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Is HIV Infection Possible Through Oral Sex?

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Posted on Mon, 1 Dec 2014
Question: Dear Doctor,
I received a blow job from a female sex worker, i do not know if she is HIV positive. I did not even ejaculate. However, when i was having bath after reaching home, i released there was a cut in the outer skin covering my penis.
I would like to know, firstly, can i get HIV from this cut ?
Secondly, if I want to do a HIV test, how many days should i wait ?
Thirdly, from this day till the test day, should i take any preventative medication ?
Looking forward to your quick reply
doctor
Answered by Dr. Dr. Kakkar (27 minutes later)
Brief Answer:
HIV risk is negligible with oral sex

Detailed Answer:
Hello and welcome to healthcaremagic

I am Dr. Kakkar. I have gone through your query and I have understood it.

Oral sex as such is a very low risk route for HIV transmission. Unless and until there are sores in the oral mucosa of the person giving oral sex, the risk is almost negligible.
Moreover saliva is supposed to have anti HIV properties.
However, testing would confirm that and it is advisable to get tested no matter how less the risk for your own peace of mind.

You can go for a HIV combo test (tests for both antigen as well as antibody) at 1 month since most of the individuals infected with HIV are positive by HIV combo test at 1 month. If it is negative at 1 month, a repeat test negative at 3 months (it is always better to have 2 negative tests) is taken as conclusive.

Post Exposure Prophylaxis should be started if at all within the first 72 hours of a risky sexual contact. However, this being a low risk exposure, PEP is not mandatory.

Regards
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Dr. Kakkar (47 hours later)
Dear Doctor

Thank you for your quick response.
Your reply has given me some mental relief.

I would like to explain some more facts and seek your advice.

First for my satisfaction, I did a HIV test, 4 days after the activity, the result was negative. I will do another test in 1 month’s time.

Now, this part is what is worrying me.

I am somebody who maintains good health; I do not fall sick very often.

However, it’s been 5 days since the activity, and all these 5 days my whole body feels tired, lazy, and my eyes have a slight burn.

My throat and lips are dry, so when I am eating, even slight spicy food, I feel like cuffing, and I cannot swallow the food easily.

I do not have an appetite, just after 2-3 bites, I feel full.

I had loose-motions; I took tablets for it for 2-3 days. Today the motions are much better.

It’s only been 5 days, I am worried. Pls advice.
doctor
Answered by Dr. Dr. Kakkar (10 hours later)
Brief Answer:
Can go for RNA PCR testing at 2 weeks if desired

Detailed Answer:
Hi,

4th day testing for HIV is too early and cannot reveal anything.
At the earliest, a 2 week test and that too with an HIV RNA PCR would be reliable. A negative RNA PCR test would completely rule out HIV. You may take this test.

However, HIV RNA PCR has a high false positive rate (5%), therefore a positive test is not confirmatory.

Whereas, HIV Combo test (Antigen / Antibody test), which I had suggested in my last reply, is 99.8% sensitive at 28 days/4 weeks.

Regarding the symptoms, they are flu like and do not indicate anything as far as HIV is concerned. These symptoms are too early to be suggestive of HIV (you have had these since all 5 days after contact, right!).

Regards
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Dr. Kakkar (2 hours later)
Dear Doctor

Thank you for your response, it is quite comforting.
Sorry for this repeated Q&A, I hope you understand that I am worried.

Firstly, yes.. I have had these symptoms since all 5 days after contact. If it is common flu, what medicine would u recommend for these symptoms?

Secondly, I have a unique situation here.

I work in a rural area, I am not sure the laboratory here has the testing facility that you have mentioned. I need to ask them. The report I received on the 4th day only stated that I was HIV negative.

I will get my leave after 2 months; there I will get access to a specialized Lab to do all these tests.

Until then, I am just trying to do whatever possible from my end, so there is no delay from me.

As these details are private, I hope this conversation will not be uploaded for others to read.

Looking forward to your reply on the medicine for flu and pls advice on the situation mentioned.
doctor
Answered by Dr. Dr. Kakkar (1 hour later)
Brief Answer:
Symptomatic treatment for flu

Detailed Answer:
Hi.

Please don't feel sorry for your follow-up. You are entitled for a follow up.

Since this seems to be a flu like illness, which is mostly a viral etiology, therefore, you just need to take symptomatic treatment for a few days.

I would suggest an OTC analgesic, antiinflammatory e.g either Ibuprofen or Paracetamol, twice or thrice daily for 3 days. Avoid Aspirin or Disprin.

You may increase your fluid intake, it would be good to include a soup, twice daily, in your diet/fruits and fruit juices etc
Take light and frequent meals like e.g a bowl of rice porridge/corn flakes in a bowl of milk/oats in a bowl of milk etc

You may check with the lab if they have PCR RNA for HIV. They may transport your blood sample to a tertiary care lab Or else you may wait till you have access to a specialized lab.

Sure, this discussion is private and we never share the identity of our user with others.

Regards
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Dr. Kakkar (3 days later)
Dear Doctor

Today, I complete the 8th day since the contact.

