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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

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What are the chances of HIV transmission through oral sex?

Answered by
Dr.
Dr. Sunil Jangid

HIV AIDS Specialist

Practicing since :2009

Answered : 1961 Questions

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Posted on Wed, 8 Jun 2016 in HIV and AIDS
Question: Performed receptive fellatio on a guy on 12th feb ( msm) RNA PCR on 21st feb and 19 th march are both undetectable, 4th gen tests on 4th april is also non-reactive.
i have diarrhea for more than 7 days now, and what looks like an oral thrush also I've been consistenly feeling weak, drowsy and lightheaded . Last month, I had a sore throat which got okay with medicines.
MY RNA PCR AT 35 Days is undetectable ( 20 copies pr 1000 ml) and elisa combo 4th gen at 53 days is non reactive.
Could I still be infected with HIV ,considering all my tests are negative?
Or these problems could be related to something else.
I'm really panicking here.
My risk was receptive fellatio but i did not ingest the sperm.
If my RNA PCR at 35 days is negative, i'm supposed to be negative right?
Pl look at the picture and tell me if it's an oral thrush?
doctor
Answered by Dr. Sunil Jangid 2 hours later
Brief Answer:
The problems are not related to HIV.

Detailed Answer:
Dear XXXX,

Welcome to HCM. I have gone through your query and understand the concern you are worried about. Being your physician I will try to solve it at the earliest.

Fellatio is the only type of oral sex that carries more than a theoretical risk of HIV transmission, although the receptive partner in fellatio (the person who takes the partner's penis into his or her mouth) is also much less likely to acquire HIV than the receptive partner in anal or vaginal intercourse.

Your test results for RNA PCR at 10 and 35 days along with 4th generation combo test at 53 days both are negative then you are definitely safe from HIV and not infected at all so don't get worried or feared about that.

Your symptoms are related to some other bacterial or viral infection. For which consult your physician to isolate the cause and follow the treatment regime. No need to be anxious or tensed. For any further query you can write to me again any time and I am always available here to help you out straight way.

Thank You
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Sunil Jangid 5 hours later
Hi Doctor
Thank you for your answer.
So I should conclusively assume that I am HIV negative?
Also what about the oral thrush?
I sent you a picture , in the previous question, pl examine that?
Also just for my peace of mind, if I have had a RNA PCR at 35 days with no detection, that means, I have no hiv in my body right? could there have been a situation where the virus would not have been detectable?
Also I continue to have a SORE THROAT now, but could that be stress related?
Awaiting your answer.
doctor
Answered by Dr. Sunil Jangid 4 hours later
Brief Answer:
You have to go for repeat testing after 3 months.

Detailed Answer:
Dear XXXX,

Welcome back and thanks for follow-up.

You can absolutely assume that you are HIV negative but still you have to go for repeat testing after 3 moths as per international HIV guidelines.

The picture in the attachment does not look like oral thrush to me. You can consult ENT specialist for expert opinion. Sore throat can be due to stress or anxiety so be relaxed, don't get worried and do warm water gargles.

With RNA PCR there is only one situation where the virus is not detectable that is the absence of infection or the viral load is too low to be detectable so avoid thinking too much about HIV as the risk is not there in your case.

If still any doubt left in your mind you can ask me any time. Don't get panic and move ahead in life. Always stay happy and healthy.

Thank You


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sunil Jangid 1 hour later
Hi Doctor
Foremost thank you for being patient about this.
Considering I took my RNA PCR at 35 days, logically if there was HIV infection, it couldn't have been 'undetectable' right? Because of what I've read on the internet, in the initial few weeks, the HIV infection progresses rapidly and I took a RNA PCR which was 20 copies per /10000ml sensitivity.
So logically the viral load can not be undetectable in this situation, right? It would have definitely shown.

Also I do agree that i'm stressing about this, a 53 day negative 4th gen is very encouraging right?



doctor
Answered by Dr. Sunil Jangid 24 minutes later
Brief Answer:
Yes the result at 53 days is definitely encouraging.

Detailed Answer:
Dear XXXXX,

Welcome back once again.

You are absolutely right that if there is anyinfection it would have been detected in RNA PCR. The viral load is also high during initial few weeks than it is surely detectable if any would be present.

The test result after 53 days is highly encouraging and reliable so don't get anxious or feared about it. Forget the incidence and move on in life happily. If you need any help in future write to me directly.

Thank You
Above answer was peer-reviewed by : Dr. Deepak
doctor
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Follow up: Dr. Sunil Jangid 2 days later
Hi Doctor
Sorry to be disturbing to you again but today I saw a little swelling above my right knee, like my knee feels heavy , like when it is cramped and there is some involuntary twitching.
Also there is a burning sensation in my right underarm, and there seems to be an enlarged lymph node there, its not there in my left underarm.
The knee swelling is quite apparent as it is absent in my left knee, and only the right knee is twitching on it's own.
Should i still be worried?
Why would the area above my knee suddenly swell and also if i have a swollen lymph node in my right underarm, would it hurt and give a burning feeling?
i'm almost in tears here.Also every morning when i urinate, for the past few days, my urine is dark yellow in color and it burns a little.
pl help
doctor
Answered by Dr. Sunil Jangid 20 minutes later
Brief Answer:
Dark yellow urine may be due to urine infection.

Detailed Answer:
Dear XXXX,

Welcome back once again.

