Performing oral sex on an African guy without a condom in the UK

[Sammy100]

I'm very very worried.I performed (gave) oral sex without a condom on an African guy who is living here in the UK, who has said he is clean & is HIV negative. We did not engage in any other sexual activity, but i'm still so stressed as I don't know him well & concerned about his African background. Firstly, when researching, there appears to be a risk of HIV 2, as well as HIV 1 and am also confused by the varying risks associated with varying viral loads. His penis appeared clean & I performed the act on him for 3-4 minutes. He did not reach climax and therefore did not ejaculate in my mouth. I was not overly aware of precum, but am assuming it was present. Firstly, is HIV 2 more aggressive or easier to transmit through oral sex than HIV 1. Secondly, what are the risks of HIV 2/HIV 1 when performing oral sex  & how protective is saliva against HIV 1 and HIV 2. Finally, is there less HIV 1 & HIV 2 present in precum and if so, assuming that it was present, what HIV 1/2 risks are there upon me if there was some precum in my mouth? I did brush my teeth a few hours before performing the act and used mouthwash 80 minutes after. I never seemed to notice/feel any bleeding or anything in my gums (which i think are healthy) & I have not had any  dental surgery.

Lastly, I believe the guy is from Nigeria & if he is a refugee, are you aware if they are allowed into the UK (or more difficult to enter) if they have HIV & if so, would they be able to access treatment in the UK, thus reducing viral loads & thus putting the rest of the population at < risk, And finally, as there was no ejaculation, are the odds then less than 1/10,000 as well, a figure which I have been reading quite frequently by US Doctors on Medhelp? What other STD's should I be testing for and are the risks high/medium/low/zero?


I am going to have a DNA test @ 10 days (does this identify HIV 1 & 2) and or could you advise what tests are the quickest to de-stress me.

Sincerely worried!!

Many thanks

[Dr Sean Cummings]

Hello Sammy,

I think you should relax and calm down about HIV - 1 or 2 - I really do not believe you were at any significant risk at all. The statement by Dr Hook on one of the other areas of Medhelp is entirely correct in our view and I think even then it is overstating the risk. 1 in 10,000 is probably too high and I think the risk is much lower with no ejaculation as was the case with you.

Other STD's are a possibility including syphilis, gonorrhoea and chlamydia. You can test reliably for chlamydia and gonorrhoea at the ten day interval when you go for your test.

I don't think you need to have an urgent HIV test and you could wait until the 28 day mark and have an HIV DUO instead. This would be quicker and cheaper. I repeat, that I do not think you need to get too panicky about this. I do not believe it represents a severe risk.

I would suggest if you do proceed to test that instead of the DNA PCR you go for an HIV 1 and 2 RNA PCR which is extremely accuarate at the ten day mark. The problem with these tests is that they are firstly expensive and secondly they take at least five working days to be returned. In addition they all go to a specialist referral laboratory and the Icelandic Volcano dust has meant that the flights carrying the samples have all been cancelled. I'm sure it will be back to normal by the time you have yours.

With respect to HIV testing migrants to the UK, this is not routine unless there is a particular porblem. HIV positive people are allowed to enter the UK without restrictions. They are all entitled to full NHS care and our NHS provision of HIV therapy is probably the best and most consitent in the world.

With respect to HIV 2, this is a feature of life in West Africa, but even there where it is at it's commonest in the world, it is still the least common form with HIV 1 being more prevalent. That said HIV 2 runs a gentler longer course than HIV 1.

So on balance I agree with your thoughts on having other STD tests as these other STD's will be hugely more infectious and much more likely than HIV tranfer. I think a cool calm approach to HIV is needed and I would be happy with a 28 day HIV DUO test.

very best wishes, Sean

[Dr Sean Cummings]

Hi Sammy

You are fine. The HIV 1 and 2 PCR RNA DNA is highly accurate at that time - you are HIV negative.

Best wishes, Sean

[Sammy100]

Dear Dr,

Thanks for your reassuring words in what shouldn't have been a stressful time! As mentioned earlier my Gonorrhea and Chylamidia tests were both returned negative, for the swab test taken at 9 day and 15 hrs. Also I had an RNA test for HIV 1, HIV 2, Hep B & C  at 9 days & 15 hrs, this too returned negative for everything (is this still greater than 99% accuracy for 9 days & 15 hrs, i.e. slightly less than 10 days!?). What is your experience with the RNA tests accuracy and is it better than the DNA test? I am going to test for Syphillis at 28 days as advised. Can my results now be considered conclusive for my 'oral' exposure and can I at last move on with my life!! Many thanks for your knowledgeable and reassuring words when I was irrationally stressing!!

