Hello Dr. Frascino,

I hope you are doing well. I've been reading this forum for the last couple of days, but this is my first time asking a question. I'm really scared about a recent incident, and I would appreciate your advice. Here is my situation:

The other day I performed oral sex on another man. There was a large amount of precum that went inside of my mouth. His main ejaculation, however, was done outside. I'm very worried because my oral health is not good right now. I have swollen and bleeding gums.

I had a baseline HIV oral swab test yesterday (which was negative). I went to the city clinic today, and the nurse practitioner that I saw consulted with a physician, and they both decided that PEP would NOT be advised for me. The nurse practitioner said that my risk was "infinitely low." I was told the risk from the PEP would greatly outweigh any potential benefit I'd get from it.

Do you agree with the NP at the city clinic? I understand oral sex is very low/no risk, but is it really always that cut and dry? I don't understand why my risk would be "infinitely low." If there is potentially infected fluid (precum) and an open access to my blood stream (bleeding gums), wouldn't that put me at a significant risk?

I'm a student, and this fear is paralyzing me now. I can't study or do anything. Please bring me back to my senses.

Thank you very much.

Hi.

I agree PEP is not warranted. We don't know the HIV status of your buddy, and he did not ejaculate in your mouth. These two facts decrease your HIV-acquisition risk. Gum disease can increase the HIV-acquisition risk. However, all things considered, your HIV-acquisition risk remains extremely low and consequently PEP would not be warranted. A single HIV-antibody test at the three-month mark is all that you need. Well, that and a visit to the dentist plus flossing daily!

Good luck.

Dr. Bob