Cunnilingus / ARS clarification

[J_20]

Hi Docs,

I have been in Dubai for a couple of months now. Since that time I have been with a number of CSW’s. In all cases there has been vaginal penetration but FULLY protected – I am fastidious about this, given a stupid thing I did a few years ago. My worry is cunnilingus I performed on that last couple of CSW’s, and the fact that 2-3 weeks after the last interaction I have developed some severe nasal congestion. So my questions are as follows:

1. Do you guys still subscribe that Cunnilingus (whatever spin you put on it) is essentially a no risk HIV activity in practical terms and to date neither of you have come across a real live case in your practice / many years of experience (as opposed to anecdotal ‘documented’ cases that are sighted on the web)?

2. My symptoms were initially slightly sore throat followed by severe nasal congestion (lots of blowing my nose). My rectal temperature is usually 36.8 but is 37.1 C (I am pretty sure this does not constitute a fever?). No rash or severe sore throat. Can you confirm this is not typical of ARS? (this is probably what worries me a bit)….

3. Do I need an HIV test? I am pretty good with ensuring my sexual health is ok, so I am not too keen to rush out and have another test unless you guys indicate its necessity.

I understand that the above has probably been answered countless times here, and you may be frustrated answering essentially the same questions again (apologies for this)..but I have just started seeing a girl here so want to be sure before things move forward sexually and that I don’t need to rush out and have an HIV test.

Many thanks is advance.

Regards……

[H. Hunter Handsfield, M.D.]

You correctly understand:  those are exactly the correct "take home" messages.

Thanks for the thanks.  Happy holidays.

[J_20]

Thanks Doc.

Just with regards to cunnilingus, independent of 'evidence' or lack there of, the act it self is 'safe' with regards to HIV from a medical stand point (assuming no major wounds in the mouth)?

Probably best I get tested for piece mind......thanks again..

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your questions.  I'll go straight to them.

1) To my knowledge, it remains a fact that no cases of HIV infection have been credibly and scientifically documented to result from cunnilingus.  The least reliable of all kinds of evidence is testimony by people who make such claims.  The large majority of people with HIV can only guess at the source of their infections.  Could such transmission happen?  Perhaps.  Does it happen with any measurable frequency?  It would seem not.

2) Your symmtpoms don't suggest ARS, which generally does not cause nasal congestion, cough, or other typical cold symptoms except sore throat.  And everybody's temperature varies by a couple of degrees over the course of the day.

3) Do you "need" an HIV test?  No, at least not on account of your symptoms or your exposure history.  However, your apparent skepticism about what you've already seen on the forum suggests my comments won't completely settle things for you, and that you'll need a negative test for its reassurance value.  And all people who are sexually active outside mutually monogamous relationships should be tested from time to time anyway, even if all exposures were seemingly safe.  So you may as well do it now, while it's on your mind.  But based on the information you have provided, you certainly can expect a negative result.

I hope this has helped.  Best wishes--  HHH, MD