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Avatar universal

My risk for HIV transmission

Hello Dr.

A couple of nights ago I have made a foolish error whilst out in Bangkok. While out in the popoular tourist bar district (Go-Go Bars), I met a sex worker from the bar and took her back to a hotel where the following events took place: Mostly deep kissing and some mutual masturbation. In one instance, she briefly performed gentle unprotected oral on me for ~ 5-10 seconds before I realised the exposure and stopped her, immediatly I flushed my foreskin/penis with water. Also at one point, she sat up on me briefly with her vagina slightly rubbing on the shaft base of my penis. We continued kissing/masturbating for a little while longer after. There was no penile penetration involved during these events but possibly some vaginal fluid may have touched penis head during masturbation. Approximately 5mins after finishing, I itched my anal opening (not deep, just surface) with a finger I had placed inside her and realising quickly washed with water. I am worried about this exposure also. My fingers had touched clothing/sheets prior to this so I assume amount of vaginal fluid on fingers would be small.

I would like your expert opinion on if there is any real risk for HIV transmission to myself in the events I have described. I have a partner whom I wish not to expose and would like to know if I can continue unprotected sex with her. I just happen to have already been taking Roxithromycin 300mg antibiotics for the last 10 days, would this prevent any bacterial infection that may be possible? Would greatly appreciate your advice. Thanks for this service.

5 Responses
239123 tn?1267647614
Welcome to the forum and thanks for your question.  Bottom line:  you are at no risk for HIV from the events described, and at little if any risk for other STDs.  Nearly identical questions have been asked many, many times.  You could scan other threads, or use the search function, to find other discussionthat should also reassure you.

Thailand used to have high rates of HIV in sex workers, but due to highly effective government-sponsored condom promotion and other prevention programs, it's now quite rare.  There's probably no more than a 1% chance your partner had HIV.  Second, sexual transmission of HIV doesn't occur except by unprotected vaginal or anal sex.  If it occurs at all by oral sex, it's very rare; on estimate is once for every 20,000 events.  And your risk is lower still, given the very brief oral sex exposure.  Finally, HIV is not transmitted at all by hand-genital contact, fingering, kissing, etc.

The risk of other STDs from the oral sex is a little higher than for HIV, but still very unlikely given the brief exposure.  And your roxithromycin treatment protected you from most of the possible ones, including gonorrhea, nongonococcal urethritis, and syphilis.

Therefore, on the basis of this exposure, you do not need testing for HIV or other STDs, and you can safely continue unprotected six with any regular sex partner(s) you may have.

So congratulations on your decision to use safe sex for this event.  You really should have no worries about it.  Best wishes--  HHH, MD
Avatar universal
Hi Dr. Thank you for this reassurance regarding my HIV concern.

If I may, could I ask just what is the supposed theoretcial mechanism by which HIV can be transmitted via oral sex (insertive)? Is the virus carried in the saliva and therefore this is the source as it gets rubbed on the head of the penis? Or is it from possible sores/blood in the mouth being the source of the virus?

Just finally, in regards to the kissing I described, as an estimate this may have totaled 5-10mins during the event. Does duration of kissing change the risk in any way? Or kissing does not transmit period?

Again, really appreciate your time and this great service you are able to provide.

239123 tn?1267647614
I would turn your first question around:  Why is oral sex such a rare transmission mechanism, if it occurs at all?  Partly it's because saliva doesn't contain much HIV, and actually inactivates the virus -- so even if there is blood, the virus is killed and cannot infect.

Kissing has never been reported to transmit HIV.  Some kisses go on for much longer than the few minutes you describe -- and yet no transmission.

My advice is that you not worry about the biological explanations.  The data on rare or no transmission by such exposures are quite reliable, so I don't see that the biological reasons matter very much.

Thanks for the thanks about the forum.
Avatar universal
Hi Doctor,

Sorry in advance if i appear to be wasting your time with this question/concern again but i just want to make sure my risk position has not changed with possible symptoms i'm experiencing. 7 days post the exposure (now 11days) i described, i've been noticing what appears to be mild gland sensation just under jawline/neck at times during the day, and perhaps ear irritiation/popping and slight mucas on the throat-mostly in the morning, no other noticable symptoms. Prior to the exposure, for a couple of weeks i'd been battling a virus- mainly sore throat and had fluid in the ears/irritation and throat mucas, and thought it was improving around the time i had the exposure.

Should i be concerned about this slight feeling in my glands i'm experiencing in relation to early HIV symptoms? Or is this probably still my body trying to overcome previous infection? Probably didn't help i was flying around a bit for 2 weeks and noticably affecting my ears. While i accept your no risk position, i guess this is playing on my mind like it seems to for most. If i was to consider a test for peace of mind, when/what would you recommend?

Thanks again Dr.
239123 tn?1267647614
Symptoms almost never make much difference in assessing whether or not someone has a new HIV infection.  Even the most typical symptoms of acute HIV infection are much more commonly cuased by other conditions. And in any case, your symptoms do not even hint at HIV.  I can't explain your symptoms (and I doubt it has anything to do with "my body trying to overcome previous infection".

I always recommend HIV testing for peace of mind if that's what someone needs to get beyond worrying about it.  So go ahead if you wish.  A standalone antibody test any time 6 weeks or more after the exposure, or a duo/combo test (for HIV antibody plus p24 antigen) at 4 weeks will give definitive results.

But the bottom line is that this additional information does not change my opinion or advice.
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