Brief Answer:
Unlikely chances of getting the infections

Detailed Answer:
Hello young fellow,

Welcome to the forum again.

Regarding above condition, it is a good news for your friend that the risk of transmission is almost negligible again. There are certain medical reasons for the same:

- As the girl is negative for HBV , HCV , VDRL , HIV 1&2 Ab/Ag, so it is almost least likely to get any kind of infection.

- For the HIV infection- it is not seen practically that there can be any chance to get the infection by oral sex. Medically HIV virus can not spread by oral sex. There are least of chances only when both the partners have XXXXXXX blood discharge from a cut wound that get mixed in adequate amount. In our mouth there are certain enzymes which makes the HIV virus inactivated.

In my clinical experience with oral sex, I have not observed HIV positivity.

For VDRL- Now a days there is least chances of syphilis infection. It is one of the sexually transmitted infection which is seen in least number of cases in modern world. As the test itself is negative so is a very good news for your friend.

Regarding HBV and HCV, If you can let me know whether your friend and the commercial sex worker is immunised with hepatittis B vaccine or not. Though the chances are rarest but even then if a person is immunized then it is unlikely to get HBV as well as HCV.

I hope these informations will help you. I will be glad to answer any further of your queries.

Regards,
Dr Sanjay Kumar Kanodia
(MD- Dermatology & Sexually Transmitted Diseases)

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Brief Answer:
Give chemoprophylaxis under medical supervision

Detailed Answer:
Hello young man,

Thanks for your prompt reply and further follow up.

After reading all your queries it appears that you are presuming as if the lady is positive for HIV, syphilis, Chlamydia, Gonorrhea HBV and HCV. Fine, on one side the tests shows that she is negative after three days of testing but in your own assumption she might be in window period for all the conditions above. In all these cases of unknown status I see the glass half filled rather than empty. It means if there are 50 % chances of her positivity then are 50 % chances of negative status too.

So coming on rest of your queries considering the lady to be positive and in window period:

- HIV test has a window period as my understanding for above test is 2-3 weeks which during this time the test will not show the virus.

During this time she could be infected and the viral load will be very high which may be pass the virus to my friend, Kindly clarify oral insertive risk ?

@You are right that the window period for HIV is minimum of 2-3 weeks. But as I said previously in clinical scenario we do not consider oral sex to be mode of transmission of virus. In all the very few number of reported cases of HIV by this mode had blood to blood mixture by one or the other means. SO in your friend’s case if there had been XXXXXXX blood form the girls mouth coming in contact with open sore of penile site then only had been a chance of catching he infection. As I said in my clinical experience in patient s with fear of HIV after oral sex, I have not observed any positive case till now. Even if your friend is really distressed for HIV then should start Post exposure prophylaxis at the earliest possible within 72 hours of exposure


- For syphilis, Chlamydia and Gonorrhea : My friend will take a course of 15 days ( 3 tablest one time of Doxycycline 100 mg ) please advise ?

@ For all the above your friend can take a chemoprophylaxis under medical supervision and there is no harm in taking the same. It would be the best effort to prevent all the above mentioned problems.


- HBV and HCV : I dont know the status of the firl but my friend has no immunization , so please clarify the XXXXXXX insertive risk with considring the same argument for window period ?


@ As your friend is not immunized there fore he should take Human Hepatitis B Immunoglobulin (HBIG) that destroy the hepatitis B virus. Along with this hepatitis immunization should also be performed simultaneously.


Finally, you quite correct in our observation that I want to release your anxiety state. It is a duty of every doctor to only provide clinical facts but simultaneously make his/her patient at ease rather than complicating the issue. I have many time consulted patients who were deeply stressed because of the anxiety of the disease rather than disease itself.

So it is my first issue to provide you simple facts and therefore accordingly should relieve whatsoever anxiety is there in you or your friend. For me any query is not just to be answered for a patient itself but for serving the humanity for whom we doctors care so much.

I hope these informations will ease your mind regarding your friend's issues. I will be glad to answer any further of your queries or if not then can close the query and rate answer.

Regards,
Dr Sanjay Kumar Kanodia
(MD- Dermatology & Sexually Transmitted Diseases)

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Brief Answer:
Ask your friend to get immunized

Detailed Answer:
Hello young fellow,

Thanks for your follow up and further queries.

HBIG is a immunoglobulin which is given by trained medical professional. You have to medical professional and tell him the risk involved in your case. As per his clinical decision the immunoglobulin as well as Vaccine can be given as it is almost 18 days since the suspected exposure. it is always best to be given within 24 hours.

The risk of HBV and HCV is present in your friend's case if the other person is infected. The test can not be taken as conclusive at 18th day after proposed infection as the incubation period for both HBV and HCV is minimum few weeks to up to few months.

