HIV exposure

[coveredbyink]

About 5 weeks ago I had called a prostitute who posted online.  She was African American.  We met at the hotel for her incall location.  We started by kissing and then moved to oral sex.  I gave her oral sex for about 5-10 minutes and then she gave me oral sex.  When we were through I realized the mistake I had made and called it off.  The problem I am having is that I don't know her sexual history and probably sure she has been with many guys.  At the time I had a sore on the outside of my mouth on the right side where the bottom and top lips meet which was healing at the time because it was scabbed.  Since then I have been having such bad anxiety and nervousness that I contracted HIV.  I haven't had any symptoms except for diarrhea which seems to be the worse before I test., my skin on my hands seems to peel in some areas after I wash dishes or take a shower and also the tips of my fingers wrinkle after a shower or dish washing but goes away after I put lotion on them. which seems to be the worse before I test.  I tested 15 days and 21 days it came back negative, mouth swab at 21 and 36 days came back negative, and had a PCR at 23 days that came back negative (the company said Lab Corp who tested it says after 14 days test results are definitive)  My question is

1) Can I believe that I don't have HIV after taking the PCR test showing a negative after 23 days of possible exposure?

2) How accurate is the PCR test?

3) Are all the negative test a good sign for me not having the contracted HIV

4) How likely is it that I got HIV from having oral sex where my mouth was only on the woman's clit and not on her actual vaginal opening

5) Also I use long cut tobacco, would that have increased my hiv chance if I didn't get a substancle amount of vaginal fluid in my mouth?

[Edward W Hook, MD]

Welcome to our Forum.  This was a no risk exposure.  Kissing is no risk, even deep kissing and even with gum or dental disease. The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  This includes by all of the people who had gum disease, cold sores etc.

Your testing proves that you did not get HIV.  Your antibody tests (including the oral swabs) are negative out to five weeks.  By this time between 90 and 95% of persons who acquired HIV would have positive tests.  When these data are combined with your HIV PCR test results, you can be confident that you did not get HIV.  Just to be clear however, in general we do not recommend HIV PCR tests for HIV diagnosis.  The problems with these tests are: that they have a higher false positive rate than antibody tests, that the time course by which they become positive in infected persons, while certainly sooner than the antibody tests, is not well characterized; and that they tend to be expensive.  

With regard to your specific questions:
1.  see above. The combination of your PCR and antibody tests prove that you do not have HIV.
2.  See above.  the problem is false positives and that we do not know precisely when all PCR tests become positive.
3.  Yes, your combined test results prove that you do not have HIV.
4.  see above, this was not a high risk exposure.
5. There are no data on the association of tobacco use and risk for HIV.  I doubt that it has any effect although it does clearly increase your risk for oral cancer.

I hope these comments are helpful.  You do not need further testing related to the exposure you describe.  EWH

[Edward W Hook, MD]

No matter what you say, this is essentially a no risk exposure.  We could go back and forth again and again and it would not change my assessment of recommendations.  This thread has gone on longer than we can sustain and still have time for other clients.  As a result, this will be the last comment as part of this thread.

1.  IF your partner has HIV which has a less than 10% probability and IF the risk was 1 in 10,000 (and all data I have after years of study indicates that estimate is too high- see original comment), your risk would be less than 1 in 100,000. To put that into perspective, you are more likely to get hit by lightening,  My assessment remains - no risk.  Then we incorporate your test results and again, as I have said, they PROVE you do not have HIV.

2.  No.

3.  No

4.  We do not recommend testing for HSV in situations such as yours.  In the absence of an outbreak, your risk of a false positive result is higher than the likelihood of infection.  You can test for syphilis at this time. Believe the results when you get them (they will be negative)

5.  Yes the Oraquick is just as reliable as a standard lab-based test.

Further testing is, as I have also said before, a waste of time.

This thread is now over.  Further questions will be deleted without comment. EWH

[coveredbyink]

Dear Doctor Hook,

     I just had a few question I hope you could take a few minutes to answer.

1) I don't understand how you could say my exposure was no risk.  I gave cunninglus to a sex worker, you guys say they are high risk.  I only put my mouth on her cliterus for 5-10 minutes sucking and licking and never put my mouth on her urethra or vaginal opening.  You say that cunninglus is 1 in 10,000 but I have also read on other threads that you can't get HIV from cunninglus that the 1 in 10,000 in from stats from fellatio.  Is that true and how could my cunninglus exposure be no risk?

2) Would antibiotics like amoxicillin or erythrocin complicate the results of the PCR, HIV 1/2 oral swab, or HIV blood test?

3) Would antibiotics like mentioned above prohibit the immune system from producing antibodies or antigens against HIV or any other STD to make the test results negative?

4) What is my risk assessment for other STD's like Herpes, Syphillis, etc. from giving cunninglus and receiving fellatio from this prostitute and should I test for those now?

5) Is the Oraquick HIV 1/2 oral swab test as reliable as the standard blood test you get from the Health Dept.?

Also wanted to tell you that I took an Oraquick HIV 1/2 oral swab test today (day 56) week 8 and it came back negative.  Should I keep testing?

Thanks for your time

[Edward W Hook, MD]

Nothing you ahve said changes my opinion.  Following your NO RISK exposure you have repeatedly tested with a variety of reliable tests and guess what, your tests are negative, as would be expect following your no risk exposure.  There is no need for further testing- your tests show that you do not have HIV and should be believed.  You can test at 3 months or 3 years, you still will not have gotten HIV.

