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Insertive Oral Sex
Jan 29, 2010

Hi Dr Bob

Your website is amazing and I'll be making a donation to the cause.

I was in Thailand recently and had 2 sexual encounters with prostitutes.

The first was protected vaginal sex. It lasted 5-10 mins and I came in the condom, tied it off. When I picked it up the next morning no seamen came out so I an only assume it was in tact. After sex (30 mins later) I fooled around some more, putting my penis between her breasts etc, masturbating. I'm not sure as to whether having vaginal fluid on my hand from sex (30 mins prior) would be a risk if masturbating? Interested in your thoughts here.

The second encounter (5 days later) was with a girl from a go go bar. She told me she was clean and only working for 3 months (I'm sure they all say that) and her test the previous month was negative. I had unprotected oral sex with her in the shower and another 2 times during the night in bed. It was 'fairly vigerous' but no blood or obvious on me her her. Each time she sucked for probably 5-7 mins. I also found her giving me oral sex to the anus.

So... you have the situation as plain as I can explain it. Interested to hear the risks for these both encounters. I phoned a sexual health clinic who tell me the risk is negligible and not to bother getting tested for HIV but try for gonerea and siphilis. What do you think?

One day after the second encounter I was unable to sleep on the plane home, I've been experiancing nausea since then for 3 weeks 1 day (today). I had constipation for the first week since returning home. I've had some headaches from time to time and in the last week (I think) lymph nodes feel sore but I have been touching them way too much! The major complaint that continues is the nausea and a bit of dizziness, runny nose. Not sure if this is related to an ear ache I've been having...? Certainly no rash or bad diarrhea or night sweats most common with ARS as I've read.

I'm working and exerising but I've been home for over 3 weeks (also 3 weeks since last encounter) and have generally feeling not in good health.

Response from Dr. Frascino

Hello,

You state: "So you have the situation as plain as I can explain it." OK, but I'm really not sure what "fairly 'vigerous' but no blood or obvious on me her her" even means!

Regarding encounter #1, protected sex is indeed protected, assuming the latex condom was used properly and did not break. Having residual vaginal fluids on your hands for 30 minutes before masturbating is not an HIV-transmissions risk.

As for encounter #2, oral sex, particularly insertive oral sex, carries only a very minimal risk for HIV transmission/acquisition. Primarily for piece of mind, you could get STD screening to cover gonorrhea (not "gonerea") and syphilis (not "siphilis") in addition to a single HIV-antibody test at the three-month mark.

Your symptoms are not suggestive of nor worrisome for HIV acute retroviral syndrome (ARS). They are, however, very consistent with anxiety.

Thanks for your desire to make a tax-deductible donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return I'm sending you my good-luck karma that your definitive three-month HIV test is negative. (I'm quite confident it indeed will be negative.)

Good luck.

Dr. Bob



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