Doctors please answer

[ooehs123]

Dear Dr,

I am a male from India and I am 26 years old. Yesterday night I had an exposure with a female prostitute who is also Indian. There was no penetrative vaginal sex and no penetrative anal sex that happened during the exposure. Since yesterday morning I have got 2 deep cuts in the inner part of my lip that have kept bleeding. In fact those 2 deeps cuts are even bleeding now.
The exposure I had with the prostitute was this - I kept licking her vagina for about 9-10 minutes. During this process vaginal secretions in large quantities were released from her vagina that I ingested. The vaginal secretions also came in contact with the 2 bleeding deep cuts in the inner part of my lip.
In addition to this, blood in large quantities were released from her vagina that I ingested. The blood from her vagina also came in contact with the 2 bleeding deep cuts in the inner part of my lip.
Can you please answer the questions below:
1)  Is there a cause for concern for HIV in the exposures that I mentioned above and do I need testing for HIV?
2)  Is ingestion of HIV infected blood that is high on HIV virus content ever considered a risk for HIV? Please note that in my case I also had the inner part of my lip bleeding. The blood from her vagina came in contact with the inner part of my bleeding lip.
3)  Is ingestion of vaginal secretions that is high on HIV virus content ever considered a risk for HIV? Please note that in my case I also had the inner part of my lip bleeding. The secretions from her vagina came in contact with the inner part of my bleeding lip.
4) Have there been any cases like mine in the past where a person has contracted HIV through the exposures I mentioned above?
I would appreciate your responses for the same

[Edward W Hook, MD]

My statement means what it says.  In the U.S it is recommended that everyone be tested for HIV at least once.  Beyond that recommendations depend on behaviors and risks.  In general, persons who have new partners, who have multiple partners or whose partners have other partners should be tested more often, about once a year in many cases although logical, as risk increases it is also wise to increase the frequency of testing.  

In your case, as I have already told you, from my perspective you do not need a test.  This is the 3rd time I have said this to you related to your question, I will not say if again.  EWH

[ooehs123]

Can you please elaborate you're statement above - "Here in the U.S. it is recommended that everyone be tested at least once".
Does it mean in US, people are recommended to get tested time to time for HIV irrespective of whether they have an HIV risk exposure or not or does it mean they are recommended to get tested for HIV post an HIV risk exposure same as mine?
Please let me know.

[Edward W Hook, MD]

Use of the term CSW is fine.  Testing is a matter of personal choice.  Here in the U.S. it is recommended that everyone be tested at least once.    The exposure you describe is low risk and from a medical perspective I see no need for testing.  If you, like some of our clients, have trouble accepting there is no need for testing, then a test at 4 weeks using either a combined HIV p24 antigen/HIV antibody test (often called "DUO" or "combo" tests) or at 8 weeks using an HIV antibody only test will provide defintiive results (which I am confident will be negative).   EWH

[ooehs123]

Dear dr, in my post immediately above csw means Commercial Sex Worker. Apologies for using the abbreviation and not writing the complete set of 3 words.

[ooehs123]

Dear Dr, thank you for your reply. There is no way i will be able to find the commercial sex worker and ask her to get tested for HIV.
Do you advise I wait till the 8 week mark post this exposure and get tested for HIV using a standard HIV antibody test or can I totally forget about this incident with the female csw and move on with life without getting tested for HIV for this particular exposure with the female csw.
Please note I haven't had any HIV risk exposures in my life before this exposure with the female csw.

[Edward W Hook, MD]

Welcome to the Forum.  I will be pleases to comment. You do not know that your partner had HIV- most commercial sex workers, including those from India, do not have HIV.  Further there is no risk of acquiring HIV form swallowing infected materials and the risk from performing cunnilingus is very, very low- less than 1 infection per 10,000 sex acts (i.e. that would be like performing oral sex on an infected person once a day for over 27 years).  The presence of bleeding oral cuts does not change this.

As for your specific questions:
1)  Is there a cause for concern for HIV in the exposures that I mentioned above and do I need testing for HIV?

See above.  I see no medical need for testing.,

2)  Is ingestion of HIV infected blood that is high on HIV virus content ever considered a risk for HIV? Please note that in my case I also had the inner part of my lip bleeding. The blood from her vagina came in contact with the inner part of my bleeding lip.

See above- no risk.

3)  Is ingestion of vaginal secretions that is high on HIV virus content ever considered a risk for HIV? Please note that in my case I also had the inner part of my lip bleeding. The secretions from her vagina came in contact with the inner part of my bleeding lip.

Again, no.  See above.

4) Have there been any cases like mine in the past where a person has contracted HIV through the exposures I mentioned above?

There are one or two cases in which a person MAY have acquired HIV by performing oral sex on an infected female partner.  Even these cases are not definite.  The risk is tiny.  

My advice is not to worry.  If you are really concerned, the most direct way to determine if you are even at risk is to find this person and pay for her to be tested,  If her test is negative. then you are not at any risk.  

I hope these comments are helpful,  EWH