AboutTerry B Expertise Help in assessing personal and professional risk of HIV transmission; tips in teaching about HIV/AIDS; cultural competency for teaching about HIV/AIDS in Catholic settings; considerations in US and overseas HIV/AIDS programs and education for health and other professionals. Specific questions about treatment should be referred to your health provider; opinions and information offered are not meant to replace medical advice
Experience Seven years with academic medical center and national AIDS education and training center, seven subsequent years with focus on international HIV/AIDS in East and South Africa. Former clinician, bioethics preceptor at an academic medical center and presenter in wide range of fora including international AIDS conference.
Organizations Disabled American Veterans
American Public Health Association
MENSA
AA
Publications Human Variety, EC Sociological Society
Proceedings of the International AIDS Conference, Durban, South Africa
"HIV and Primary Care"
Education/Credentials BS Psychology
MPH Master of Public Health
PhD studies underway
Awards and Honors Naval School of Health Sciences, Hospital Corps with Highest Honors, Neuropsychiatry with Honors and High Distinction
Expert: Terry B Date: 3/2/2008 Subject: HIV Risk for BJ w/possible semen in mouth and scrapes on penis
Question QUESTION: Well, here goes. I need some, hopefully good, info regarding a recent encounter I had that was bad and stupid on my part and has me very fearful now.
I recieved a BJ from a guy who had given a BJ to someone else moments before and possibly had semen in his mouth. He then proceeded to blow me in such a rough fashion (which I stopped, but it was too late) and it resulted in bruising and a few small cuts on my penis head.
I have since found out that this person was HIV positive and now I am incredibly fearful. While there seemed to be no blood in his mouth of his own, there could've been other men's semen.
Do I have a big concern for transmission here? Would saliva have killed any possible infected semen or blood in his mouth? Could possibly infected semen or the possibility of blood in his mouth have entered the lacerations he gave me during the oral sex?
Any statistics, facts, advice or otherwise you can give to put my mind at ease here would be truly appreciated.
I'll never compromise myself like this again, but is it likely it's too late to matter?
Thanks for your kind help.
ANSWER: Dear FoolForSex:
Peace. As you can probably imagine, there aren't studies specific enough to help with the number of variables. So let's talk about some of the factors:
1) Frequency of exposure - you describe one incident.
2) Amount of fluid to which you were exposed - presumably his mouth wasn't full of semen, and you don't know the HIV status of the person on whom he'd performed oral sex before you,
3) Potential route of transmission - here I have significant concern, as you describe breaks in your skin.
4) Concentration of virus in the fluids - again, we don't have a good measure.
5) Duration of exposure - short time.
6) Amount of area exposed - you are at less risk than if you'd received his fluids.
7) General health/STI - the presence of other sexually transmitted infections increases your risk.
As I noted, my primary concern is the 'small cuts' - are you describing broken skin with bleeding? This is high risk, but the mediating factors above reduce the probability of infection.
Get thee to a trusted health professional and explain the situation, or if you have no access to health care, find a voluntary counseling and testing site. This is a significant exposure though your 'odds' of this causing HIV infection are at worst moderate, in my opinion, because of the variables cited above.
So, NO, it's not likely too late to matter. "I'll not compromise myself like this again" is not a reliable strategy. While good intention and willpower can reduce your risk in themselves, you know now that the right circumstances may override your resolve - carry a condom just in case.
Get tested. In the likely event that you will test negative, you will reduce your anxiety and plan better prevention strategies in the future. The unlikely possibility of a positive test result will also provide you with the information you need to protect yourself and others and access the wide variety of treatment available in most of the world.
I hope this helps, and wish you and yours the best.
Terry
---------- FOLLOW-UP ----------
QUESTION: Hi again Terry, thanks so very much for the very thorough and candid response. I truly appreciate it.
While I plan to go to my doctor about this for a thorough checkup including full STD spread, is there any benefit to going as soon as now considering tests wouldn't show a positive for hiv for at least a few weeks?
Thanks again, I truly appreciate your very thorough analysis of the situation. You are right about the not compromising myself plan. Situations change actions and I should always be prepared. Condoms and blow jobs don't go together very well, but it sure would prevent this.
Again, many thanks.
Answer Dear FoolForSex:
Peace. HIV is not your only concern here, you are at risk for other Sexually Transmitted Infections and developing (or continuing) a relationship with your doctor now will do you no harm. My preference would be that you talk with her/him about the situation, share my feedback if you wish, and see what options are available. He or she may also refer you to a provider with expertise in HIV/AIDS; new developments occur almost daily and providers already managing a large number of patients with HIV may be more likely to be on the cutting edge of treatment. Additional information for your doctor is available with the local AIDS Education and Training Center.