As instructed, I have been taking Ibuprofen 400mg for 3 days x thrice daily. I have also increased my intake of water.

I am now able to eat spicy food and swallow it without any problem. The burn in the eye is not there. My throat and lips are still dry but no problem eating and swallowing. I do not feel like cuffing.
However I still do not have an appetite and I am forcing myself to eat, to prevent any form of weakness. The loose motions are on and off for which I take norflox (norfloxacin 400mg +tinidazole 600mg)

I have slept more than 8 hrs for the last 2 nights. Earlier for 6 nights at a stretch I have hardly slept for more than 5 hrs due to stress.

I was sensing some swelling in between my gums and lips 2 days back. I was expecting some blisters in my mouth, so yesterday I took Folic Acid 5 mg x thrice daily for 2 days (yest/today). Today the blisters are pretty evident.

Today in the morning I was feeling well and fine, then suddenly in the evening I felt a sense of weakness in my legs, after taking some rest, I felt better. Even after 8 days, the tiredness has not gone yet. I feel tired and lethargic throughout the day.

Please advice on the above situation.
doctor
Answered by Dr. Dr. Kakkar (6 hours later)
Brief Answer:
May add B-vitamin supplement

Detailed Answer:
Hi.

I feel the mouth ulcers are probably 'Aphthous Ulcers' (I will be able to confirm once you upload a photograph of the oral ulcers), probably because you are not been eating well lately; also because the oral antibiotics that you have been taking (off and on) for loose stools, can alter resident intestinal flora. Together these two factors can lead to a B-Vitamin Deficiency and may be responsible for ulcers.

You may add an B-complex vitamin supplement once daily.

Also can add lactobacilli spores (probiotic) for loose stools and for normalizing the resident intestinal flora, since you have been taking antibiotics regularly which can alter intestinal flora. That would also be good for oral ulcers as well. It is available as capsules. it is available OTC in most of the countries you may check for it from a drug store.

Lactobacilli are also present in curd. Therefore, Intake of curd would also help in your case.

Flu like illness can last for 2 weeks and you just need to take symptomatic treatment.

Regards
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Dr. Kakkar (35 hours later)
Dear Doctor

Please find attached photo of the mouth ulser. It has a red outer lining and it is yellow in the center, it is 2-3mm wide. Luckily it is not hurting so far.

Today is the 4rd day for taking folic acid 5mg x thrice daily. How many days should I continue taking it?

I have been taking Ibuprofen 400mg for 5 days x thrice daily. How many days should I continue taking it?

I have started to take vitamin b-complex tablet x once daily from today.

What is the generic name of the tablet for lactobacilli spores (probiotic)? We get only generic medicine here.

In your last reply, I did not understand much, if you could please explain in a simple/non technical language it will help.
doctor
Answered by Dr. Dr. Kakkar (15 hours later)
Brief Answer:
Symptomatic treatment

Detailed Answer:
Hi.

Unfortunately I have'nt received the photograph.
You may try and upload it again. To do that go to the reports section and upload there Or else you may also mail the photographs to YYYY@YYYY with the subject line as "Attn Dr. Kakkar"

Most probably these are aphthous ulcers, the likely reasons being because you have not being eating well which can lead to B vitamin deficiency; flu like illness can itself cause aphthous ulcers; and also since you have loose stools and have been taking oral antibiotics which in turn can suppress the intestinal flora that is normally present (resident) in the intestine i.e lactobacilli which are a source of B complex vitamins.

B complex vitamins deficiency is also a cause for aphthous ulcers.

That is the reason I asked you to take B complex vitamins. You may discontinue folic acid since B complex tablet already has folic acid as well as other B vitamins.

Continue B complex for a few days. This alone may prove effective for aphthous ulcers even if you don't find lactobacilli spores.

Lactobacilli are present in curd, therefore you can increase curd intake.
Lactobacilli spores are also available OTC in many countries as generic (capsules or sachets). You may try from a drug store.

Topically for aphthous ulcers you may use an antiseptic mouthwash twice daily.

Basically you need to be treated symptomatically.

Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Dr. Kakkar (2 hours later)
Hi, I have provided some attachments. Please review them.
doctor
Answered by Dr. Dr. Kakkar (21 minutes later)
Brief Answer:
Aphthous Ulcer

Detailed Answer:
Hi.

I have reviewed the photograph. This is an aphthous ulcer as I had suspected

You may refer to my previous detailed reply.

Regards
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Dr. Kakkar (10 days later)
Dear Doctor,

Today it is 21 days since the contact.

About a week back I stopped taking Ibuprofen 400mg after 7 days x 3 times daily as my symptoms had gone.

As soon as I stopped the Ibuprofen 400mg, the mouth blisters also started to reduce; now I have no mouth blisters and I continued the Vitamin B complex tablets till the strip of tablets was over, yesterday.

But I am still feeling tired and my body still feels lazy since all 21 days.

Since the last 3-4 days I am having pain in my legs, mainly in the calf area. I have taken good rest during the weekends and I have not exerted myself. But I am still getting pain in my legs. Please advice.

The second problem is that I am feeling some Itchiness in my ass. It is going on since 2-3 days. Please advice.

