HIV Risk Assessment and Testing

[Erock123]

Dear Doctors,

I was wondering you could provide some insight into my risk and testing needs. As a preliminary matter, I do plan on testing soon as I am nearing the six-month mark since my previous test.

I have been intimate with a few men over the past 3 months. The activities would be rimming, unprotected oral (no ejaculation) both giving and receiving, and two instances of protected anal sex (condoms did not fail). All of my partners have claimed to be HIV negative.

About two weeks ago my throat become a little swollen. It's not sore, but I could tell a difference. I believe I have acid reflux, so I'm not sure if that could be the source of concern. I am not certain if this is a symptom of ARS. I know you have said the symptoms appear together if at all.

Any thoughts? Thanks for any advice or feedback you might have.

[Edward W Hook, MD]

Just to put htings in perspective, a 1 in 10,000 chance is once chance if you were to perfrom oral sex on an infected person daily for over 27 years.  It has happened but is very rare.  EWH

[Erock123]

Sorry about the confusion regarding my six-month test. I meant to say I am tested every six months as a routine matter.

My primary question was whether it was truly necessary to be concerned based upon my risk activity. I'm a firm believer that condom-protected sex is safe.

I tend to be a bit worried about the oral sex. I'm the person that worries I will be that 1 in 10,000 person. Even though everyone I have been with assures me they are tested and negative. And the swollen throat with the lymph node under my right side of my jaw slightly swollen, made me a bit worries.

Sorry I wasn't as clear as I was hoping. And thank you so much for taking the time to help!

[Edward W Hook, MD]

Welcome back to the Forum.  As pointed out by Dr. Handsfield during your last exchange, you had asked questions about sex with an HIV infected partner on medications, now you ask about sex with others who state they are HIV negative. Further, you talk about a six month test.  All of this leaves me a bit confused as to what your situation and circumstances are. Thus my comments will be general in nature.

1.  There is virtually never a need for six month testing.  Test results with current HIV tests are conclusive at 8 weeks and, if tested with a combination HIV antibody/HIV p24 antigen test, at 4 weeks.  

2.  As Dr. Handsfield told you, condom protected rectal sex with an infected partner is safe sex as long as the condom is worn throughout sex and does not break.  Condoms break about 1% of the time they are used.

3.  There are no proven cases in which persons have acquired HIV from receiving oral sex.  There are a handful (less than 5) cases in which persons have gotten HIV from performing oral sex on an infected partner but this is rare, occurring on average less than once in every 10,000 acts of fellatio.

4.  Rimming is likewise not know to be associated with risk for HIV.  

5.  Isolated swelling, or even an isolated sore throat is not the ARS. The ARS is manifest by a combination of symptoms which include sore throat, high fever, muscle and joint aches and sometimes a rash and/or diarrhea.  It typically occurs 2-6 weeks after a sexual exposure.  

I hope these comments answer your questions. EWH