Assessing Risk, not sure if I was exposed

[mact338]

hi, i am a 19 year old female in college.  In October of 2010 I received oral sex from a male (23 years old) that I did not know very well- I also performed fellatio on a different male who did not ejaculate in my mouth who has since been tested and the result was negative.  Anyway, the oral that I received was very brief and mostly just toward the top near the clitoris (i don't know if this will make a difference or not).  I don't know him so I cannot get in contact with him about his status (negative or positive).  At the end of December 2010, i experienced swollen lymph nodes, extreme fatigue, night sweats, ***** tonsils, slight fever and for one night a reddish rash on my chest area.  I was tested for strep and mono which both came back negative.  The first week in January (about a week after all the symptoms and 2 months after both encounters) I was tested for HIV with an ELISA test that came back negative.  I also was tested with a PCR test that also came back negative.  The health department where I went to told me to stop worrying and stop testing, but I hadn't told them about the male I received oral from.  I have heard so many mixed things about having to wait 3 months until you can get a reliable result and that PCR is not FDA approved so you can't trust it.  In all my research I'm not even clear if you are able to get it from receiving oral!  Clearly I am very very confused.  Do you think I should be tested again? how would you assess the risk in my situation with receiving oral from the male of unknown status?  I can't shake the feeling that I'm going to keep going on with my life and not know I have it until it's too late.  

I would really appreciate it if you can help me!! Thank you.

[Edward W Hook, MD]

Welcome to our Forum. I see from looking at your past interaction on the HIV community site that these exposures have been on your mind for some time.  I hope that I can help put your concerns to rest.  I can assure you, you do not have HIV and do not need further testing.  

Before I comment on my reasoning for the statement above, let me make another comment.  My sense is that you have been researching the topic, probably using the internet as most of us do.  In doing so, I am sure that you have encountered some mis-information.  While there is much useful information available on the internet, much of it is also taken out of context, overly conservative or a bit unbalanced and some of it is just plain wrong.  

Now, for my comments as to why you do not have HIV.

1.  Your partners.  HIV is uncommon among non IV drug using, heterosexual men, occurring in fewer than 1 in 10,000 people.
2.  Oral sex is not a risk factor for HIV.  The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.
3.  Your symptoms were non-specific and were most likely due to the sort of every day, non-STD viral illness that most people get from time to time.  The symptoms of the ARS are TOTALLY non-specific and when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes. In contrast, over a given year, there is almost no one who has not had a viral illness, night sweats or both (sometimes on multiple occasions).
4.  You've been tested with negative results.  You are correct that the PCR is not approved for diagnosis of HIV however, the problem with this test is false positives, not false negative.  When we consider the combination of your having had both antibody tests and a negative PCR, you have scientific proof that you do not have HIV.

While you might argue that any one of these points could have exceptions, when they are considered in combination, there is simply no way that you have HIV or need to be concerned. it is time to put your fears behind you and move forward.  I hope my comments will help you to do so.  EWH

[Edward W Hook, MD]

Glad to help.  Take care. EWH

[mact338]

I appreciate the time you have taken to answer my questions! thank you so much. you have put my mind at ease and I will be sure to be more careful in the future.