So to be conclusive we have to wait for atleast 3 months for HBV and almost 6 months for HCV for the serum testing and almost for 30 to 60 days for virus detection.

All this we are thinking only in case if the girl is in window period and accordingly the risk factors involved. But as you have yourself given the history that the girl is negative so in my view is the best of sign for your friend's issue.

Ask your friend to get immunized and take HBIG as per schedule if required.


I hope these informations will help you. I will be glad to answer any further of your queries or if not then can close the query and rate answer.

Regards,
Dr Sanjay Kumar Kanodia
(MD- Dermatology & Sexually Transmitted Diseases

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Brief Answer:
HIV antibody test is conclusive at 3 months

Detailed Answer:
Hello young fellow,

First of all I beg your pardon to reply you bit late.

Now regarding your further queries:

As I am saying from the beginning that your friend has got almost unlikely chances of getting HIV infection by the fellatio but even then academically or theoretically speaking to be cent percent sure a RNA PCR can be done at this stage or the total antibodies HIV 1 & 2 is considered best at 3 months of period. At this stage the antibody tests are not considered conclusive.

In the same manner the HBV & HCV PCR Tests could be performed best at 60 days period to be on conclusive side.

But over all I in my clinical observation your friend is completely free from HIV infection and the rest can be managed well accordingly.

You feel free to ask as many queries form your side and I am always there to help you best regarding all your queries.

I hope these informations will help you. I will be glad to answer any further of your queries or if not then can close the query and rate answer.

Regards,
Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually Transmitted Diseases

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Brief Answer:
For HIV antibody 12 weeks is the conclusive time

Detailed Answer:
Hello young fellow,

Thanks for your further follow up.

Regarding the test performed on 16 th day- It is basically antibody based test and the p24 is transient antigen expressed from 3rd week onwards. The antibody test at 16th day is not conclusive as both antigen and antibody have less chances to be expressed at 16th day. We consider RNA PCR to be best at this stage. After around 12 weeks of suspected exposure then 12 weeks is the appropriate period to declare positive or negative status according to the test result.

But as I say it to you again that the chances of HIV is completely negative in my clinical experience.

The science of every viral infection is so different that it even sometimes vary from person to person. But in all the infections there is a particular term known as Infective dose. If this dose is not reached then there is less or least chances of infection. The infective dose is best attained on blood to blood contact. But as there is less number of viruses required for HBV therefore, comparatively there is high infectivity of HBV than HIV.

In most of cases of oral sex, as there is least chances of contact of blood therefore for all the infection including HIV is less.

I hope these informations will help you. I will be glad to answer any further of your queries or if not then can close the query and rate answer.

Regards,
Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually Transmitted Diseases

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Brief Answer:
HPV is a simple and curable so no testing required

Detailed Answer:
Hello young fellow,

Thanks for your follow up.

Regarding your further query for HPV virus transmission - As for all the viral infections there is risk for the transmission of virus but again on lower side by oral sex. For the part of investigations or any other tests including PCR, I myself is not in favor of any testing regarding HPV virus detection. This is because of three important reasons-

- There is long incubation period of the virus because of which the manifestations are seen quite late. Therefore the detection period may vary form person to person.

-Secondly, there are so many strains of virus in relation to HPV and therefore even if we detect one or the virus by all the efforts then also there is no proper prophylaxis for the same.

- Lastly if at all we see that there is clinical manifestation in the form of appearance of warts then it has to be known that warts are one of the very simple viral infection which can be removed and cured very easily.

Therefore rather than wasting time and money for detection of teh HPV virus it is better to not bother about the same.

I hope you must be relaxed to know all these important facts.

I hope these informations will help you. I will be glad to answer any further of your queries or if not then can close the query and rate answer.

Regards,
Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually Transmitted Diseases

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Brief Answer:
NO chance of HS and HPV in friend's wife

Detailed Answer:
Hello young fellow,

Nice to hear from you again. I really appreciate your efforts and caring for your friend. it is really admirable to know all your efforts.

It is a normal human nature to commit mistakes in life, but it is also human nature to forget about the past and start a new beginning. Every human being is prone to do one or the other thing which may be good or bad but we should not be so much tensed about all the goods and bad.

Explain your friend regarding the simplicity of the problem and the simple outcome also. His wife will not be affected at all by any of the infections and she will deliver a healthy baby.

As I have already told you that the risk of HSV is unlikely. It is almost more than 2 weeks since the incidence and if HSV had to occur then must have appeared by this time. In my own clinical experience I see the cases within 7 days only and not later than 14 days. So as your friend is not affected and therefore is his wife too.

For HPV again there is least of chances in your friend and accordingly there is no chance in his wife too.

So reassure and explain all the situation and its simplicity to your friend. Make it sure that your friend should not sit alone and must not think about it again.

