Risk from Cunilingus with a prostitute

[789Worried]

Four nights ago, I preformed unprotected cunilingus on a colombian prostitute. I fingered her with just the tip of one finger. She was slightly wet. I've read previous posts where you say there is no risk from cunilingus, but given two things I'm still confused, concerned-and freaked out.

Two days before the incident, I recieved a second degree burn on one finger.  It blistered-white. Then, about 8 hours before I preformed cunilingus, the blister broke & drained clear liquid. Underneath the blister the skin was red and sore, but never actually bled. I can't remember if I used this finger when fingering the woman. It seems likely, as this is the finger I would naturally use.  My question here is, is that raw skin likely to provide a conduite to my blood stream for HIV transmission.

I have also read in other websites that there is "some" risk of HIV transmission on the receptive partner (one performing the cunilingus).  However, in a previous post, you say there is no risk. I've also read that there is a 1 in 10,000 risk, and I've read that studies have been done of couples where the woman is HIV positive and they have continued to perform cunilingus without transmission - so what is the reality here? Is there a risk - is it negligable?

Finally, I'm scheduled to have a PCR test done 10 days after the potential exposure. I understand that 28 days are needed for the test to be 100% conclusive - however, I've read that the results will be 'significant' at 10 days. What does this mean?  If the test is negative, should I feel like I am safe?

My third question involves sex with my wife during this window period.  I sometimes come outside her after intercourse, so I will be sure to do this, but am I being stupid going into her at all? We never use condoms, so using them now would raise questions. I am just a little freaked out, mostly because I am married & terrified of passing this onto my wife and of losing her if telling her of my transgression

[H. Hunter Handsfield, M.D.]

I stopped reading after the first 2 sentences.  It is probable that nobody in the world ever acquired HIV by performing cunnilingus or fingering; both are zero risk for HIV.  It doesn't matter what the rest of your message says about symptoms or anything else.  You are not at risk and do not need HIV testing.

Now I have read the rest.   To your specific questions:

1) Burns or other sores on fingers make no significant difference.  In theory it might increase the risk. But if you take zero risk and multiply it by 10, you still have zero risk!

2) Nobody has accurate data.  I don't know where you got 1 in 10,000; some people might use that estimate for performing fellatio, with ejaculation in the mouth.  I have never seen any numbers for transmission by cunnilingus. but any way, all such figures are extremely rough; nobody knows the real odds, except they are too low to measure accurately.  Anyway, have you thought at all about what 1 in 20,000 means? Your chance of dying tomorrow in an accident are higher than that.  Your lifetime chance of getting killed by lightning (if you live in the US) is 1 in 27,000--that is, about the same as the estimates for some forms of oral sex.  Also, 1 in 20,000 means you could perform that particular act--say receiving a BJ by an HIV infected person--once a day and might (or might not) catch HIV after 66 years.  Those odds are so low that they are equivalent to zero.

3) It is a waste of money, time, and energy for you to have a PCR test.  I recommend against it.  The odds are much higher that you will have a false positive test than the chance you actually caught HIV.  (Then think what you'll go through for 10 days as the truth is sorted out by addtitional testing).  It's also a waste to have an HIV antibody test.

But you're going to do those things anyway, because people with your aberrant perspective on the risks are never satisfied by the odds analysis I gave above or by my opinion.  If you really need to know your test results are negative for anxiety relief reasons, just have a standard antibody test 4-6 weeks after the event.

There is no chance you have anything from this event that you can transmit to your wife.

Regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

You may not keep coming back with trivial "yes but" or "what if" questions.   This thread is over.

[789Worried]

Hello again Dr. Handfield, one thing has been bothering me since yesterday.  The broken blister on my finger.  You remember that two days before the risk exposure, I burned a finger.  Then, about 8 hours before the risk exposure, the blister tore.  The blister had a hole you could easily look through and see the damaged skin - red.  Like I said, it never actually bled, but it looked like raw skin to me.  Is the damaged skin underneath a second degree burn likely to provide protection against HIV getting into the bloodstream?

[H. Hunter Handsfield, M.D.]

I don't know enough about the PCR test to answer those questions.  Sorry.

[789Worried]

Thanks again Dr. Handsfield.  Okay, last question about the PCR test.  From additional research and your comments, I realize that the PCR test may not be a good indicator for not being HIV positive (with such high false positives).  My question is then, does the PCR test also have a relatively high rate of false negatives at 10 days?  What about at 28 days?  I might be willing to gamble on not getting a false positive, if a negative result will help me out of the purgatory I'm now putting myself through.

By the way, this forum is a godsend.  Thank you.

[H. Hunter Handsfield, M.D.]

I don't know the rate of false positives for PCR tests, but in some labs it might be as high as 1%, and it's probably at least 1 in 1,000.

[789Worried]

Thank you for answering my questions.  This event has thrown all my perspective - like other people in your forum, my anxiety is through the roof.  

I do have one more question for you - you're right, I'm probably going to get that PCR test, but what is this about a false positive?  Do you know the chances of this?  Any statistical research on false positive events in the PCR tests?

You're right, if I test false positive, the living hell I think I'm in now will seem like mild purgatory compared to the hell I'll be in a living till it is sorted out.