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Oral Sex and PEP / Confirmed Exposure
Feb 7, 2010

Hi Dr. Bob. Thank you so much for your work, we all appreciate it very much. Last night, I drank heavily and I don't remember all the details perfectly but I had a protected sex 3 times with a sex worker in Thailand. She told me that she is HIV positive. Basically, I am curious if you would generally prescribe PEP for these circumstances.

About a month and a half ago, I caught gonorrhea. The symptoms are better but they are not totally cured. Also, I have a small open sore (broken skin, non- STD related) on the wrinkly skin area near the head of my penis. I am wondering how this would effect the probability of transmission. I think I read that oral sex has a 1 in 10,000 possibility of transmission.

She gave me oral sex that was probably brief but I think it happened about 4 or 5 times. Later, I fingered her and her vagina was wet. She wanted to have sex again after we had run out of condoms and maybe 4 or 5 times she tried to insert my penis. It never actually went inside but I think it did touch the opening of her vagina a few times and I am guessing there would have been some vaginal secretion around where I touched.

Normally, under these circumstances, would you prescribe PEP medication? It happened about 12 hours ago.

Also, are runny nose, dry cough and itchy skin generally seen during ARS?

Last one, unrelated but do you know if untreated gonorrea would clear up on its own? or would it just be permanent if never treated?

Thank you again, I will make a donation.

Response from Dr. Frascino

Hello,

Would I recommend PEP for three episodes of "protected sex" with an HIV-positive Bangkok cockbanger? Nope. Protected sex is indeed protected, assuming the latex condom was used properly and did not fail (break). That you "drank heavily" and "don't remember all the details perfectly" is a bit concerning. If there was a chance you had unprotected sex with an HIV-positive hooker, PEP would be warranted.

Oral sex carries only a small risk of HIV transmissions/acquisition. To PEP or not is open to discussion when considering unprotected oral sex with a partner confirmed to be HIV infected. Additional information, such as whether the source is on effective antiretroviral drugs or has a detectable HIV plasma viral load; whether trauma was involved and/or if concurrent STDs, oral lesions, cuts, etc. were present would influence the decision. That you have oral sex "4 or 5 times" increases the risk and might lead to a recommendation for PEP.

As for gonorrhea, this STD does not clear up on its own and should be treated promptly and aggressively. Untreated gonorrhea can lead to nasty complications. An active STD, such as gonorrhea, increases your HIV acquisitor/transmission risk.

Thanks for your 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 HIV tests are negative.

Good luck!

Dr. Bob



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