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Dr. Andrew Rynne

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Can HIV be contracted through oral sex?

Answered by
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Dr. Monika Dede

Infectious Diseases Specialist

Practicing since :2003

Answered : 793 Questions

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Posted on Wed, 15 Mar 2017 in HIV and AIDS
Question: I performed oral sex on two men this week. No ejaculation in the mouth, but not sure about pre-ejaculate, but I did notice two spots in my mouth. One was teeth marks and the other looked as if I bit my cheek. One encounter was Monday, one was Tuesday. I had spoken with them about HIV and STDs and both claim to not have anything. However, I developed a headache on Tuesday, then yesterday I had a brief runny nose and then a sore throat developed. This evening I felt like my thighs were chafing and I noticed a rash which I will attach a picture of. It is on both inner thighs, but I only took a picture of one side. Today I went to the doctor and did a test for Strep, Gonorrhea, and Chlamydia as well. I was prescribed a Z Pack because I cannot take Keflex. My question is whether or not I am experiencing acute HIV infection? It has only been a few days, and I thought those symptoms presented after a few weeks. I was aware that performing fellatio is rather low risk, but I am always concerned that I am the one person who gets the short straw.
doctor
Answered by Dr. Monika Dede 3 hours later
Brief Answer:
Hello XXXX! I have been through your question and I have seen the pct.

Detailed Answer:
Related your concern you should know that getting hiv from oral sex without ejaculation, there is little to no risk but other STD can be transmitted during oral sex.
Though the risk of HIV transmission through oral sex is low, several factors may increase that risk, including sores in the mouth or vagina or on the penis, bleeding gums, and the presence of other sexually transmitted diseases .
Based on your history that the men are free of HIV, and there wasn't ejaculation and you have only spots in mouth and not bleeding gums and sores I think you don't have to worry about hiv.
It is a good news that you are screening for strep and std and start azytromicini but you should know that the right choice for an gonococcal infection of pharynx is taking a combination of ceftriaxon or cefipimi with azytromicini.

Regard acute HIV infection don't worry you have right, is a condition that develops within two to four weeks after someone is infected with HIV and not after few days as you have.
But, what I suggest for you in this moment is to take a test now for syphilis and for HIV as well(combo duo test) first after 14 days and after 3 months to be absolutely sure that you don't get HIV.
I hope my answer helps you.
I wish you a quick recovery.
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Monika Dede 29 minutes later
Thank you for answering. I needed to hear a second opinion regarding the STD issue. I screen for STDs on a regular basis (usually every 3-6 months) based on my recent sexual activity as I have been active with both men and women.

While I understand that ceftriaxon is the better choice, the issue is that I am allergic to that family of medications so I am unable to take them. Unfortunately alternative regimens are needed in my case. I have not gotten the results of the GC/Chlamydia test yet either.

My tonsils are swollen with white blotches on them they look like pockets of pus. I am not sure if that would be indicative of an Oral STD or maybe even plain tonsilitis. There have been lots of illnesses going around in my area.
doctor
Answered by Dr. Monika Dede 26 minutes later
Brief Answer:
hello XXXX! Ι have been through your question.

Detailed Answer:
Thank you for you question.
Related your concern I think that the most probably based on your data(swollen tonsils with white blotches) this could be acute tonsillitis but I couldn't exclude an mononucleosis and strep throat. So you need to meet a infection diseases specialist to do a differential diagnosis and start antibiotic treatment.
Regarding ceftriaxon allergy if you result positive for gonorrhea, you should know that are limited data regarding alternative regimens for treating gonorrhea among persons who have a cephalosporin allergy and potential therapeutic options are dual treatment with single doses of oral gemifloxacin 320 mg plus oral azithromycin 2 g or dual treatment with single doses of intramuscular gentamicin 240 mg plus oral azithromycin 2 g.
I hope my answers helps you.
I wish you a quick recovery.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Monika Dede 8 minutes later
Thank you. My rapid strep test was negative. I will definitely speak with my doctor about possible alternative treatments for gonorrhea if I am positive. I made sure he was aware of my allergy.
As for HIV, I always make sure I discuss STDs with potential partners. They both disclosed to me that they do not have HIV or anything for that matter. However, I did not see proof. I always test for STDs periodically as well.
doctor
Answered by Dr. Monika Dede 3 hours later
Brief Answer:
Thanks for writing back.

Detailed Answer:
Related your recent data you should know that a negative rapid strep test result can mean there are no strep bacteria present, but the rapid strep test can give negative results even when strep bacteria are present (false-negative results).
So, if the rapid strep test result is negative but strep throat is still suspected, your doctor may order a throat culture to verify the results.

