Worried about HIV exposure

[braziliangus]

Hello,

I tested negative for HIV in July 2012 and was free of every possible earlier exposure. So from July thru September I had 3 exposures with sex workers. On all 3 cases I received and gave unprotected oral sex ( vaginal - oral ) and cunnilingus. All other contacts ( anal, vaginal ) was protected. All oral exposures was in the range of 2 to 3 minutes. On one of the cases, after i came in her mouth the sex worker said she had a little blood in her mouth when she spitted the sperm in the sink. I asked her about HIV status and if she had any oral problems and she said her last HIV exam was 6 months ago and was negative and that she did not have any gum or oral problem. But who knows right? I read a lot of post in this forum, understand that my oral exposure is a "negligible risk " but from the last exposure 20 days ago, i started to freak out. 3 days ago I had a mild rash in my trunk, some 20 red spots, flat marks that appeared and went away in 72 hours ( it is almost gone  now ), I looked for images of maculopapular rash but could not identify it as such. Some pictures resemble it, some dont.  Last week I had a swollen gland in my armpit that started and went away in 36hours. And today I noticed another swollen gland in my throat. I have extreme anxiety and was on Lexapro for 10 months until i dropped it last July. Was feeling very well but now I am in extreme fear again. Please:

- Does the description of my symptoms looks like ARS ? I had no fever. Does fever ALWAYS come with ARS?
-  Do you think i need to get tested again, even tough it was oral exposures that, according to the doctors here, are no risk situations ( for HIV )?

[Edward W Hook, MD]

Your question about CSWs is not disrespectful- its fine and reflects a common misperception. The fact is the "high risk" should really be thought of as RELATIVELY high risk.   In the United States less than 10% of men who have sex with have HIV.  Similarly, inglobal studies of CSWs, it is uncommon for more than 10-15% of women to be infected, even in places like SubSaharan Africa the rates are typically less than 25% and in the US, typically less than 5% and typically far less have HIV.

Unfortunately, governmental agencies are, by nature conservative and tend to take a "we can't afford to be wrong" approach.  There is little chance that they will change their pronouncements relating to HIV and oral sex- sorry.  EWH

[braziliangus]

Thank you Doc for your answer. It helped a lot. Just one last tought: Why the government and policies makers around the world does not adjust the guideline for oral sex? The public guideline is " oral sex is less risky than vaginal an anal sex but there´s a risk and you should not do it unprotected"; but when you start investigating deeper in the medical community , the less convinced you become that oral sex is a transmission route for oral sex. this has to be one of the greatest debates of all time in medical history. Why tehy dont update the guideline? And is there any movement to do so?
Let people have their blowjobs without fear. thank you.

[braziliangus]

hello Doc I dont mean no disrespect to you extreme professional answers but i was reviewing some anwers about oral sex exposures and in one of them, from a guy who received oral sex from a TRANSEXUAL SEX WORKER you stated:

"There is virtually no risk for HIV from the exposure you describe. Despite the fact that your partner was a transsexual, it is unlikely that she had HIV.  More importantly, even if she did, there are no cases in which someone has gotten HIV from receipt of oral sex.  Some official sites will tell you that, IF your partner had HIV, the risk of infection is about 1 infection in 10,000 episodes but even that low estimate (it is the equivalent of receiving oral sex once daily from an infected partner for more than 27 years) is probably too high. "

What is the rationale to state that that it is " unlikely " that the sex worker had HIV. He/She is a sex worker ( high risk group ) who has sex with men ( high risk group ). Of all the possible risks groups of people in the world, on an statistical basis, isnt she the MOST LIKELY to have HIV?

Again I am sorry to question your answers, and I hope I did not do it in a disrespectful way. Thank you for everything .

[Edward W Hook, MD]

Welcome to our Forum.  Dr. Handsfield and I share the forum and take questions based on our availability.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

Since you have already read other replies on our Forum you will know that the oral exposures that you mention are virtually no risk at all for HIV and should not concern you.  I understand how you might worry that your rash and possible swollen glands could be due to HIV but the odds are very much against this.  When people develop symptoms for recently acquired HIV, they almost always have fever.  Further, the symptoms of the ARS are TOTALLY non-specific and are mimicked by many, many other far more common, non-STD viral infections.  When this has been studied, less than 1% of persons with classical ARS (and your rash and possible swollen glands is not classical ARS) turn out to have HIV.

Further in answer to your follow-up question, the fact is that when studies have been performed, most commercial sex workers do not have HIV or other STDs.  Even in very high risk parts of the world like sub-Saharan Africa, less than i 4 CSWs have HIV and in most parts of the world the rate is far, far lower.

Thus, the likelihood that your rash is due to HIV is very, very low.  So is your risk for HIV. In fact, the risk is so low that I would not even recommend HIV testing from a medical perspective.

I hope this information is helpful to you. EWH