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why won't you answer me??
Oct 19, 2003

Hello Dr. Bob. I appreciate how much you do on this forum, and in the healthcare community in general. You're a superman. But... I have written so many, many times over the last few months, but I've never gotten a reply. It's really upsetting, since I do read your responses daily and have read through the archives (at least once), but my concerns have never really been addressed in those other correspondences. Yet you continue to answer questions posed by men who put themselves in the same position, over and over again. Frankly, I'm sick of reading about men who had protected sex with sex workers. If you think my questions are redundant, fine, but please do me the service of answering it, as you do with all of the other redundant questions!

Now on to my question. I am a woman, who received unprotected oral sex. I think that makes me the insertive partner. About a month or so later, I came down with flu-like symptoms: severe chills, nausea, sore throat, swollen glands, including the glands at the base of my scalp in back, etc. I ended up testing positive on the monospot test and that's as far as the doctor took it. I was relieved to hear that, but the relief lasted a short time. I read of a medical study that concluded that the monospot test can sometimes be inaccurate, and can be positive in the setting of ARS, not mono. Of course, that concerned me immensely. I am not stupid: I know oral sex poses an extremely low risk--for men. I have never seen anything written about oral sex for a woman on the insertive end. I also know that saliva acts as a barrier to HIV, but is it a good enough barrier to prevent transmission to the insertive oral partner when the receptive partner has a very high viral load? I guess what I'm getting at is: if someone is seroconverting and performs unprotected oral on a woman, does the higer viral load associated with seroconversion increase the risk of transmission? Sorry for the long-winded question. I had a two month test done after the experience, and it came back negative. Do you think I should have another test, or is the risk so low as to not warrant any additional testing? Also, if you don't mind answering, if you do indeed experience ARS, is it safe to say that you would have developed detectable antibodies by the end of ARS? Thank you so much.

Response from Dr. Frascino

Hello,

If you think you are sick of reading about men who had protected sex with sex workers, can you imagine how I feel? I've thousands and thousands of them writing in almost continuously! (So all you guys who have has protected sex better check the archives before posting your question otherwise this lady is going to get even more pissed off OK?)

So, let's get on to your question. Oral sex, no matter who is playing the part of "tab A" and "slot B," carries an extremely low risk for HIV transmission, but can result in other STD's that I've discussed on this site multiple times in the past. The "insertive partner" is generally considered to be at even lower risk than the receptive partner. But that's because the receptive partner in oral sex often winds up with a mouth full of spooge.

So your risk is incredibly low. The monospot most likely was indicative of Epstein Barr virus, not HIV. Your 2-month negative HIV test is encouraging, but HIV antibody tests are not considered definitive until 3 months, as I'm sure you have read at least a gazillion times in the archives right? Well, things haven't changed! So if you want to be HIV tested, do it at 3 months or greater for a definitive result.

As for "is it safe to say you would have developed detectable antibodies by the end of ARS?" Perhaps -- but only if you were certain your symptoms were ARS, and the only way to do that is with a positive HIV test. Hence, if you are basing anything purely on "symptoms," it is NOT SAFE to say anything!

Hope that helps!

Dr. Bob



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