Many thanks

[Dr Sean Cummings]

Hi Sammy

Listen matey, you're bombarding me with too much detail and you're not paying attention to the key points in my original answer.

For clarity again I don't think you were at risk. I said that at the outset.

I'll deal with the detail in the most recent of your further questions and then I'll be signing off this post.

"I had my chlamydia and gonorrhoea test (swab test taken 9 days & 15 hrs) after the event both return negative. A urine test taken at 5 days also returned negative (can a urine test be used for oral exposure?) Can my results be considered conclusive?

Yes.

Secondly, I had the RNA test done at 9 days & 15 hrs as well. What accuracy is associated with this test. I believe the lab is UK based and the results are still getting returned within 5 days.

Greater than 99%.

Finally, when performing oral, can syphilis be noticed on the penis? And when is the soonest this can be tested for? Lastly, what other std's are a risk and where/how can I test for them. I seem to see nothing other mentioned for oral sex other than syphilis, gonorrhea and chylamidia.

No, not necessarily. Syphilis is a systemic disease which spreads from the point of contact to involve the entire body. So he may not have had a visible lesion but still might be infectious. You need to wait a minimu of 28 days before testing for syphilis. Syphilis, chlamydia and gonorrhoea are the main contenders for spead from oral sex. HSV 1 or 2 might be possibilities but are much less likely.

Please, please also have a look at my earlier posts, so I can put this behind me.

As I say, you will need to test at 28 days for syphilis and then you can forget it. I am relatively unconcerned by what you've relayed. I think you are fine.

over and out,

Sean

[Sammy100]

Dear Dr,

I had my chlamydia and gonorrhoea test (swab test taken 9 days & 15 hrs) after the event both return negative. A urine test taken at 5 days also returned negative (can a urine test be used for oral exposure?) Can my results be considered conclusive?

Secondly, I had the RNA test done at 9 days & 15 hrs as well. What accuracy is associated with this test. I believe the lab is UK based and the results are still getting returned within 5 days.

Finally, when performing oral, can syphilis be noticed on the penis? And when is the soonest this can be tested for? Lastly, what other std's are a risk and where/how can I test for them. I seem to see nothing other mentioned for oral sex other than syphilis, gonorrhea and chylamidia.

Please, please also have a look at my earlier posts, so I can put this behind me.

Thanks!

[Sammy100]

Apologies, I forgot to address the above posts to you.

Many thanks

[Sammy100]

Thanks Doctor,

I did actually get the 10 day RNA test and swabs taken today. I know this seems irrational, but am keen to just forget about it now! In your statement above you have said that I did not put myself at severe risk. This use of the word 'severe' adds a bit to my anxiety. Am I correct in thinking or interpreting that you believe the odds are lower than 1 in 10,000, and even lower because there was no ejaculation in this instance.

Secondly, in respect to viral loads, if presuming one was infected with a high load, would the amount of precum (if present- not noticeable) still be easily disabled by the saliva and stomach acids. And lastly, any chance that you could address the couple of points detailed in my second post. I am aware that I am being irrationally anxious, particularly with the information I have acquired on Medhelp, but if you could provide a response to the comments briefly mentioned here and above, I can just forget about it and move on, with the knowledge that I have engaged in something which statistically appears more than safe.

Many thanks!

[Sammy100]

Hi Dr's,

And lastly, this was my first sexual encounter, beyond kissing. Possibly panicking because I didn't know the guy that well/his African background/my lack of experience. Would there also not be a risk of my teeth causing cuts/small cuts on his penis during oral. I did not notice this, i.e. taste/see any blood, but am still panicking! This was the first time I have performed oral as said above. Is the skin on the penis as tough as the hand for example, and would accidentally cutting the penis during oral be normally recognised by either partner? I did not notice anything at the time/neither did the guy seem to suddenly retract or anything.

Still sincerely Worried still!

Hope someone can take a look at this!!
Thanks