Would the fact that my immune system is currently fighting an Acute HBV infection, potentially delay seroconversion for HIV? Does the immune system work in a first-come, first-served basis?
3.) I spoke to the a phone rep from the CDC and they told me that there was a test that I could take for earlier detection. I believe it's PCR-RNA and it's valid starting 9-11 days after the event. Can I take that test? Is it worth it?
This will be my last post for a while. I don't expect to bother you again until 4-6 weeks. I'll come back to post my results. Hopefully negative.
Thanks again doctor.
You're correct, the specialist that confirmed my HBV diagnosis had me tested for HIV (1/2). The results came back negative.
If you don't mind doctor, I have 3 follow-up questions:
1.) As I read your response, I understand that you're saying, that the fact that I was in the middle of an a Acute HBV infection does not raise the risk of acquiring HIV during the oral episode on May 17th. Is that correct?
2.) Would the fact that my immune system is currently fighting an Acute HBV infection, potentially delay seroconversion for HIV? Does the immune system work in a first-come, first-served basis?
3.) I spoke to the a phone rep from the CDC and they told me that there was a test that I could take for earlier detection. I believe it's PCR-RNA and it's valid starting 9-11 days after the event. Can I take that test? Is it worth it?
This will be my last post for a while. I don't expect to bother you again until 4-6 weeks. I'll come back to post my results. Hopefully negative.
Thanks again doctor.
MEDICAL PROFESSIONAL
Welcome to the foru. Thanks for your question.
You are correct that an African American sex worker, is statistically more likely than most persons to have HIV. However, it depends somewhat on geography as well; if you're in Washington DC or any number of other eastern urban areas, the odds would be a lot higher than in, say, Denver, San Francisco, or Phoenix. And even in the highest risk settings, most such women in fact don't have HIV.
As you already know, and as commented by Teak in the community forum, oral sex has rarely if ever transmitted HIV in the oral to penile direction. While blood contact during such an exposure in theory might raise the transmission risk, oral lesions that bleed aren't all that rare (dental problems and many other possibilities) -- so there must have been millions or billions of fellatio events with HIV infected partners that also involved blood exposure, but still no clearly documented cases of oral to genital transmission. So that aspect doesn't significantly elevate your risk.
To my knowledge, there are no data to suggest that acute HBV infections raise the risk of HIV infection if exposed -- and I don't see it as biologically likely. So your recent diagnosis also doesn't alter my perspective.
Of course the other issue, which you don't address, is the source of your HBV infection. In itself, that's a major red flag signalling HIV risk -- not because of susceptibility (as just discussed), but all behaviors and exposure events that transmit HBV also are high risk for HIV. The usual incubation period of hepatitis B is 2-3 months, sometimes as long as 5 months, so it seems likely you had a substantial blood or sexual exposure in that time frame. On that basis, it wouldn't be all that surprising if you were found to have HIV.
That said, most doctors would automatically test any patient with new HBV infection. If that was done and negative, you can dismiss it. As for your recent oral sex exposure, I really don't see a high priority for HIV testing -- but if you would like the additional reassurance of an expected negative result, you can be reliably tested any time more than 4-6 weeks after the exposure, depending on which test (or comination of tests) are done.
I'll be happy to comment further if you would like to post either a current or future HIV test result. In the meantime, I hope this has been helpful.
Best wishes-- HHH, MD
You are correct that an African American sex worker, is statistically more likely than most persons to have HIV. However, it depends somewhat on geography as well; if you're in Washington DC or any number of other eastern urban areas, the odds would be a lot higher than in, say, Denver, San Francisco, or Phoenix. And even in the highest risk settings, most such women in fact don't have HIV.
As you already know, and as commented by Teak in the community forum, oral sex has rarely if ever transmitted HIV in the oral to penile direction. While blood contact during such an exposure in theory might raise the transmission risk, oral lesions that bleed aren't all that rare (dental problems and many other possibilities) -- so there must have been millions or billions of fellatio events with HIV infected partners that also involved blood exposure, but still no clearly documented cases of oral to genital transmission. So that aspect doesn't significantly elevate your risk.
To my knowledge, there are no data to suggest that acute HBV infections raise the risk of HIV infection if exposed -- and I don't see it as biologically likely. So your recent diagnosis also doesn't alter my perspective.
Of course the other issue, which you don't address, is the source of your HBV infection. In itself, that's a major red flag signalling HIV risk -- not because of susceptibility (as just discussed), but all behaviors and exposure events that transmit HBV also are high risk for HIV. The usual incubation period of hepatitis B is 2-3 months, sometimes as long as 5 months, so it seems likely you had a substantial blood or sexual exposure in that time frame. On that basis, it wouldn't be all that surprising if you were found to have HIV.
That said, most doctors would automatically test any patient with new HBV infection. If that was done and negative, you can dismiss it. As for your recent oral sex exposure, I really don't see a high priority for HIV testing -- but if you would like the additional reassurance of an expected negative result, you can be reliably tested any time more than 4-6 weeks after the exposure, depending on which test (or comination of tests) are done.
I'll be happy to comment further if you would like to post either a current or future HIV test result. In the meantime, I hope this has been helpful.
Best wishes-- HHH, MD
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