Please Advice - Should I test?

[Season05]

I had a sex with a Chinese sex worker in Singapore Geylang 3 months ago. She did 2 times of unprotected oral sex on me. I did not check if there was any blood left on my penis. Worse, I also licked her vagina for a few seconds to max 1 min. I did not dig into her vagina. As I remembered, she was dry and I did not taste any vaginal fluid, but can't be sure. However, I can't said that I have a perfect oral health condition, as I do have bleeding (not too serious) sometimes during brushing. Moreover, I had a meal 30 mins prior, soft food. I don't think I damaged my teeth/gum in any way. However, I can't be sure if any her vaginal fluid get into any open cut in my month. She helped me to put on a condom and we started intercourse. At the middle, she said she felt pain and I asked her to put off the first condom. I asked her to put in another condom and I continued until finished. So the vaginal sex should be protected.

After the sex, I rinse with mouthwash, which I heard reduce the ability of saliva to inhibit HIV virus. After 30 mins, I rinse with water and then even Dettol. I am afraid that Dettol actually hurt my month and cause some leftover HIV virus to came into my system. Will this increase my risk?

Moreover, I just circumcised at Mar, half year before the incident and if she is newly infected (antibodies have been developed yet). Would these factors put me at a higher risk?

Dear doctors, what's the level of my risk contacting HIV in that my very first and single incident?  Should I get tested? However, I am so scared to get tested which I think I might be found out as the 'unlucky' one. I also heard that Singapore government is very strict. They require the working girls to go for mandatory monthly checking including HIV monthly.

[Dr Sean Cummings]

Good Morning

BeSafe2010 is correct. The calculated risk of HIV transmission overall - that includes sucking, being sucked, cunninlingus and receiving cunninlingus is between 0 (zero) and 0.04%. This is a mathematical model but the very good studies - some in Europe and some in the US where HIV discordant couples (that is where one is HIV positive and the other HIV negative) have had unprotected oral sex with around just short of 40% of these receiving HIV positive ejaculate in their mouths - have shown that there is zero transfer.

We know from common sense alone that there must be some risk at some point but it is fantastically rare so far as we know - hence the stated risk of 0 to 0.04% per episode. All that assumes of course that the other person is HIV positive which is unlikely in itself.

Regarding Singapore, I would not test there ireespective of the result.

Regarding absence of ARS symptoms the medical literature records rates of between 30 and 90% of people developing ARS symptoms within 2 to 4 weeks after an event. This is a huge variation and probably reflects the fact that the questions were either not asked or the information was ignored or not recorded. The 90% figure represents diligent collection of information. Our personal experience at Freedomhealth is that the majority of new patients with a very definite exposure who then become HIV positive will have a significant and obvious ARS syndrome.

Regarding the test - yes of course. Being scared of the result is worse than the result itself as you are effectively now living as though you are HIV positive - which I'm sure you are not. Having a test will get rid of this anxiety for you.

Best regards, Sean

[halfoldman]

good question, semen remaining in mouth if at all it occurs,the receptive partner is at risk, not the insertive partner, further once semen is in the mouth either its swollowed or its spit out,the little remains gets diluted and the mouth has oxigen and enzimes which is hostile to the  fragile virus, so chanses are less.

[damnworried]

how about some semen that is residing in the mouth from the previous customer the sex worker serves. Does that increases the risk of receiving oral sex since there is exposure to a 3rd party's semen in the sex worker's mouth.

[Dr Sean Cummings]

The 0,0.4% is demonstrated in a paper by Vittinghoff in the American Journal of Epidemiology 1999; 150; pages 306-11.

You will need to access this yuourself by susbcription if you wish to read it.

best wishes and over an out now,

Sean

[Season05]

Thanks doctor!!! Really appreciated.
Do you know how they come out the 0-0.04% of oral sex risk?

[Season05]

Doctor, can u comment on my questions?

[BeSafe2010]

I think what the Doctor means is that no risk for being sucked (because saliva does not infect; only blood, vaginal fluids, and semen do) and a very tiny risk, if any, for sucking her.

[Season05]

Thanks Dr. Sean.

1. Your constantly use of the term "low risk" or "no risk" is really a relief for me. However, do you mean "no risk" or "low risk"? :-)

2. You also raised the concern of singapore govt's react on foreigner tested positive. If the above is my only exposure. Do you think that if I have any risk of being tested positive?

3. For the past four months. Fortunately, I did not have any ARS symptom. Statistically, how many percentage of people contracted HIV but not showing any ARS in the following 4 months?

4. I am so scared to get test. Do you recommend I should go test?

Thanks again!!!

[Dr Sean Cummings]

Hello,

I do not believe you are at risk of HIV from this episode. You might be at risk of other STD's such as chlamydia, gonorrhoea, syphilis and herpes but you are at extremely low risk of HIV if at all.

The risk of HIV transfer via oral sex is described as extremely low. No cases have been demonstrated in the very well done studies involving mixed HIV positive and HIV negative couples from around the world. There are some poor studies which have seemingly shown startlingly high rates of oral transmission - in excess even of unprotected penetrative sex and these have either been discredited or are viewed with exteme scepticism. I am certain that you are at zero risk of HIV from being sucked.

Similarly your oral episode where you performed oral sex on the lady in question is equally low risk, irrespective of your oral hygiene and having previously eaten. The mouthwash and Dettol seem extreme but of little consequence.

Overall I do not believe you have exposed yourself to HIV even if the lady was HIV positive.

I don't know about Singapore Government policy towards sex workers. If you remain worried then having an HIV test is easy though I believe the Singapore Government has strong policies against non residents who test positive so I would suggest testing outside of Singapore if you can.

best wishes, Sean