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Should I do PEP - risk from cunnilingus, HIV Transmission

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Hello doctor,
This past Tuesday, I performed cunnilingus (for about 5 to 10 seconds, and slightly using my tongue, in open air in the room) on a female of unknown HIV status - had just met that night (I am a male). Also, that was before I engaged in brief, protected sexual intercourse with her. She also was not 'wet' when I performed the brief cunnilingus on her (my tongue did not enter her vagina either) I don't believe any vaginal fluids were in my mouth and that was right at the beginning of the encounter. I am extremely worried. I don't believe I had any particular mouth sore / cuts, due to the cold though, the outside of my mouth was a bit shapped. I have been reading online forums / reports about the low or non-existent risk of hiv transmission through oral sex and wanted some clear MD feedback. I have been so paranoid, anxious and unwell in the last few days. What if that woman was HIV positive (even though I did ask her and she said that she was totally clean)? Should I have done PEP? Please let me know. I have consulted 'WedMD' and responses from renowned HIV MD Dr. Hunter Handsfield and other ones, all seem to agree that there is little to no risk, but I am still so worried and upset.
Thanks so much."

Category: HIV- AIDS Specialist

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Category: HIV- AIDS Specialist
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Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
Just to start by reassuring you, even if the woman is HIV positive, exclusively from oral sex, there is minimal risk of acquiring HIV. There has been no such reported cases in my knowledge where a man got HIV from oral sex. If the female is performing, it's a different story since the guy can ejaculate and if there is an open lesion, the virus can go in through the mucosa. But it is different when a man is performing oral sex on a woman. No risk for HIV, only other STDs such as Herpes.
Also since you engaged in protected sexual intercourse, there is no worry.
Feel free to discuss further,
Regards.


Patient replied :

Thank you. I indeed tried to post a question.

Hello doctor,
This past Tuesday, I performed cunnilingus (for about 5 to 10 seconds, and slightly using my tongue, in open air in the room) on a female of unknown HIV status - had just met that night (I am a male). Also, that was before I engaged in brief, protected sexual intercourse with her. She also was not 'wet' when I performed the brief cunnilingus on her (my tongue did not enter her vagina either) I don't believe any vaginal fluids were in my mouth and that was right at the beginning of the encounter. I am extremely worried. I don't believe I had any particular mouth sore / cuts, due to the cold though, the outside of my mouth was a bit shapped. I have been reading online forums / reports about the low or non-existent risk of hiv transmission through oral sex and wanted some clear MD feedback. I have been so paranoid, anxious and unwell in the last few days. What if that woman was HIV positive (even though I did ask her and she said that she was totally clean)? Should I have done PEP? Please let me know. I have consulted 'WedMD' and responses from renowned HIV MD Dr. Hunter Handsfield and other ones, all seem to agree that there is little to no risk, but I am still so worried and upset.
Thanks so much.


Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
Just to start by reassuring you, even if the woman is HIV positive, exclusively from oral sex, there is minimal risk of acquiring HIV. There has been no such reported cases in my knowledge where a man got HIV from oral sex. If the female is performing, it's a different story since the guy can ejaculate and if there is an open lesion, the virus can go in through the mucosa. But it is different when a man is performing oral sex on a woman. No risk for HIV, only other STDs such as Herpes.
Also since you engaged in protected sexual intercourse, there is no worry.
Feel free to discuss further,
Regards.


Patient replied :

Thank you so much doctor. I appreciate the quick response. Should I still get tested at the 6 week and 12 week mark? What if I had a small ulcer (discovered it the next day). I had not brushed my teeth before the encounter, and as I had said, it was only for a few seconds that it lasted and there were no vaginal fluids in my mouth, or very little I guess - does that make a difference? I had drunk a couple of alcohol before, would that make a difference / increase any risk? Is is true that saliva kills a lot of the HIV cells? Should I be assured and not test?
I apologize about all of these questions, but I overanalyse and over think things and deeply regret that episode.

Thanks again!


Hello Sir,
I appreciate you're acting on your doubts quickly because a lot of people tend to delay, and then the thoughts over burden them.
No from your exposure testing is not required at all. If you want just for your own satisfaction, you can get it done. Even if there was a small ulcer chances of getting HIV from femle vaginal fluids is almost negligible, As i said, i am yet to hear of a case, getting HIV from a female partner only on the basis of oral sex.
You should be assured.
Please do not worry,
Regards.


Patient replied :

Thanks again Doctor, for this helpful and clear response. This message will be my last one, because I know it can start getting annoying, especially after you were clear with me and told me that there is no HIV risk.
What I have been researching and reading (been doing a lot of that since Tuesday), there have been conflicting reports of how much HIV is present in vaginal fluids, having mouth sores, etc. and it has just been confusing to me, menstrual blood (was not there, could have felt it on my tongue if there was I guess). I appreciate your final response and reassurement, and I apologize about the annoying, repeated questions. I also understand that some STDs can be transmitted, but hopefully, that will not be the case either, due to the briefness of the episode.


Hello,
Yes the reports are very confusing, and the evidence that vaginal fluids are capable of transmitting HIV through oral sex is lacking. Since a woman does not have the same volume of discharge like a man, chances of her transmitting the infection, is much lower compared to males, even through unprotected intercourse. But from a practical point of view, there still has not been any reported cases. So you should not worry. And yes if there ws menstrual blood, you definitely would have felt it.
Given the briefness, yes chances of other STDs like herpes is also low, but can't be ruled out completely.
Regards.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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