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Protected Sex, Had Cunnilingus With Wound In Tongue. Have Fever, Weakness. Tri-DOT Test Negative. Is It A Reliable Test ?

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Posted on Mon, 11 Jun 2012
Question: Hello Sir/Madam,

on 21st JULY 2011 - I had sex with a sex worker. It was a condom protected sex but the big problem is I gave her cunnilingus for about 10 mins, one day before all this happened - I bit my own tongue while eating and the tip of my tongue had some blood for few mins after I bit my tongue.
Now the next day when I met this sex worker and had some time with her I didnt realize that my tongue had a small wound.
3 weeks after all this on a sunday weekend I had fever like symptoms - I had mild temperature and felt weak. I had 1 paracetamol (200mg i guess) and the same day by evening everything was back to normal. I also had sour throat for a week. I was worried about possible exposure.
I have also read about the Lymph nodes on the internet. I have 3 peanuts size painless and very soft bulges on my neck bellow the right ear and 2 slightly smalled below the left ear. None in Arm pits or Groin. Is that normal or are they swollen? How big will they be when swollen and do they cause pain ?
I waited for 8 weeks ie., 16th SEP 2011 - (exact 57 days) and then got a HIV Tri-DOT test which came out NEGATIVE.
I am planing to re-test once I complete 3 months (22 OCT) - what are the chances my test remaining Negative?
Is Tri Dot Test reliable enough and if so what is the best window period - 6 weeks, 8 weeks, 12 weeks or 6 months ?
How risky was my act of Oral sex ?
What is the most XXXXXXX form of HIV transmission through sex, Oral, Vaginal or Anal. Also in Oral I mean Fillatio and Cunnilingus both for both receiving and giving partner.
I have looked on Internet and I see a lot of disputing information about the testing window period and the Hiv-Tri dot test. Is it worth taking or do you suggest some other test ? I am from India.

Please advise.

Thank you so much for the help and information.

Regards, XXXXXXX
doctor
Answered by Dr. Dr. Rakhi Tayal (4 hours later)
Hello,
Thanks for posting your query.
Palpable lymph nodes in the neck means the nodes are swollen. It is not necessary that they should be painful.
Your symptoms are like that of a viral illness.
Since your tri-dot test is negative after 8 weeks it is less likely to be positive after 6 months. Still it is best to repeat the test after 6 months.
The chances of transmission of HIV are present through oral sex if the sex worker was infected.
The chances of contracting the infection would be as follows.
A. Female-to-male transmission is 0.04% per act and ‎
B. Male-to-female transmission is 0.08% per act. ‎
C. The rate for receptive anal intercourse is much higher, 1.7% per act
The rate of transmission by oral sex is even lower.
Another test which can be helpful is Western Blot test after 6 months. Tri dot test is also a very sensitive test.
Hope this answers your query. I will be glad to answer the follow up queries that you have.

Regards.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dr. Rakhi Tayal (8 hours later)
Thank you So much Doctor XXXXXXX

I totally regret on spending time with a sex worker and I have decided to remain monogamous for ever. That was my first encounter with a SW.

I got 3 questions:

1 - I have read on some internet articles that swollen Lymph nodes can be a symptom of HIV but they say this is a full body pronominal and not confined to one particular region in the body. I have tried very hard to feel some lymph nodes on Armpits, groin and behind my ears but I dont feel any. The only spots where I feel these small XXXXXXX pea sized bulges are on both sides of my neck. (painless offcourse) -- SO WHAT IS THE NORMAL SIZE OF LYMPH NODES AND HOW BIG IS CONSIDERED AS SWOLLEN?

2 - Thank you for giving me the numbers on the risks associated with different types of risky sexual activities. I have also seen these numbers on Wikipedia - YOU MENTIONED ORAL SEX HAS EVEN SMALL NUMBERS AND AS I SAID I SEE THESE NUMBERS ON WIKIPEDIA TOO, MY CONCERN IS RELATED TO CUNNILINGUS AND I DON'T SEE THE EXACT RISK FACTOR FOR CUNNILINGUS ANYWHERE ON INTERNET, HOW MUCH RISK DO YOU THINK I HAVE WITH MY ONE TIME CUNNILINGUS WITH A SMALL CUT ON TONGUE.

3 - I have read a lot of articles on HIV and have been to many forums and there is one common thing I see about oral sex - MANY FORUMS AND EXPERT ARTICLES SAY THAT SALIVA HAS OVER 12 DIFFERENT ENZYMES AND PROTEINS THAT RENDER THE HIV USELESS WHICH IS WHY THE RISK ASSOCIATED WITH ORAL IS SO LOW THAT IS SOME TIMES IS CONSIDERED SAFE (Not for other STDs but HIV). IS IT REALLY TRUE THAT SALIVA CAN INHIBIT HIV ?

Doctor, I am really worried - this was my first sexual encounter and it turned out to be a nightmare. I am 27 and my parents are thinking of getting me married soon and all this is disturbing me mentally.
This weekend (22 OCT) I am planing for another HIV test as it will be 3 months. DO you advise I go for Tri Dot for this test too ?
Is ELISA and TRI DOT very similar and produce same results or are they entirely different - I read they both are tests for anti-bodies so are they same ?
I will sure go for a Western-Blot after 6 months but for now I want to know the best test for 3 months period.

