Assessing HIV Risk: Transmission and Symptoms After Oral Exposure - Urology

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When assessing the risk of HIV transmission, particularly in the context of oral sex, it is essential to understand several factors that contribute to the likelihood of infection. Based on your description, there are multiple elements to consider, including the nature of the sexual activity, the presence of any oral or anal injuries, and the health status of both partners involved.

1. Nature of the Exposure: Oral sex, especially when performed without protection, can carry a risk of HIV transmission, but it is generally considered to be a lower risk compared to anal or vaginal intercourse. The risk increases if there are open sores or cuts in the mouth, as these can serve as entry points for the virus. In your case, you mentioned having a cavity that had progressed to the dentin, which could potentially increase the risk if it was bleeding or inflamed.

2. Presence of Blood or Other Fluids: You indicated that you licked the partner's prostate fluid and that there was a possibility of contact with their genital area. If there was any blood present, either from your anal fissure or their genital area, this could elevate the risk of transmission. However, if the fissure was healed and not actively bleeding, the risk would be significantly lower.

3. Health Status of Both Partners: The viral load of the HIV-positive partner plays a critical role in transmission risk. If the partner is HIV-positive and not on treatment, the risk is higher. Conversely, if they are on antiretroviral therapy and have an undetectable viral load, the risk of transmission is effectively zero.
4. Symptoms and Testing: You mentioned experiencing fatigue and weakness for several days. While these symptoms can be associated with acute HIV infection, they are also common in many other conditions, including viral infections, stress, or even fatigue from lifestyle factors. The saliva test you took at four weeks post-exposure is a good initial screening tool, but it is important to note that the window period for HIV tests can vary. The HIV antibody tests typically become more accurate after three months post-exposure.
5. Recommendations: Given your concerns and the nature of your exposure, it is advisable to undergo further testing. The HIV Ag/Ab combo test is highly sensitive and can detect HIV earlier than antibody-only tests. It is recommended to wait at least three months after the potential exposure for the most accurate results. If you continue to experience symptoms or have concerns about your health, consulting a healthcare provider is essential. They can provide a comprehensive evaluation and may recommend additional tests for other sexually transmitted infections (STIs) as well.

In summary, while there is a risk associated with the activities you described, the actual probability of HIV transmission in your specific case may not be high, especially if there were no active bleeding wounds. However, the best course of action is to follow up with appropriate testing and seek medical advice to address your symptoms and concerns.