Very scared.....oral

[Worried197833]

Dear doctor(s), hello from The Netherlands,
I always ask a partner (female) about there sexual and HIV test history beforehand. I always use a condom for vaginal sex. But now I am really terrified. I have gotten an unprotected blowjob from a woman. After the blowjob I saw a sort of abrassion, it is difficult to describe. I think a little piece of the horne layer of the skin was gone, or it could be a friction burn.  Two days after the blowjob the abrassion was gone.
As I told you I asked the lady about her sexual history and HIV test history. She told me that she whas tested for HIV ans STD’s 7 months a go (negative) and she said that she dit not have a HIV risk afterwards. So I was totally relaxed, and did not see a risk. But as I found out later that people perceive risks differently. After the test she has had unprotected sex with a friend of her. But because it was a friend she dit not see a risk. I freaked out. Please answer my specific questions.
Q1: Could this have been a way in to my bloodstream?
Q2: I did not see blood and it did not hurt during the blowjob. Is this a good sign?
Q3: 5 -7 days after the blowjob I got sick. Runny nose, cough, full nasal cavity. I do not know if I had the flu. Could this be ars?
Q4: I already have a rash on my back torso due to medication. But it is getting worse. It is slightly raised, pinkish, and some are spots others are big patches.  Does it sound like a Hiv Rash?
Q5: Do I need to worry? And do I need to test for HIV from a medical standpoint?
Q6: I will admit that I have a HIV phobia. What do you say to your heterosexual patients about their HIV risk?
I am really scared doctor because of the abrassion.
And a final general queston. Don’t you find it odd that there are almost no questions from women?

[Edward W Hook, MD]

Lasst answer- further questions will be deleted without comment.  There is no math to be done. Your 9 week test result is conclusive.  

A result at 6 weeks after and exposure is over 95% conclusive.  

End of thread.  EWH

[Worried197833]

Please, I hope you will help me one more time. I was happy with me negative outcome after 8-9 weeks, but I got sick again after 10 weeks. This has fueled my fear and anxiety. I am doubting everything right now!
Would you do the math with me please? I received unprotected oral. later I found an abrasion or friction burn on my penis, and I am not circumsized.
So instead of 1/20.000 I think it was 1/5000, do you agree?
So 1% chance woman was infected x 1/5000 x 2% chance test will show positive after 8-9 weeks. Do you agree?
Could ARS start as late as 10 weeks?
Say my exposue was only 6 weeks before the test. Am I also safe then?
I was tested with a 3rd or 4rd generation test.
Pleas help me one more time.
Regards, E

[Worried197833]

I tested negative today, 9 weeks after exposure. I want to thank you Dr. Hook and your colleague Dr. Handsfield. Your answers were the only thing that kept me sane. I will go in therapy for my overinflated fear of HIV.
Inquiringhsv, thanks and good luck to you!  Keep me posted..

[inquiringhsv]

Hi Worried197833, all the best! do post up your result when it is available. thanks!

[Worried197833]

I have had blood drawn today after 9 weeks. Please wish me luck!

[Edward W Hook, MD]

Last answer.  I anticipate your test will be negative.  A4th generation test will be definitive at 4 weeks, a 3rd generation test at 8.your worry is far out of proportion to your risk.  EWH

[Worried197833]

Good day Dr Hook. It has now been more than 6 weeks after the perceived exposure. I will wait with testing for HIV untill the 8 week mark. Despite your reassurance, I think I really need this. But the wait is very hard. I have found out that they use mainly the 4th generation Elisa test. Say they use the 3th generation, would 8 weeks be enough?
I am almost scared to ask you again, but how would you describe my odds staying negative?
With regards,  
E

[Edward W Hook, MD]

I treat my clients the same as I would treat myself.  I would not seek testing if I were in your situation.  EWH

[Worried197833]

It would be very reassuring for me to here from you if you would test for HIV if you were in my situation, keeping the abrassion in mind? This will end my posting. Thanx.

[Edward W Hook, MD]

No, that she drinks alcohol heavily and has a psychiatric history does not change my opinion or advice.  eWH

[Worried197833]

Your words are very helpfull, really. One last thing, The lady I was talking about has had a history of alcahol abuse and has a borderline disorder. This I learned just recently. Does this change your perception that she maybe from a higher risk group? This is actually what scared me the most.
It is nof fair, but I have got to ask.
Thank you for your quick replies....you do good work.

[Edward W Hook, MD]

Correct.  The exposure you describe was of minimal risk with a low risk partner.  "need" refers to medical recommendation.  Another way of saying the same thing is to say I see no need to recommend testing for HIV at this time.  

You need to relax.  EWH

[Worried197833]

Thank you for your reply...you said: I see no need for testing from a medical perspective.
So you think I am not infected with HIV? I don't quit understand what "need" means....
I you were in my situation, with the abrassion, would you take an HIV test?

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help. First however let me congratulate you on your practice of asking partners about their sexual and HIV test histories as well as your commitment to condom protected sex. These practices will go a long way towards keeping you safe.  As for the encounter you ask about above, it was low risk. Despite her poor choices related to sex partners, her risk for infection is low- HIV is rather uncommon among heterosexual women and, even more importantly, there are no data that receipt of oral sex leads to acquisition of HIV.  There are no proven cases in which HIV has been obtained in this way and the presence of a small abrasion on your penis does not change this.  Many experts would not even recommend testing for HIV in this situation.  

As for your specific questions:

Q1: Could this have been a way in to my bloodstream?
The theoretical risk of getting HIV form receipt of oral sex, if your partner had HIV (and that is unlikely) is estimated to be no more than 1 in 1000 and I know of no proven cases in which HIV was acquired through receipt of oral sex.  While some would argue that this might theoretically increase risk for HIV, there is no evidence that abrasions resulting from receipt of oral sex increase your risk for getting HIV.

Q2: I did not see blood and it did not hurt during the blowjob. Is this a good sign?
Yes- see above.

Q3: 5 -7 days after the blowjob I got sick. Runny nose, cough, full nasal cavity. I do not know if I had the flu. Could this be ars?
This is a bit early to be the ARS and sounds much more like a cold than the ARS.

Q4: I already have a rash on my back torso due to medication. But it is getting worse. It is slightly raised, pinkish, and some are spots others are big patches.  Does it sound like a Hiv Rash?
No.

Q5: Do I need to worry? And do I need to test for HIV from a medical standpoint?
See my comments.  I see no need for testing from a medical perspective although I understand that it might make you feel better.

Q6: I will admit that I have a HIV phobia. What do you say to your heterosexual patients about their HIV risk?
I point out that HIV is a rather rare infection, particularly among heterosexuals and that the things you do - asking partners and using condoms will keep them safe.

I am really scared doctor because of the abrassion.
And a final general queston. Don’t you find it odd that there are almost no questions from women?
It is a bit odd that more of our clients are not women.  I am not clear what that means.  

I hope my answers are helpful. Take care.  EWH