Please let me know doctor, Thank you so much once again.
I just hope and wish I am not infected.

Thank you, XXXXXXX
doctor
Answered by Dr. Dr. Rakhi Tayal (18 minutes later)
Hello,

Thanks for writing again.

1. Lymph nodes are of variable sizes. Most of them are less than 0.5cm in size.
Clinically any lymphnode that is palpable is considered as swollen node in the neck. However it does not necessarily indicate HIV if the lymphnode is swollen.

2. There are no studies carried out to find out the exact incidence of transmission with cunnilingus with a cut on the tongue. However expert guess is that it is less than 0.1%

3. Saliva can inhibit growth of HIV to some extent, but does not completely prevent infection. But there are no cases of HIV transmission caused via saliva (oral sexual intercourse) reported yet. Hence all experts believe oral transmission is relatively safe.

I understand your anxiety. HIV ELISA and Tridot test though very similar test (looks for presence of HIV antibiodies) are different test with HIV ELISA test being superior to Tridot test.

If you are asymptomatic then you can directly go for western blot after 6 months of exposure. This will alleviate you of all anxiety that you have now.

Hope my answer is helpful. Write back if you have further queries.

Wishing you good health.

Regards


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Dr. Rakhi Tayal (3 hours later)
Hello Doctor,

Thank you so much for clearing all my questions.

I think I don't have any symptoms (asymptomatic) and the only suspected symptom that I had was the one day mild fever and sour throat after approximately 20 days post my potential exposure.
It was monsoon season and many were getting mild fevers and coughs during those days but I was worried because I didnt have any fever for almost 2 years before all this happened. I some how feel the fever and sour throat were due to the season change.

Doctor, before I close my request - can you please tell me what symptom you were pointing towards when you mentioned "asymptomatic". As its been almost 3 months (5 days to go) do I have to watch-out for some suspicious symptoms that possibly may fit in with the HIV symptoms ?

Also what are the most common classic HIV symptoms that we find in Indian subcontinent and is it widely seen or only few people have symptoms while the rest go unnoticed ?

I didn't have any high fever, or sever sour throat or any body rashes. I am not even loosing weight, in fact I have put on 2 kilos recently thanks to the festival season and no workout due to mental tension I am going through due to all this.
My mind is playing havoc with me and I am unable to concentrate on my work and life. Do you think I am infected, I know its not a proper question as Tests are the only solution but based on my 8 weeks test that came out negative - what are the chances that it remains negative ?

Hope you understand my mental state and I am praying to God to forgive me for my mistake it was my first sexual exposure and I am so scared and worried now.

This is my last question for you doctor. Thank you once again for all your advise and help. I really appreciate everything you are doing. Have a wonderful and beautiful life.

Thank you & Regards, XXXXXXX
doctor
Answered by Dr. Dr. Rakhi Tayal (19 hours later)
Hello.
Thanks for the follow up.

The common symptoms associated with HIV include weight loss, irregular fever, generalised lymph node swelling, repeated viral infections, diarrhea, generalized rashes on the body, etc.

You are not having any of these symptoms even 3 months after the exposure.

It is not necessary that everyone who is exposed to this infection will have symptoms.

The mild cough and cold episode you had might have been seasonal.

You need not worry so much. I would like to reassure you that your chances of being infected with HIV are minimal. Just wait for another three months and get a western blot test done to remove your doubts.

Laboratory tests are the only way to know the status of your infection. Plain guessing would not help.

Hope this is helpful.

Wishing you good health.
Take care.
Regards.
Note: Get personalized answers to your HIV related queries You can choose to talk face to face with your doctor. Book a Video Call now.

Above answer was peer-reviewed by : Dr. Radhika
doctor
Answered by
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Dr. Dr. Rakhi Tayal

OBGYN

Practicing since :2001

Answered : 14041 Questions

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Protected Sex, Had Cunnilingus With Wound In Tongue. Have Fever, Weakness. Tri-DOT Test Negative. Is It A Reliable Test ?

Hello,
Thanks for posting your query.
Palpable lymph nodes in the neck means the nodes are swollen. It is not necessary that they should be painful.
Your symptoms are like that of a viral illness.
Since your tri-dot test is negative after 8 weeks it is less likely to be positive after 6 months. Still it is best to repeat the test after 6 months.
The chances of transmission of HIV are present through oral sex if the sex worker was infected.
The chances of contracting the infection would be as follows.
A. Female-to-male transmission is 0.04% per act and ‎
B. Male-to-female transmission is 0.08% per act. ‎
C. The rate for receptive anal intercourse is much higher, 1.7% per act
The rate of transmission by oral sex is even lower.
Another test which can be helpful is Western Blot test after 6 months. Tri dot test is also a very sensitive test.
Hope this answers your query. I will be glad to answer the follow up queries that you have.

Regards.