It is good way to prevent a HIV/STD infections discussing this with your sexual partner and well done testing periodically for STD but I suggest you consistent and correct use of the latex condom to reduce the risk of STD and HIV transmission, because many infected persons may be unaware of their infection because STD often are asymptomatic and unrecognized.
I hope my answer helps you.
I wish you a quick recovery.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Monika Dede 20 hours later
One more question. Were you just recommending a syphilis and HIV test just as a precaution? Because you said based on what I told you you feel it is little to no risk. The only marks were bites on my cheek (though one looked like a red mark, very small, maybe a blood blister but not open).
doctor
Answered by Dr. Monika Dede 1 hour later
Brief Answer:
hello XXXX! Ι have been through your question.

Detailed Answer:
Thanks writing me back again!
Related the HIV based on your history ( oral sex and no open and bleeding sores just not open blood blister) I said exist a little to no risk get HiV but is better to test for HIV just a precaution. But related syphilis is an STD that can get it even through skin contact if the partner is infected.
Let me ask related about your symptoms above mentioned any changes or improvement?

I hope my answer helps you.
I wish you a quick recovery.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Monika Dede 7 minutes later
Yes, I plan to get a slew of full tests in some time. I prefer to wait to test when the results are conclusive unless I notice something out of the ordinary. I should let you know that I was treated for late latent syphilis two years ago as well so I am very vigilant about that. While it is not everything, I did check my partner's genitalia for any open sores and none were present as far as I saw, but I know they can be hidden.

The symptoms disappear with Advil. However the headache returned and the sore throat has not gotten better yet without Advil. I was also very tired today, but did not get adequate sleep although my energy returned after work when I got home. In addition, my temperature was 99.4. I also noticed red spots on the roof of my mouth and a foul taste in my mouth.
doctor
Answered by Dr. Monika Dede 3 hours later
Brief Answer:
Hello XXXX!

Detailed Answer:
Thanks writing me back again! I am sorry for my late answer.
Related your recent concern with red spots on mouth , headache, feeling tired, sore throat and low grade fever I think could be a viral situation with the upper airways.
But just for information you should know that red spots on mouth sometime could be as a result of thrush or oral candidiasis (not related with HIV), or canker sores (are generally a result of stress as you have or contact with irritants).
I suggest to use some kind of antiseptic oral for this situation.

I hope my answer helps you.
I wish you a quick recovery.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Monika Dede 4 hours later
I took NyQuil last night around midnight and went to sleep. I woke up this morning around 8:06 AM and did not feel feverish. The red spots are still there, and my throat is still sore, but less sore than yesterday.

As for feeling tired yesterday, I also did not receive adequate sleep the night before as I as only asleep from midnight to around 5:30 AM. I live in a noisy house and I also suffer from severe anxiety.
doctor
Answered by Dr. Monika Dede 1 hour later
Brief Answer:
follow-up consultation

Detailed Answer:
Hello again! Thanks writing back.

Don't worry, I read the above mentioned facts and this supports my opinion that I said before. This is only a acute viral situation associated with your anxiety.

It is a good news that you don't have any fever and feel a local oral improvement.

Take care for yourself, eat well and have a lot of fruits, drink a lot of water, take some multivitamins to raise your immunity and get some good rest and do things that improve your mood.

I hope my answer helps you.
I wish you a quick recovery.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Monika Dede 8 minutes later
So in your opinion, is this most likely related to something other than sexual contact? I know this time of year many things go around. I live in the New York City Area and we have had large temperature swings during the month of February from blizzard conditions to near over 60 degrees this year! And yes, I am under a lot of stress. The other question I had is regarding Haemophilus Influenzae as I heard that can also cause tonsillitis. The reason I ask is because my mother had this last year and she became septic and died, though it was in her lungs and not her tonsils as she had a tonsillectomy as a child.
doctor
Answered by Dr. Monika Dede 3 hours later
Brief Answer:
Thanks writing back.

Detailed Answer:
Firstly, I'm very sorry for your mother.

Yes, as I've mentioned above, this could be a viral infection not related with STD, but as well, I'd request you to exclude syphilis and HIV as just a precaution.

Related the haemophilus influenza, don't worry, because H.influenza usually causes epiglottitis, pneumonia and meningitis, sepsis in mostly elderly adults with long-term chronic underlying medical conditions. However, this is not your case (based on your above mentioned symptoms).

The good news for you is that you have improvement.

I hope my answer helps you.
I wish you a quick recovery.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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