Concerned about HIV from Cunnilingus

[musicafrica]

Good day to the health professionals on this site, as well as knowledgeable contributors

I live in South Africa and 4 weeks ago went to an erotic massage establishment within one of our upmarket urban metropolitan areas. The masseuse (a caucasian female who seemed to be in excellent physical shape) performed the massage on me and in the course of the massage, sat astride my face, placing her clitoris over my mouth and instructed me to lick it, which I did for approximately 2-3 minutes. At no time did our genitals make any contact and we did not have intercourse; I noted that she was quite "dry" - i.e. no lubrication or vaginal fluids. I also have excellent dental health, without any form of gum disease or mouth ulcers

I would like to know the following:
a) According to what I have read from your group of professionals, it appears as if I was not at risk of contracting HIV. Is this true and more to the point, if so, do I need to be tested for HIV - I am an anxiety sufferer and this has been on my mind for some time?
b) I have not experienced any other symptoms since this contact. Is there any need for me to be tested for any other STD's.

Looking forward to your response and thank you

Mark

[Edward W Hook, MD]

If I were you I probably would not test because of this exposure but this is a personal decision.  No one would fault you of you chose to test.

Take care.  eWH

[musicafrica]

Thank you Dr Hook - I'm afraid in South Africa (despite our attempts to progress to create social equality) HIV rates vary signficantly, depending on which population group you belong to - according to a 2008 survey, amongst African people the infection rate is 13%, whilst amongst whites it is 0.3%.

This is a very similar statistic I believe to the U.S., and given my masseuse was a white woman, I think the chances of her being positive are as low as you would expect in the U.S..
In this case do you feel testing is still not necessary?
I wont bother you after this and thank you for your response and wish you good health
Mark

[Edward W Hook, MD]

You are correct that the difference between very, very low and no is mostly semantic.  Had you not been in South Africa, I might not have recommended testing at all but, because HIV rates are relatively higher in South Africa than many nations, my threshold for testing is a little lower.  That said, the risk for infection from the exposure is quite low and not a major concern.  EWH

[musicafrica]

Dear Dr Hook

Thank you so much for your advice and I am gratified my $22 has gone some way to help what you are doing.

I have subsequently read some of the contributions of Dr Handsfield's and others, who have stated that cunnilingus is not a risk for HIV  (or very low risk - a semantic difference?) and as such an HIV test is not indicated for such an exposure. So would I gather from your comments as well, that in this case you would not see it necessary to test for HIV? Infection rates in Africa are generally higher than the rest of the world

Your detailed response has been most re-assuring, and I am most grateful to you for it.

Thank you

Mark

[Edward W Hook, MD]

Welcome to our Forum.  I'll be glad to comment.  This was a very low, but not quite no risk event.  It is unlikely that your partner had HIV or any other STI (most people do not) and most exposures do not lead to infection if she was.  There have been a very few cases in which performing oral sex on an infected partner has led to HIV transmission but the frequency of this event is less than 1 infection in more than 10,000 exposures.  When you consider that it is unlikely that you partner has HIV, this is not something to worry about.

As for other STIs, the only meaningful concern is that your partner might have had gonorrhea which then infected your throat.   Rather unlikely but slightly more likely than for HIV.  Other STIs are really not a concern unless you develop symptoms.  

Infections of the throat are typically asymptomatic so the absence of symptoms does not assure that infection is not present.  Thus, if you are concerned, it would be simple to have a swab specimen taken from your throat to rule out gonorrhea.  This can be done at any time.  I would not worry about HIV if I were you but some clients wish to be tested nonetheless.  If so, best to wait several weeks before testing.

I hope these comments are helpful to you.  EWH