Risk Assessment

[sillyboy1214]

Doctor,

I am a twenty-six year old gay male in the San Francisco Bay Area. I was in a monogamous seven year relationship until very recently. In the period of intense psychological depression that followed the breakup, I acted very unusually and perhaps a little compulsively.

I posted ads to Craigslist looking for men upon whom I could perform fellatio. I wasn't totally out of my mind, though, so I screened them as well as I could and avoided any who admitted to barebacking or anything like that. Craigslist is not known for safety or honesty, though, so I'm not making any assumptions.

I performed oral sex on six men in total. A few of them were very rough with me, forcing their shafts past my gag reflex and deep into my throat. It was traumatic enough that my throat was sore the next day. I don't know if this makes any difference with respect to the risks involved.

I swallowed semen in each case.

Today I have a sore throat and an ulcer on the inside of my lip that MAY be herpes. I'm not sure. My only concern there is that if it is herpes, it may have elevated the HIV transmission risk if HIV were present.

What do you honestly think my risk is here? Should I be at all worried about having acquired HIV through this episode? I'd rather move on with my life and get on with the healing process rather than spend time worrying about my health. I can't undo stupidity, but I can move past it.

Thanks in advance for your time.

[clemsonmike]

Anytime.  Thank you for the clarification.

[Edward W Hook, MD]

Sorry, typo. The quoted risk for getting HIV is 1 in 10,000 aqnd I suspect that is too high. Thanks for pointing out my typo,  EWH

[clemsonmike]

Hi Dr. Hook,

You stated above that, "The quoted risk for getting HIV through performance of oral sex is typically stated at about 1 in 1000 (1/10th or 1%)."

Is this the case?  I thought the quoted risk was 1 in 10,000?

Thank you,

Mike

[Edward W Hook, MD]

I understand your concern however, as you correctly point out, your risk that this is HIV is less than 1%, even if all the partners you described above had HIV.  EWH

[sillyboy1214]

Thanks, doctor. So, if I understand you correctly, you're saying that I have less than a 1% chance overall to have acquired HIV even if all of these men were infected?

My sore throat has gotten worse, and I have a low grade fever of about 100.4. Since the particularly rough exposure was about 25 days ago, I'm a little worried about ARS.

[Edward W Hook, MD]

Welcome to the Forum.  As you probably know, we receive many question on our Forum about risks for HIV from oral sex and fellatio in particular.  The fact is that performance of oral sex is a very low risk encounter.  While there are no known cases of HIV which have been proven to be obtained through receipt of oral sex but there are a very few cases in the medical literature in which persons MAY have gotten HIV through performance of fellatio.  The fact that your encounters were particularly rough might slightly increase risk as well

The quoted risk for getting HIV through performance of oral sex is typically stated at about 1 in 1000 (1/10th or 1%).  Thus there is some risk.  I doubt that the possible ulcer on the inside of your lip dramatically changes this.  Getting an HIV test is reasonable.  In general, the right time to do so is about 6-8 weeks after your last exposure although testing about a week after the onset of your sore throat would give you definitive information as to whether your sore throat is due to AHIAV or not.  

If you choose to seek testing, my advice is to seek evaluation at the SF Department of Health STD Clinic- they do a great job there.  EWH