Your dermatitis is not HIV related

You posts suggest that your biggest problem is guilt.  EWH

[coveredbyink]

One more quick thing,

     I am worried because my fiancee of 5 years has wanted sex and I didn't want to raise any alarms so we had sex, first without a condom and then I put the condom on before I ejaculated.  I am so worried that I might have given her HIV because my status atleast to the CDC's standards is not viable because I am not outside the 3 month window period.  Like I said up to 54 days all test blood, PCR, and Oral Swab have come back negative but I am still worried.  Also how reliable do you feel is the Oraquick HIV 1/2 test.  I have been taking them every two day for the last 2 weeks.  Thanks again for all your help and will keep you posted on future test.

[coveredbyink]

Hey Doc Hook,

     I am now at 54 days from possible exposure.  I took an oral mouth swab today and it came back negative.  I seem to have got contact dermatitis on my hands.  Could this be a cause of potential HIV infection.  Also I have seen and ENT doctor for the congestion in my ears and they said that it was allergies.  I have never heard of this but the meds seemed to help but today the congestion started again and then has slowly subsided.  Could this also be a cause of potential HIV infection?  I also have been getting mixed responses on the PCR by DNA test.  The CDC says that it can detect HIV between 2-3 weeks (which I took 23 days after possible exposure and was negative) but that was it.  They don't recommend and they also said that I should test after 3 months even though I am coming up on 8 weeks this Sunday and up to the last test I took today I am negative.  My exposure if you forgot was from giving a prostitute oral sex (mouth only on clit and fingers inside vagina) and kissing.  There was no penetration.  I am just so worried that a future test will come back positive.  Please help!

[Edward W Hook, MD]

With all due respect, these are groundless, "what if" and “have you ever”  type questions related to a no risk exposure.  Other questions you ask have to do with basic biology.  As I have told you, you unneeded tests now PROVE that you did not get HIV.  The crisis that you refer to is real but it is not an HIV crisis, it is an anxiety crisis.  If you cannot accept that you did not get HIV from this exposure I urge you to discuss this with a trained professional (counselor, psychologist, psychiatrist, etc).  I say this out of concern, nothing more. EWH

[coveredbyink]

Hey doc, sorry to bother you.  I am just so scared that I will test positive down the road.  I have a few questions:

1) They say you can get HIV from vaginal secretions.  Does that come from the clitorus also.  I only had my mouth and tongue on her clit and my fingers were in her vagina

2) Have you had or read of someone testing negative by 6 weeks and then tested positve at 12 weeks

3) Why does it take longer for some individuals to make anitbodies than others.  Is it because of a weakened immune system and what classifies as a weakened immune system.

4) If my immune system fights off an inner ear infection, then would my immune system recognize the HIV and produce antibodies

5)  If I was having symptoms of HIV then would the anti bodies test show and would the PCR test confirmed positive?

Thanks for you time I really appreciate it in this time of crisis.

[Edward W Hook, MD]

My assessment and advice stand.  LEt's dispense with the "what if" and "how could it" questions.  Antibody response is a bilogical process.  Thi sis how long it takes to produce antibodies.

The recommendations for testing at 3 and even 6 months are the result of two factors- data from older tests no longer used (you really do not need to worry about which generation of tests you were tested with, at this time virtually all tests are far more sensitive that they were even 2-3 years ago when the 3 month recommendation was made) and secondly, the fact that some, mostly governmental agencies which have to provide recommendations for virtually everyone without the sort of interactions such as those you get with your doctor or on personalized sites such as this one, feel the cannot "afford" to be wrong and therefore make recommendations and guidelines which leave most people unnecessarily nervous for 4-6 weeks longer than the 6-8 weeks it takes virtually everyone to develop HIV antibodies.   You can test all you want, it won't change your result.  EWH

[coveredbyink]

Sorry,  also why is it they say to wait till 3 months to be definitive for the antibodies test.  why does it take up to that amount of time to produce antibodies and how are you so sure that I didn't contract the virus.  Is it because of the method of oral sex with no pentration sex involved?  Thanks for your time and hope you are right cause I am going to test a 12 weeks.

[coveredbyink]

So the dry skin, diarrhea, and the ear ache I have been having is not a cause for concern of having contracted HIV.  Is the doctor right about allergies causing an ear ache?  Also, HIV doesn't cause dry skin does it because the dry skin is wrinkly on the tips of my fingers and on the palms of my hands the skin tends to peel with no ulcer after washing the dishes, my hands, or after a shower.

[Edward W Hook, MD]

Oral cuts, scrapes and sores will not change your risk.  Try not to worry.  I hope your ears clear up soon. EWH

[coveredbyink]

Thank you for your quick response.  So you believe that the little cuts that the tobacco makes in the mouth is not sufficiant enough for the HIV exposure.  Also, I brushed my teeth and used mouth wash before meeting with this woman.  that wouldn't play any factor in acquiring the virus.  I am just so worried.  I have also been having an ear ache since the weather has changed.  The doctor I saw said that he thinks it allergies causing fluid build up in the canals deep in my ears.  He didn't see any infection when he looked in my hears.  Also my stools have become normal again, was stress, nervousness and anxiety the cause for my diarrhea, dry skin, etc.  Thank you for you time.