HIV Trasmission / Other STDs

[John_024]

Dear Doctors,
I will be as succinct as possible as I have posted before. I am a heterosexual circumcised male. I have been working in both Bangkok and Manila for the past few months and have been with a handful of girls. I cannot really comment on their HIV status. All penetration (vaginal only) has been fully protected (I had one episode of condom slippage with half the shaft covered, however the head of the penis was totally covered throughout and condom intact – I understand that as long as the penis head is totally covered there is no chance of HIV infection - can you confirm this?). I always check the condoms.

With regards to oral sex I have not performed any oral on these girls, but I have had numerous episodes of receptive oral sex, mutual masturbation, and fingering (me being anally fingered also). My questions are.
1 – From reading all the relevant posts on this forum I am understand that I have no risk of HIV transmission and I do not require HIV testing. Please confirm.

2- It is nine days since one of the encounters and have a runny nose and slightly sore throat (no temperature or rash). Could this possible be ARS or is it too early for ARS? I understand that ARS clusters round fever, rash and sore throat between 2-4 weeks. I know it is probably not an exact science but I read up 90% of infected people have such ARS symptoms and feel quite poorly. Is this so?  I guess this may be a redundant question given the above, but still am interested.

3 – Other STD’s. I read you can catch other STD’s through receiving oral sex. Is this as common / carries the same risk as acquiring an STD through penetration or less likely? I have had no symptoms.

Many thanks in advance.

[Edward W Hook, MD]

Correct.  I understood that your receipt of oral sex is typically unprotected.  EWH

[John_024]

Thanks Dr Hook - most appreciated.

Just to be clear all my vaginal penetration is totally protected. However when receiving oral sex (fellatio) this is unprotected.

But your comments are clear! Use condoms every time for vaginal penetration - no hiv. And there is no risk for HIV through receptive oral sex, and a somewhat small / unlikely chance chance of contracting other STD's through receptive oral sex.

Thanks again.

[Edward W Hook, MD]

Welcome back to our Forum. I will be pleased to comment on your specific questions but first let me congratulate and endorse your practice of condom-protected oral sex. As long as condoms are used throughout sex and do not fail, this is safe sex with no appreciable risk for HIV and little risk for other STDs.  With this background statement, let's review your questions.

1 – From reading all the relevant posts on this forum I am understand that I have no risk of HIV transmission and I do not require HIV testing. Please confirm.

Correct. condom protected sex is safe sex and there are no proven cases in which HIV has been acquired through receipt of oral sex form an infected person.

2- It is nine days since one of the encounters and have a runny nose and slightly sore throat (no temperature or rash). Could this possible be ARS or is it too early for ARS? I understand that ARS clusters round fever, rash and sore throat between 2-4 weeks. I know it is probably not an exact science but I read up 90% of infected people have such ARS symptoms and feel quite poorly. Is this so?  I guess this may be a redundant question given the above, but still am interested.

Your symptoms are early for ARS which typically occurs 2-6 weeks after exposure.  Further, as you point out, when people have the ARS, they feel as though they have a severe flu-like illness and your symptoms sound rather mild. Finally, most people with ARS-like symptoms do not have HIV but have some other, usually non-STD viral illness.  Only about 1% of persons with "typical" ARS have HIV.

3 – Other STD’s. I read you can catch other STD’s through receiving oral sex. Is this as common / carries the same risk as acquiring an STD through penetration or less likely? I have had no symptoms.

Compared to genital-genital contact, oral sex is an inefficient way to transmit STDs.  Even among persons with many sex partners, oral infections are uncommon and, for a number of biological factors too complex to go into here, the efficiency of transmission of infections through oral sex is lower than for penetrative genital-vaginal or –anal sex.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; for all practical purposes, chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.  There is also currently a large amount of overstatement of the risk of HPV and its very rare consequence, oral cancer, related to HPV infections is excessive and should not be a concern either.  If you were to get gonorrhea or NGU you would most likely develop symptoms of urethritis (penile infection) within a few (less than 7) days of exposure.  Even if a partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.

I hope these comments are helpful to you.  EWH