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Possible oral/mutual masturbation exposure?
Dr. H:
I know that oral exposures are asked to death, but I've noticed conflicting information on websites out there.
Last night, I had an encounter with a male CSW (I myself am a 27 y/o WM). Normally, I just engage in mutual masturbation during these encounters, however on this occasion he gave me oral sex for approximately 5-6 minutes. I did not ejaculate in his mouth, but he did perform oral sex on me right up until that point. We also kissed -- I had a small canker sore on my mouth during the kissing.
Some websites indicate that receiving oral sex has NO risk for HIV (e.g. the City Clinic for San Francisco has a chart that does not list HIV as a risk for receiving oral sex, but a possible, albeit minimal, risk if you are performing oral sex).
What's the bottom line here? It's been over 12 hours since the encounter, but if I have any risk, I'd consider PEP. Do I need testing? And, on a related note, what other STD's could I have been exposed to? I'm kicking myself for this encounter, but some things just happen in the heat of the moment. I did ask him (albeit AFTER) if he was negative and he reported he is tested monthly and is negative.
Thanks for your help.
I know that oral exposures are asked to death, but I've noticed conflicting information on websites out there.
Last night, I had an encounter with a male CSW (I myself am a 27 y/o WM). Normally, I just engage in mutual masturbation during these encounters, however on this occasion he gave me oral sex for approximately 5-6 minutes. I did not ejaculate in his mouth, but he did perform oral sex on me right up until that point. We also kissed -- I had a small canker sore on my mouth during the kissing.
Some websites indicate that receiving oral sex has NO risk for HIV (e.g. the City Clinic for San Francisco has a chart that does not list HIV as a risk for receiving oral sex, but a possible, albeit minimal, risk if you are performing oral sex).
What's the bottom line here? It's been over 12 hours since the encounter, but if I have any risk, I'd consider PEP. Do I need testing? And, on a related note, what other STD's could I have been exposed to? I'm kicking myself for this encounter, but some things just happen in the heat of the moment. I did ask him (albeit AFTER) if he was negative and he reported he is tested monthly and is negative.
Thanks for your help.
MEDICAL PROFESSIONAL
Conflicting information? Yes, but only if you're not selective in selecting websites. If you pay attention to the source and stick with professionally run and/or moderated websites, you won't find much conflict about the risks associated with oral sex. Those that fan the flames typically don't monitor or attempt to control the opinions of frightened people who don't understand the science involved.
Some experts indeed believe that the penile partner in oral sex is at no risk of acquring HIV. My (and Dr. Hook's) close colleague and friend Dr. Jeff Klausner, director of the San Francisco health department STD/HIV programs is one of them. The highest calculated risk, from CDC, is that such exposure carries 1 chance in 20,000 of catching HIV. My position, and Dr. Hook's, is that it doesn't matter; for all practical purposes, 1 in 20,000 is the same as zero. (It is equivalent to having a ** by an infected partner once a day for 55 years, and maybe never getting infected.)
Standard guidelines for PEP do not recommend it after insertive oral sex exposures. Even if you were to try, you probably could not find a provider willing to prescribe it. Certainly I would refuse if you came to my clinic, even if your partner said he has HIV -- and especially since he almost certainly isn't infected.
Finally, you make an excellent point that "some things just happen" despite all intentions of safe sex. That is why "do ask, do tell" -- i.e., routinely sharing HIV status BEFORE starting sex -- is a central component of safe sex among MSM. Oral probably doesn't make much difference, but what if "just happen" led to anal sex? I don't mean to lecture you, since you're intentions obviously are on the right track. But this is a lesson that other MSM readers of this forum can take home from your question.
In any case, stay safe -- and if you remain nervous about oral sex despite this response, feel free to use condoms for such events.
Regards-- HHH, MD
Some experts indeed believe that the penile partner in oral sex is at no risk of acquring HIV. My (and Dr. Hook's) close colleague and friend Dr. Jeff Klausner, director of the San Francisco health department STD/HIV programs is one of them. The highest calculated risk, from CDC, is that such exposure carries 1 chance in 20,000 of catching HIV. My position, and Dr. Hook's, is that it doesn't matter; for all practical purposes, 1 in 20,000 is the same as zero. (It is equivalent to having a ** by an infected partner once a day for 55 years, and maybe never getting infected.)
Standard guidelines for PEP do not recommend it after insertive oral sex exposures. Even if you were to try, you probably could not find a provider willing to prescribe it. Certainly I would refuse if you came to my clinic, even if your partner said he has HIV -- and especially since he almost certainly isn't infected.
Finally, you make an excellent point that "some things just happen" despite all intentions of safe sex. That is why "do ask, do tell" -- i.e., routinely sharing HIV status BEFORE starting sex -- is a central component of safe sex among MSM. Oral probably doesn't make much difference, but what if "just happen" led to anal sex? I don't mean to lecture you, since you're intentions obviously are on the right track. But this is a lesson that other MSM readers of this forum can take home from your question.
In any case, stay safe -- and if you remain nervous about oral sex despite this response, feel free to use condoms for such events.
Regards-- HHH, MD
MEDICAL PROFESSIONAL
Generally it isn't necessary to test after specific exposures except those with particularly high risk, e.g., anonymous unprotected anal sex, sex with an HIV infected partner. All MSM and others at relatively high risk for HIV should just have routine testing from time to time -- probably once a year for you, as often as every 3 months for those at highest risk. If you haven't been tested recently, go ahead and do it now, since it's on your mind. But not because of the exposure you described.
As for other STDs, oral sex is also low risk; and most STDs acquired by oral sex (e.g., gonorrhea, NGU, herpes) cause obvious symptoms. But again, as a sexually active MSM, periodic testing for gonorrhea, chlamydia, and syphilis is a good idea.
As for other STDs, oral sex is also low risk; and most STDs acquired by oral sex (e.g., gonorrhea, NGU, herpes) cause obvious symptoms. But again, as a sexually active MSM, periodic testing for gonorrhea, chlamydia, and syphilis is a good idea.
Just to confirm -- testing necessary/unnecessary; if necessary, likely to be negative for HIV? I'm guessing testing is largely unnecessary, but might be indicated for peace of mind.
Also, risk of other STD exposures?
Also, risk of other STD exposures?
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