Hello Dr

I have a friend who was diagnosed and we assume contracted Hiv in late may this year. I had protected anal sex with this person (I was insertive) and oral (insertive). I did not perform oral sex on him, this took place last Thursday. Saturday morning we engaged in masturbation and I allowed him to perform oral sex on me, for a few moments that is all, less than a minute. He then went on to analingus on me, which was more prolonged, we then went on to masturbation. Prior to this I did not notice any bleeding in his mouth, I know because of his status I did indeed check, I did not notice any blood immediately after we had finished masturbating either.

Upon finishing however, I did, he appeared to have a bleeding on his bottom teeth, he had had a dental clean a couple of days prior which may of contributed to it, and he has in the past had gingivitis. But I did not before or during or immediately after he performing fellatio on me see any blood, and his mouth did not look a mess, and I was pretty conscious of looking for it, but low and behold it appeared at the end as we were talking and of course I noticed it. (cue the freak out).

I’m circumcised and didn’t have any cuts or sores on my penis, I contacted the THT helpline three times during the day and all three different advisors said I’d be very unlucky and unlikely to of been given PEP as a result, and have told me to relax.

I’m an anxious guy in general and I tried to be rational with out viewing him as a thing to be avoided, used a condom, let him perform on me, so just being in contact with salvia which is not a risk of transmission. And then that happens….

I have had a bit of depression recently and i'm really trying to keep my composure.

Would you of recommended PEP in this instance, and what are your thoughts in general?

Jon

[Dr Jose]

Hello Jon,
Thank you very much for your post. Please, first of all, calm down.
Your sexual encounter with this man were very low or no risk at all from the point of view of HIV infection, even if he was positive with a high viral load.
You used a condom for penetration; rimming and receiving a blow job would not involve any risk of HIV infection, even in the presence of some blood in his mouth. Saliva would neutralise the virus anyway and the fact that you are circumcised would redcue even further the chances of infection.
Therefore no need to be concerned and I would certainly not recommend you starting PEP.
Even though I do not think that you even need testing, you might want to get a test for peace of mind.
If you think that you cannot wait 4 weeks to get a HIV Duo test, you can always have a HIV PCR RNA Multiplex after 7 days; this will give you complete peace of mind much earlier on.
Best wishes,
José

First of all Dr, thank you very much for your swift reply.

Can i forget about this episode ( if i can control my anxiety) and move on without stressing? receiving oral is no risk in your view?

[Dr Jose]

Exactly. Best thing to do is to try to forget it and move on.
Best,
José