HIV Transmission Risk Oral with respect to cortisone

[germanguy]

Dear Doctors,

first of all i want to apologize for my poor english, but i hope you will understand my question anyway.

I had unprotected insertive oral sex with a prostitute for about 5 minutes. I have psoriasis at my penis and used some cortisone creme on it the two days before. When i was exposed to the prostitutes mouth, i think my penis hadn't any cuts....it was only red because of the psoriasis. I explained it to the hooker and she accepted to suck it, because she meant, there is no risk in oral sex without ejaculation for her and for me. Under consideration of any possibilities like mouth sores or blood in her mouth, was i exposed to some serious risk? Did the cortison and its immune suppressive effect made it dangerous or is the neutralization of the salive still good enough?

6 days after the contact i had some unproductive cough, a little rash on my chest, diarrhoe, fatigue, not really fever but a hot feeling.

Shall i have a HIV test and how do you assess my risk?

Thank you in advance doctor!!!!

[Edward W Hook, MD]

Welcome to our Forum.  Your English is fine and your situation is clearly described.  This was a no risk exposure.  Receipt of oral sex is not a risk factor for HIV.  The topical hydrocortisone that you had applied to your penis would not change your vulnerability to HIV or other STDs.   I see no reason for concern and there is no reason to get an HIV test related to the exposure you describe.  

Your illness 6 days following the encounter you describe was too early to be suggestive of the symptoms of early HIV which typically occurs about 2 weeks following exposure, not so soon as 6 days. It is far, far more likely that you just had the bad luck to acquire to the sort of community acquired, non-STD viral illness that most people get from time to time.

I hope these comments are helpful to you. EWH

[Edward W Hook, MD]

Your question, like those of many of our clients represents a great example of the power of the internet not only to inform but also to mislead.  While there is much useful information available on the internet, much of it is also taken out of context or a bit unbalanced and some of it is just plain wrong.  I have answere these questions.  I meant what I said.  If you choose not to beleive me that, of course, is your choice.  EWH

[germanguy]

Thank you again Dr. Hook for your answer....you calmed me down a lot! Even though i continued to inform me about the transmission risks of hiv and hiv prevention.
And i read on thebody.com that inflammed skin is a risk for hiv transmission. and as i know psoriasis is something like an inflammation, i wonder if i really wasnt exposed to a high risk?
And allow me to ask another question: these statistics do include worst case scenarios like open sores + a bit blood in saliva + high viral load an so on?
I am little bit worried again, because yesterday, at day 11 after the exposure, i got a little ulzera at the inside of my cheek and in addition i have some swollen lymph nodes at the neck.

[Edward W Hook, MD]

You can have unprotected sex with your GF.

As I said, there are no data to suggest the HIV is spread through oral sex.  As a generalization for both you and other readers, you must realize that we VERY frequently get questions asking if different types of exposures or prevention measures are 100% effective.  The answer to that is that this is scientifically impossible.  For a variety of complex mathematical reasons far too complex to go into here, all one can do with well conducted scientific studies is estimate probabilities.  By definition, any estimate, cannot be 100% certain.  On the other hand, when Dr. Handsfield or I say that something is very close to no risk or of minimal risk, or use any other term to indicate a very small risk, that means "close to zero" in a world where zero cannot be attained.  You have nothing to worry about.   EWH

[germanguy]

Thank you very much for your quick answer!
Do I understand it right, that the risk to transmit HIV to the passive part of the oral act is zero or it is only no risk factor in a mathematical factor model? So i can have unprotected sex with my girlfirend without any concerns?