Oral Sex With Transexual

[nogood943]

Hello,

3 days ago I performed unprotected oral sex & rimming on a transexual escort.  

She ejaculated on my face and mouth and I continued to perform oral after ejaculation (not a lot of ejaculate).

I am very concerned about my HIV transmission risk.  There are many conflicting assessments wrt to oral sex w and w/o ejaculation.

She did show me a negative HIV test from September of this year and had tests for the past several months / years for other things as well.

But the anxiety is starting to get to me.  I intend to get tested at 2, 4, and 8 weeks, but a risk assessment would be nice.  Please be honest.

Thanks for your time....

[H. Hunter Handsfield, M.D.]

As you suspect, there are no data by which to judge risk based on the details of oral sex.  But even doubling an extremely low risk still means extremely low risk.  You should not lose sleep over something like 1 in 5,000 versus 1 in 10,000.

[nogood943]

Thanks for your response, it is rather reassuring.  I will follow your advice and get tested at 4 & 6-8 weeks.

I was wondering whether or not you feel that deep-throating and the continuation of oral sex (and swallowing) after ejaculation significantly increases the potential risk of transmission, as both of these were involved.

While I realize that there will be no real scientific data in this respect, I am asking for your professional clinical opinion with regards to this specific instance...

Best Wishes, and thank you for your service...

[H. Hunter Handsfield, M.D.]

Welcome to the HIV forum.

There are "many conflicting assessments" about oral sex and HIV transmission only if you are not sufficiently selective.  If you limit your research online (and elsewhere) to medically reliable sources, you will find nearly 100% consistency.  Specifically, you will find that all medically reliable sources understand that HIV acquisition by oral-genital sex is very rare, whether or not there is ejaculation in the mouth.  One estimate from CDC suggests people in your situation have 1 chance in 10,000 of catching HIV, if the penile partner has HIV.  That's equivalent to giving oral to an infected partner once daily for 27 years and maybe never catching the virus.  And that's if the partner has HIV, which yours probably does not -- so your risk is even lower than this.

So your risk is low enough that you don't need HIV testing at all, at least not from a medical/risk assessment perspective.  Any testing you do is strictly for psychological reassurance from the negative test results.  If you go ahead with it, I recommend a single HIV antibody test around 6-8 weeks after exposure.  If you simply cannot wait 6-8 weeks, have an initial test at 4 weeks (by which time 90-95% of newly infected persons have positive results) and a second one a few weeks later.  Testing as early as 2 weeks makes no sense at all.  If the events above are your only potential risk for HIV, you can be sure the results will be negative.

Good luck--  HHH, MD