Concerned about HIV transmission from receiving oral sex from a partner who had just given oral sex to another man..

[doondawg]

Hi,

Any help or assistance you can provide would much appreciated.

This afternoon I engaged in a sexual encounter with two men I later found out were HIV+. I always ask people if they know their status before engaging in sex with them---today i slipped.

The men had been engaging in oral sex before one of them began to provide me with oral sex (fellate me). I asked that he stop and only touch me. He proceeded to masturbate me using his saliva as lubricant on my penis. My concern is that his saliva surely had some amount of pre-seminal fluid from the other man mixed with it (neither of the men had ejaculated whilst engaging in oral sex with eachother).

How great of a risk is there of transmission from saliva/pre-seminal fluid coming in contact with my penis/urethra. I also shaved in my pubic region yesterday. Should I be concerned about any tiny nicks on my skin that I can't see or feel?

Would you recommend that I go in for the emergency PEP (post-exposure prophylaxis treatment)?

Thanks very much,

Concerned

[doondawg]

Oh, now I see that the thread was sent to you twice. I'll look into that, thanks.

[doondawg]

Thanks very much for your quick response. This has put me very much at ease.

I posted twice because I wanted multiple opinions.

I understand that PEP is not to be taken lightly--- however it is far more appetizing to me than the alternative.

Next time I'll be more careful.

Thanks Again.

[Edward W Hook, MD]

You posted this question twice.  You may wish to contact the MedHelp administrators and ask that you not be charged for both posts.

In answer to your question, the exposure you describe is very, very low risk for HIV and may well be no risk.  I would not suggest PEP in this situation.

Let's start with oral sex.  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 is true whether a person has blood in their mouth and would likewise extend to persons who might have residual genital secretions in their mouth from contact with another partner even though the blood or genital secretion might have HIV in them.  The mouth is a hostile environment for HIV – it contains many enzymes and antibodies which would tend to make HIV less likely to survive or transmitted to others.  

Similarly, masturbation is safe sex and PEP would not be recommended in this situation either, even if saliva were used as lubrication or the partners genital secretions were to get on you, something that is very common when persons engage in  mutual masturbation.  No one has ever gotten HIV from masturbation.  

Just another comment about PEP.  Many people embrace it as a mechanism for reducing HIV risk,  PEP is of proven benefit in persons exposed to HIV by needle stick and therefore is thought to also be beneficial following sexual exposure.  At the same time, it is not something to be taken lightly.  The medications have side effects (which vary depending on which medicines are used), are recommended to be taken for a month, and are costly, typically costing over a thousand dollars for a full course of medication.  

Hope the comments are helpful to you.  EWH