cunnilingus. should get tested?

Question

dear dr. kull, about two months ago I foolish performed oral sex to a prostitute. Two weeks after I experienced some symptoms: two days mild sore throat, then strong pain in the left back/shoulder for other two days, then two small lymph in the neck for about a week, then one (!) night sweat. I don't believe had fever, and I hadn't arthralgia or weakness at all. At 40 days my CBC was perfect, and ESR result was 2. Now I'm experiencing some strange sensations in the left hand, more in the middle and index finger: when I go outside (now it's very cold!) suddenly the fingers nerves become susceptible when touched, until I go in a warmer place. No weakness in the arm or whatsoever limb. Could I get HIV with a single oral encounter? What about my CBC and ESR? Should I get tested? Thanks in advance!

Answer

The bottom line is that there are only a few cases documented by the CDC that demonstrate HIV transmission to a person performing oral sex on a woman. This is the best evidence that the risk of transmission through cunnilingus is very low.

This means that your symptoms are probably not related to HIV.

The risk of HIV transmission through oral sex is low when compared to unprotected vaginal and anal sex. The reasons for this, in part, have to do with biological differences: simply put, HIV seems to have a more difficult time causing infection when introduced to the mucous membranes of the mouth (saliva may provide additional protection and the cells in the mouth may not be as prone to infection). Secondly, the concentrations of HIV in vaginal secretions seem much lower than the concentrations of HIV in cervical secretions and menstrual blood. When performing oral sex on a female, the mouth is more likely to come into contact with vaginal secretions. Some sources suggest that vaginal fluids dilute the more infectious fluid, decreasing the chances of transmission to someone's mouth.

It is important that you do not perform unprotected oral sex on a woman when she is menstruating (blood has a much higher concentration of HIV), and if you are experiencing any problems with your oral health (sores, abrasions, inflammation). If you would like to decrease the risk of transmission even further, you can use a latex barrier--like a dental dam or a condom cut into a square--between your partner's vagina and your mouth.

For more about transmission through oral sex, see the CDC's fact sheet on oral transmission (http://www.thebody.com/cdc/oralsex.html).