Hi Dr. Bob,

I've wrote to you before regarding an risky (unprotected anal recipient, ejaculation inside) exposure I had back in October 2008. 7 months and 2 rapids, 1 NAAT, and 1 western blot tests (all negative) later, I know my status is negative and wohooed! however I made a big mistake recently. On June 19th 4am I performed unprotected oral on this guy whom I met over the internet. Before the act he told me he had a scar on his penis from having being caught in the zipper. I was stupid and believed him, and since we did it in the car it was dark and I did not inspect his penis thoroughly before going down on him. As I went down and felt the bump on his penis, which I thought it was the scar. Then he came in my mouth without telling me, and I quickly spit out his cum (probably hold it in my mouth for less than 10 seconds). After he came, under the moonlight I could see the bump on his penis is not really a 'scar, but rather a wart! I asked if that's genital wart, he denied and said he's clean. I rushed him out of my car, came home and immediately rinse my mouth with mouth wash (has alcohol content) 3 times. I was so worried but since it was so late at night I just went to sleep. Today (6/21) in the afternoon I started to have a low grade fever and a terrible headache, very tired limbs and a sorethroat. The lowgrade fever and headache seemed to be getting a little better with no medication, but tired limbs and sorethroat remains. I was so worried that I called my doctor and he told me that HIV is the least of his concern since oral sex carries minimal risk. However, I worry that my risk is higher due to the following; 1) I've been having acid reflux for almost a month which has left my throat somewhat inflamed, and thus susceptible to virus (if any) in his semen. 2) I have herpes and had anal wart; the presence of STDs makes it easier for me to acquire HIV. 3) I do have cavities and they've recently got worst due to my acid reflux symptoms (I often taste sour in my mouth). 4) He was smoking marijuana and also got me to smoke a puff before we went on with it; I heard smoking marijuana actually impair immune system, therefore increase my chance of infection. 5) The fact that this guy takes drugs, lies about his STDs, increase the chance that he is HIV positive but has not told me. I asked my doctor about getting PEP but he said it's not warranted; instead he wants me to be tested for chlamydia and other stds, which he thinks is what's causing my lowgrade fever and sorethroat. I trust his advice since he's a very good doctor, however I can't help but being worried about the possibility of being infected. Please please help me Dr. Bob, considering all my risk factors, should I go to an emergency room and get initial doses of PEP right away? Since the act occurred on saturday morning, I have until monday morning before the 72 hour passed. If it weren't for my doctor, I would be rushing to ER and getting PEP now. Please help me assess what my course of action should be. Please please help!

Hopelessly Anxious

Hello Hopelessly Anxious,

You've already placed yourself at risk for HIV in October 2008, which resulted in a total freak-out, excessive HIV testing and, finally, a WOO-HOO. And now you're back with another "big mistake"??? I had hoped you had learned more from your previous experience. But apparently not. So here we go again.

Your HIV risk this time is relatively low (much lower than last time around) and involves primarily receptive oral sex.

Regarding "symptoms" that began two days after your anonymous Internet hookup in the backseat of your Love Bug (or was this a hummer in a Hummer?), these would not be HIV related, as the symptoms associated with HIV acute retroviral infection take several weeks (not days) to become manifest. I agree with your doctor! Your extenuating circumstances acid reflux, cavities, sucking on a doobie before sucking on his doobie, fears about your partner's veracity, etc. do not significantly change your HIV-acquisition risk. Marijuana does not impair the immune system increasing the chance of HIV infection! Herpes, anal warts and certain other STDs can, if active, increase HIV-transmission risk. Did you have an active herpetic lesion or HPV wart in your mouth when you sucked Mr. I-Caught-My-Dick-In-My-Zipper Guy? If not, your HIV risk would not be increased. I absolutely agree with your doctor: PEP is not warranted. Testing for STDs would be recommended, including a single HIV-antibody test at the three-month mark. Finally, I would also recommend you learn your lesson this time and never put yourself at risk in the future.

Good luck!

Dr. Bob