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Testing after Oral
Hi Dr.,
I am a male and I gave unprotected cunnilingus to and received unprotected fellatio from a female masseuse 8 days ago. Perhaps she can be considered a CSW.
So I know that oral is low risk. That being said, I can't shake the worry from my mind. So I would like to get NAT HIV testing. I read Dr. Jose's article about testing for HIV and HCV with NAT as well for syphilis IgG and IgM which can detect soon after exposure.
I plan on getting oral and urethra testing for gonorrhea and NGU.
1) I would like to put my fears to rest ASAP at whatever required monetary cost. Would doing NAT tomorrow (9 days post exposure) achieve this with respect to HIV (and apparently HCV and syphilis)? If not, how can I get the most accurate results possible ASAP?
2) Is there any reliable way to test for oncogenic HPV of the throat and if so, is it known how long one would have to wait post-cunnilingus exposure?
3) With respect to herpes, is there any realistic way to test for it with regards to this exposure?
4) Is there anything else I should do with regards to this exposure to rule out any STD's?
Thank you so much.
I am a male and I gave unprotected cunnilingus to and received unprotected fellatio from a female masseuse 8 days ago. Perhaps she can be considered a CSW.
So I know that oral is low risk. That being said, I can't shake the worry from my mind. So I would like to get NAT HIV testing. I read Dr. Jose's article about testing for HIV and HCV with NAT as well for syphilis IgG and IgM which can detect soon after exposure.
I plan on getting oral and urethra testing for gonorrhea and NGU.
1) I would like to put my fears to rest ASAP at whatever required monetary cost. Would doing NAT tomorrow (9 days post exposure) achieve this with respect to HIV (and apparently HCV and syphilis)? If not, how can I get the most accurate results possible ASAP?
2) Is there any reliable way to test for oncogenic HPV of the throat and if so, is it known how long one would have to wait post-cunnilingus exposure?
3) With respect to herpes, is there any realistic way to test for it with regards to this exposure?
4) Is there anything else I should do with regards to this exposure to rule out any STD's?
Thank you so much.
MEDICAL PROFESSIONAL
Yes.
That will end this thread. I won't have any further comments or advice.
That will end this thread. I won't have any further comments or advice.
Thank you very much, Dr. H.
I did indeed predict a response from you similar to the one you stated.
Also, in that regard, would I be correct in predicting that you would recommend (in addition to not testing for HIV) to not test for any other STD's including gonorrhea, herpes, syphilis or anything else in the absence of symptoms?
I did indeed predict a response from you similar to the one you stated.
Also, in that regard, would I be correct in predicting that you would recommend (in addition to not testing for HIV) to not test for any other STD's including gonorrhea, herpes, syphilis or anything else in the absence of symptoms?
MEDICAL PROFESSIONAL
There is no "debate among experts" about oral to penile HIV transmission by fellatio or about transmission by cunnilingus. All agree the risk is either zero or very, very low -- effectively zero. Since it is impossible to prove a negative, there is no resolution; that there have been few or no documented transmissions does not prove it cannot happen. Those who argue such transmissions are possible acknowledge they may be wrong; and those who believe they don't occur agree they too could be wrong. It's not a debate, just a trivial disagreement among equally qualified experts.
In any case, you're worrying about something that is far less likely than the possibility you'll be struck by lightning or a meteorite. If you live in the US, then according to the National Safety Council, there is 1 chance in 1,756 you'll die of an accident within 12 months -- literally hundreds or thousands of times higher than the chance you caught HIV. It makes no material difference in these odds if your massage partner has performed oral on none of her other customers or on a thousand of them. The risk to you is nil for practical purposes.
One thing I do believe you are right about is that you probably predicted a response much like the one I gave. Right?
Oh, and by the way: don't forget your seat belt!
In any case, you're worrying about something that is far less likely than the possibility you'll be struck by lightning or a meteorite. If you live in the US, then according to the National Safety Council, there is 1 chance in 1,756 you'll die of an accident within 12 months -- literally hundreds or thousands of times higher than the chance you caught HIV. It makes no material difference in these odds if your massage partner has performed oral on none of her other customers or on a thousand of them. The risk to you is nil for practical purposes.
One thing I do believe you are right about is that you probably predicted a response much like the one I gave. Right?
Oh, and by the way: don't forget your seat belt!
Thank you kindly for your helpful and informative reply and links, Dr. Handsfield.