Swelling above right knee with involuntary twitching may be due to some injury or cramps. Take some pain killer with muscle relaxants and do hot fomentation over the affected area. Don't get worried, you will be fine with treatment.

Enlarged swollen lymph node under right armpit with burning can be due to viral or bacterial infection. Consult your local physician and go for some investigation to isolate the cause. Follow the treatment advice as per expert opinion.

Dark yellow urine along with burning is typical symptom of urinary infection so drink plenty of water or oral fluids. No need to get anxious or feared about HIV as there is no risk in your case. Be relaxed and move ahead in life happily.

Thank You

Above answer was peer-reviewed by : Dr. Deepak
doctor
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Follow up: Dr. Sunil Jangid 27 hours later
Hi Doctor
So I went to an ENT to get my sore throat checked.
He told me that I don't have oral thrush. Also it's just pharnygytis.
When I explained my situation in detail to the doctor and my complains of dairrhoea, weakness, feverish feeling and hiv stress, he asked for a couple of tests.
I'm attaching the reports for the same.
I took a urine test which has ruled out UTI, but the dark urine persists.
My concern is that my ESR test is 18 , on a range of 0-15 and
my lymphocyte count is 21, on a range of 20-45 . Since it's borderline, could this be related to HIV in any way?
The doctor suspects DEHYDRATION as the cause, since my RBC & Hameoglobin has also increased.
Pl go through the reports.
Are they indicative of anything serious by any chance?
I know you've told me to not worry about HIV, but i continue to get symptoms and the fear won't just go away.
Pl have a look again.
Thanks.
doctor
Answered by Dr. Sunil Jangid 17 minutes later
Brief Answer:
All your reports are normal.

Detailed Answer:
Dear XXXX,

Your report for Dengue fever, ESR and lymphocyte count are all within normal limits and these are not related to HIV in any way so don't worry much.

If dehydration is the cause then drink plenty of oral fluids and follow the doctor's advice. Nothing is so serious in your case, it is just the anxiety or fear of HIV which is bothering you so just relax yourself.

Again I advice you not to get tensed or stressed. If still not able to cope up with these then consider counselling services with the help of psychiatrist.

Thank You
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Sunil Jangid 19 hours later
thank you for your constant support doctor.
I don't understand, even as I'm trying to put this behind me, i continue to feel weak, tired, fatigued and feverish.
All my tests also show that there is no problem with me, then why am i feeling these symptoms?
Also the knee pain and heaviness in knees isn't just going. Neither is the diarrhoea.
Even after the medicines.
I don't know how i'll wait for the 3 month test in this situation..
In your experience of dealing with HIV patients, have you ever seen a result change after 6 weeks or a RNA PCR like mine, change after 3 months?
Also have you seen any infections , in your personal experience, in the case of an oral receptive fellatio risk ?
doctor
Answered by Dr. Sunil Jangid 1 hour later
Brief Answer:
Not came across such a case.

Detailed Answer:
Dear XXXX,

What is causing wrong with you is just the anxiety or unnecessary thoughts of HIV as the risk is not there and you are absolutely safe from HIV.

The possibility of change of result after 3 months from negative to positive is also very unlikely and I have not seen any such case of infection from oral fellatio so no need to worry much or get tensed.

Do meditation or yoga for mental relaxation. Avoid excessive stress or tension. Make your self busy with work. Take healthy and nutritious diet. If still not feeling well consider counselling services.

Thank You
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Sunil Jangid 24 hours later
Hello Doctor.
So I went to an HIV specialist.
The pharyngytis is still there.
in fact i've been feeling even more fatigued , tired and have a headache also now
I also have a fever of 37.6 c
And the diarrhoea has just gotten worse, with me going to the washroom more than 3 times already.
The doctor told me , for my mental satisfaction to get a DNA PCR again. He said the RNA PCR doesn't hold any value.
Is that even correct?
Also in your opinion this could just be pharyngytis, that could be causing all the problems now?
I'm on the verge of a nervous breakdown here.
Also that doctor has confused me even more, he has said that RNA PCR doesn't hold any value, it's DNA PCR which does. is this true?
doctor
Answered by Dr. Sunil Jangid 57 minutes later
Brief Answer:
Go for DNA PCR for your satisfaction.

Detailed Answer:
Dear XXXX,

Both DNA and RNA PCR has its own value as far as HIV is concerned so don't get confused and go for DNA PCR for your mental satisfaction and relief.

I don't think that your symptoms are related to HIV in any way. They are merely due to common viral illness or anxiety nothing else so again I will advice to get your self relaxed and avoid stress or tension.

Get tested and wait for the result as it will clear all your doubts. If still any thing is bothering you feel free to ask and I am always available to help you.

Thank You
Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Dr. Sunil Jangid 28 minutes later
Sir
Just I performed receptive fellatio again on 28th march, 2016 but i used condom as a barrier hence there was no ejaculation in my mouth as the condo was intact and not torn.
So that encounter won't count right?
Because if i have started getting symptoms now at 11 days, isn't that too early for ARS symptoms?
Generally how long do ARS symptoms take to appear?
doctor
Answered by Dr. Sunil Jangid 25 minutes later
Brief Answer:
Yes it is not ARS.

Detailed Answer:
Dear XXXX,

Receptive fellatio with protection is not counted as exposure and it has already very unlikely risk of the HIV so don't bother much and forget the incidence.

These symptoms are not due to ARS as it will take atleast 2 weeks to develop after the infection so it is not ARS so be relaxed and move ahead in life.

Thank You
Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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