I had a protected sex with a CSW whom I think to be hiv positive,First she gave me unprotected oral sex just for a half minunte and then we had a protected vaginal sex.My major concern is about the cut that was made two hours before the intercourse while shaving at the base of the penis.I think that during sex condom had not covered this cut and it might came in contact with vaginal fluids which might have caused transmission.
My question is that is hiv transmission possible through this cut which is not bleeding at a time of sex???
I got high fever and extreme fatigue on the second day of sex which remained for one and half week which was not treated even on taking antibiotics every day.After fever was cured I developed white tongue and mouth ulcers which is still present in third week.I am really stressed and anxious after that incident as it was my first time to do such thing.

Thank you for your inquiry. From what we gather from the question, you were asking about your risk level of acquiring HIV after engaging in unprotected oral sex and protected vaginal sex while having a cut from shaving at the base of your penis. From the information given, this scenario is determined to be Low Risk (evidence of transmission occurring through these activities when certain conditions are met).

When assessing the risk level of HIV transmission, we focus on the activities in which you were engaged, and *not* on the person with whom you engaged in these activities. An individual's occupation simply does not provide useful information in assessing the risk level of HIV transmission, this is why we focus on the specific activities. Now, let's break the scenario down, focusing on the activities, and understand why is it considered Low Risk.

The scenario mentioned above does not meet the three components of the transmission equation(1). It does not satisfy the equation because:

* For the HIV Transmission to be fully satisfied, the following 3 components must be met: high risk activity (such as unprotected vaginal or anal intercourse or sharing needles), a bodily fluid (such as blood, semen, breast milk) AND direct access to the bloodstream (such as through the vagina, anus and other muscosal membranes)(1).

* HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host.(2)

What does this mean for the specific activities described in your scenario?

1. Protected vaginal sex, that is, vaginal intercourse with a condom, is considered a Low Risk activity. Research suggests that HIV incidence is reduced by 80% with the use of condoms during all acts of penetrative vaginal sex(3). Condoms do not reduce the transmission of HIV to zero. However, consistent condom usage is one of the primary methods to protect against HIV transmission. We understand that you are concerned about a cut at the base of your penis and if this could be an avenue transmission to occur. From what you describe, the cut in question seems to be a superficial cut and was not actively bleeding at the time of intercourse. A cut must be deep, actively bleeding, and in need of medical intervention to potentially provide access to your bloodstream. Any vaginal fluids on the outside of the condom or on the base of your penis, are considered outside of the body, and are thus exposed to environmental conditions. HIV does not survive long outside the human body, and it cannot reproduce outside a human host(2).

2. Receiving unprotected oral sex is considered a Negligible Risk activity. This means that there is no evidence or documented cases of transmission via this activity. However, there is a *theoretical* possibility. This means that you are at an even lower risk of acquiring HIV by the activity of receiving oral sex than engaging in protected vaginal sex. Saliva contains an enzyme that inhibits the transmission of HIV, therefore, HIV is not transmitted through saliva

3. We understand that the symptoms you described are very concerning for you. These symptoms can be attributed to a wide variety viral infections. We cannot attribute your symptoms to HIV without a blood test and diagnosis. The best practice is to visit your healthcare professional and discuss your symptoms in depth.

Recommendation: We recommend that you visit your healthcare professional for HIV testing, as well as an investigation into the symptoms that you have been experiencing.

AIDS Vancouver Helpline/Online, Hilary

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