I know there is still debate among experts whether insertive fellatio and receptive cunnilingus is ZERO risk for HIV or not. I must ask, in your expert opinion, are these activities zero risk (like mutual masturbation) for HIV or would you consider them not quite zero? Sorry if this is a hair splitting question, but I am curious as to where you stand on this at this at this point in time, considering the debate.
Also, I must ask (maybe I should have asked this in my initial post), but would you say beyond my fear/compulsion to test, did I have any risk from my encounter and do I actually need any testing? My main concern is that I think she does oral (possibly riskier) sex acts with other people she massages. Perhaps I can predict your answer, but I figure I should ask you directly.
Once again, thank you kindly.
I know there is still debate among experts whether insertive fellatio and receptive cunnilingus is ZERO risk for HIV or not. I must ask, in your expert opinion, are these activities zero risk (like mutual masturbation) for HIV or would you consider them not quite zero? Sorry if this is a hair splitting question, but I am curious as to where you stand on this at this at this point in time, considering the debate.
Also, I must ask (maybe I should have asked this in my initial post), but would you say beyond my fear/compulsion to test, did I have any risk from my encounter and do I actually need any testing? My main concern is that I think she does oral (possibly riskier) sex acts with other people she massages. Perhaps I can predict your answer, but I figure I should ask you directly.
Once again, thank you kindly.
MEDICAL PROFESSIONAL
Absence of symptoms of oral OR GENITAL herpes (blisters, sores, severe sore throat).
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question, and thanks for doing some research by looking at other MedHelp threads and resources before asking your question. Although I disagree with the need for testing for HIV or any other STD (as you knew I would), I'll answer your questions directly.
1) A negative NAAT at 9 days probably would be about 90% reliable -- i.e. about that proportion of newly infected people would have positive results. For definitive results, you'll also need an HIV antibody test, which I would recommend at 1 month. The combination of those two results would be 100% reliable.
2) There are no commercially available, regulation-approved tests for oral HPV infection. We also don't know how long after exposure it would take for a new HPV infection of the mouth or throat to show up on testing; it might be several months. You probably can find online sources for such testing, but for these reasons I cannot recommend them. The only HPV type to be concerned about is HPV-16, which the only strain known to be associated with increased risk of later throat cancer. If you proceed, be aware that a positive result won't tell when and where you caught it and will not necessarily mean you are at risk for any HPV related outcome; and a negative result won't prove you don't have it. Here are a couple of threads (which in turn link to other threads) that provide detailed information about HPV, oral sex, and throat cancer:
http://www.medhelp.org/posts/STDs/HPV-and-oral-sex/show/1515473
http://www.medhelp.org/posts/STDs/Oral-HPV-Cancer-Risk/show/1512873
3) Absence of symptoms of oral herpes (blisters, sores, severe sore throat) will be strong evidence you didn't catch HSV from this event. But the only way to know for certain would be to have an HSV blood test 3-4 months after the exposure. If positive for either HSV-1 or HSV-2, it probably would not be because of this event.
4) Given your obvious compulsion to be tested, I would include a blood test for syphilis at 6 weeks or more after the exposure. But this too really isn't necessary after such an exposure.
Regards-- HHH, MD
1) A negative NAAT at 9 days probably would be about 90% reliable -- i.e. about that proportion of newly infected people would have positive results. For definitive results, you'll also need an HIV antibody test, which I would recommend at 1 month. The combination of those two results would be 100% reliable.
2) There are no commercially available, regulation-approved tests for oral HPV infection. We also don't know how long after exposure it would take for a new HPV infection of the mouth or throat to show up on testing; it might be several months. You probably can find online sources for such testing, but for these reasons I cannot recommend them. The only HPV type to be concerned about is HPV-16, which the only strain known to be associated with increased risk of later throat cancer. If you proceed, be aware that a positive result won't tell when and where you caught it and will not necessarily mean you are at risk for any HPV related outcome; and a negative result won't prove you don't have it. Here are a couple of threads (which in turn link to other threads) that provide detailed information about HPV, oral sex, and throat cancer:
http://www.medhelp.org/posts/STDs/HPV-and-oral-sex/show/1515473
http://www.medhelp.org/posts/STDs/Oral-HPV-Cancer-Risk/show/1512873
3) Absence of symptoms of oral herpes (blisters, sores, severe sore throat) will be strong evidence you didn't catch HSV from this event. But the only way to know for certain would be to have an HSV blood test 3-4 months after the exposure. If positive for either HSV-1 or HSV-2, it probably would not be because of this event.
4) Given your obvious compulsion to be tested, I would include a blood test for syphilis at 6 weeks or more after the exposure. But this too really isn't necessary after such an exposure.
Regards-- HHH, MD
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