Looking forward to your advice for the pain in the leg calf and itchiness in the ass.
doctor
Answered by Dr. Dr. Kakkar (8 hours later)
Brief Answer:
Multivitamin supplement; Topical antifungal

Detailed Answer:
Hello again!!

I think the weakness/laziness is just an after effect of the illness and surely would be better as you are on the recovery path.
Anxiety can be a contributory factor too for non-specific symptoms like generalized weakness/laziness.
The pain in the calves is most likely part of generalized weakness and might be due to a little electrolyte imbalance.

The good thing is that you have been sleeping well recently.

How have you been eating? Has the apetite improved? Once the apetite improves things should get better.

Also need to take a good amount of fluids/fruits and fruit juices etc.

You may add a multivitamin, multimineral supplement once daily for a few days. You may find one of these OTC from a drug store.

Your second concern is anal itching. Candidal infection seems to be the likely cause of perianal/anal pruritus most likely because of broad spectrum oral antibiotics, which you were taking recently for loose stools; oral antibiotics can suppress the resident bacterial flora thereby giving a chance for candida to proliferate.
Sweating and maceration can also encourage candidal growth in the body folds.

You may use an OTC topical antifungal cream (e.g clotrimazole 1% cream), twice daily for a few days.

An OTC oral antihistamine e.g cetrizine 10 mg, once daily, would provide you symptomatic relief from itching.

Regards
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Dr. Kakkar (7 days later)
Dear Doctor

Today I will complete 30 days since my contact.

Tomorrow I intend to go for the HIV test as recommended by you in ur earlier emails.

I need ur advice on this matter below.

I have been feeling hot in the ears the last 3-4 days and my temperature rises above 37 degrees (37.1-37.2).

I have been taking 2 sinarest tablets x twice daily (paracetamol 500mg, phenylephrine hydrochloride 10mg, chlorpheniramine maleate IP 2mg, caffeine {anhydrous} 30mg).

After taking the 2 tablets the temperature drops between (36.4 – 36.8 degrees)

Today morning I did not take the tablets the temperature XXXXXXX to 37.2 this morning from 36.5 last night.

Is it safe to take tablets 24 hrs before the tests ? Will the intake of tablets make a difference in the tests tomorrow ? Or should I just not take the tablets today and take the test tomorrow ?

Please advice on the intake of tablets 24 hrs before the test.
doctor
Answered by Dr. Dr. Kakkar (10 minutes later)
Brief Answer:
Can take this combination for symptomatic relief before HIV tests

Detailed Answer:
Hi.

Dear User, there is absolutely no issue with the intake of this combination prior to HIV testing.
You may take it as and when required for symptomatic relief.

Regards
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Dr. Kakkar (31 hours later)
Dear Doctor

I did the HIV test after 30 days it has come NEGATIVE. The laboratory in-charge told me that he checked it twice and it came negative.

I am so thankful for your support the last 30 days. Your assurances were really helpful in calming me at every point.

I have been asked by the laboratory to do a re-check after 3 months.

Doctor I need some advice on the following points.

1)     Do I need to take another test anytime soon?
2)     I will be meeting my wife in 50days from the day of contact. Can I have unprotected sex with my wife? Do I need to take any precaution?
doctor
Answered by Dr. Dr. Kakkar (22 minutes later)
Brief Answer:
In all probability you are safe

Detailed Answer:
Hi.

Thanks for the update. I am so glad to know that. It must have been an Antibody test (Rapid test), which is the most commonly used screening test for HIV.

Almost all individuals who are infected with HIV develop detectable antibodies within 1 month. So a negative test almost 100% rules out HIV infection in your case.

Repeat testing at 3 months is routine and is advisable to cover for the window period of HIV detection (which is 3 months) i.e rarely it may take up to 3 months for detectable antibody levels to appear.

I think you can just wait for 90 day test. Till then no more testing is required.
Surely, you can have sex with your wife but a protected one. In all probability you will have a negative retest at 90 days too; however, still I would not advice unprotected sex with your wife till you are through with the 90 day test.

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. Vinay Bhardwaj
doctor
Answered by
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Dr. Dr. Kakkar

Dermatologist

Practicing since :2002

Answered : 9612 Questions

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Is HIV Infection Possible Through Oral Sex?

Brief Answer: HIV risk is negligible with oral sex Detailed Answer: Hello and welcome to healthcaremagic I am Dr. Kakkar. I have gone through your query and I have understood it. Oral sex as such is a very low risk route for HIV transmission. Unless and until there are sores in the oral mucosa of the person giving oral sex, the risk is almost negligible. Moreover saliva is supposed to have anti HIV properties. However, testing would confirm that and it is advisable to get tested no matter how less the risk for your own peace of mind. You can go for a HIV combo test (tests for both antigen as well as antibody) at 1 month since most of the individuals infected with HIV are positive by HIV combo test at 1 month. If it is negative at 1 month, a repeat test negative at 3 months (it is always better to have 2 negative tests) is taken as conclusive. Post Exposure Prophylaxis should be started if at all within the first 72 hours of a risky sexual contact. However, this being a low risk exposure, PEP is not mandatory. Regards