"My all best wishes to you and your friend's family"

Best wishes of healthy life ahead.

Dr Sanjay Kumar Kanodia

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Brief Answer:
HPV vaccine is never given to pregnant lady

Detailed Answer:
Hello young fellow,

Heartily thanks for your admiration. Your sincere thanking words are the continuous source of working best in the field of medical sciences and therefore to help people across world.

Regarding your further queries-

HPV vaccine is not recommended for pregnant ladies. It should be therefore not be to be given to any pregnant lady. Once your friend's wife delivers baby then your she can be given the vaccine.

Regarding spread of HPV- it can spread through mutiple of routes including saliva and even simple skin to skin contact too. It depends upon the immunity of the person to have or not to have clinical manifestation of the HPV. Routinely we exposed to so many of different virus that we even do not know when and how we got exposed but we never or barely see any clinical manifestations. Just by having one time oral sex do not mean to get infection and its clinical manifestation. Our body's immunity plays a very vital role in protecting ourseles from all the infections.

It is my personal suggestion again that HPV is very very simple virus and never pose any problem. SO you should explain your frind regarding the simplicity of the problem if at all it is there in his mind. Do tell him that from my clinical experience he would not have the problem and even if it occurs in least of the chances then also can be treated very easily.

There is also no risk of the virus to the pregnant lady as well as the fetus, so reassure your friend fully.

You are most welcome to India and do visit Pink City Jaipur. You can find my clinic address on my address page at:

bit.ly/drsanjaykanodia

"With all my best wishes"

Regards,
Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually Transmitted Diseases

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Brief Answer:
she can be given the vaccination after delievery

Detailed Answer:
Hello dear fellow,

For the above case of passage of virus to his wife- the first thing is that the escort girl must harbor the virus, then those viruses should be passed to you friend and then your friend if have relation to his wife his wife pass the same viruses to his wife. Can you get how long is the above sentence, in the same manner the passage of the viruses has to take a long journey. But simply saying in case if you think that your friend has the viruses then due to sexual relation it can be passed.

Yes in this case the first thing is your friend should not have any sexual relationship with his wife. This is not only important from the part of viruses but also from the part odd her second trimester of pregnancy. It is not at all safe in second trimester to have sex by any means. So the the first and foremost thing is to avoid sex.

Secondly, after delivering the baby, she can be given the vaccination not as a part of protection from the incidence but also as routine part because all females after the age of 13 years should be given HPV vaccination. SO this vaccination will definitely be helpful in preventing warts as well as cancer.

I hope this information will help you in your friend's situation.

"With all my best wishes"

Regards,
Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually Transmitted Diseases

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Brief Answer:
she can be vaccinated after delivery

Detailed Answer:
Hello young man
I am highly thankful that my suggestions are helpful in your friend's condition.
Regarding your further query
your friend's wife can be vaccinated again even if she had been vaccinated before and if she do not know the same.
It will going to over all improve her immune status.

So just wait till her delivery of healthy baby and just relax.

With best wishes"

Dr XXXXXXX

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Brief Answer:
PCR best around 8 weeks (around 60 days) of period

Detailed Answer:
Hello young fellow,

Always thankful for your kind regards.

Regarding your further query of HBV and HBC- The incubation period of the same can vary form few weeks to up to months. Also in different of the clinical settings there are different of timings for the tests to be performed.

In my own clinical experience with such a situation I have my suggestion for the PCR test to be done at around 8 weeks (around 60 days) of period which is almost confirmatory. You can go for the test at around 3 weeks but a repeat of test at 60 days is the best.

Overall in my opinion the test will come negative as there are less chances by oral sucking.

I hope this information will help you in your friend's situation.

"With all my best wishes"

Regards,
Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually Transmitted Diseases

Reassure your friend for everything and ask him to relieve his anxiety as well as forget teh incidence as past.

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Brief Answer:
Our saliva has a strong neutralizing capacity

Detailed Answer:
Dear young friend,

Thanks for follow up.

I have already given you the suggestion that though penis to saliva can be considered as a rout e of infection but in general as well as in my own clinical experience I have never found any case to be positive by fellatio.

Yes you are right in your reading that saliva kills the viruses. I have told you before that our saliva contains so many of enzymes which actually stripes of the part of viruses and even in HIV infection or HBV infection makes the virus inert. Our saliva has a strong neutralizing capacity and therefore even in positive cases of these types of viral infections the possibility of infection is on rarest of rare side.

It is therefore a very relaxing thing that saliva is not a potential source of infection and therefore clinically there is rare or nil chance of infection.

So you should not be worried about any of the conditions and rest assured for any of the conditions enumerated.

My all best wishes for all you.

Regards,
Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually Transmitted Diseases

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