Im a married male for 12 years, my wife has had 2 cold sores episodes on the lips since we are together. I have not had any myself either genitally or orally.

Yesterday I had an extra marital affair with an old flame. We kissed and she performed oral sex on me. She had her period so no sex took place but I did penetrate her with my fingers.

After this happened I asked her if she ever had cold sores and she said she had two episodes in 2018 and 2019, never happened again after that.

She is also married and likewise, she mentioned that her husband never had sores either orally or genitally.

My questions are.

1) what stds am I at risk at? Are there any suggestions I can do at this time to lower a potential infection (24 hours after the event)

2) she has not had any visible sores but that doesnt mean she is not shedding, how likely would it be for her to shed without an obvious lesion?

3) in the event that i got infected with either oral or genital herpes, could my wife also be a source of infection deflecting the way I  got it in order to not disclose my extra marital indiscretion?

4) would the blood from her period make an infection more likely? Would fingering with blood increase any risk? 

 Thanks so much

This question is somewhat similar to the ones you had two years ago, i.e. STI risks from oral sex. As discussed there, oral sex in general is low risk. I would also guess your old flame is at no higher risk for STI than you have been in the last few years -- assuming that this event was just as much a one-off event for her as it was for you. And even in the event she has a transmissible STI, the events you describe are mostly zero risk. As for cold sores and herpes, it's probably no risk at all, for a couple for reasons. First, having been with your wife for many years and her cold sores, undoubtedly caused by HSV1, the odds are strong that you also are infected with HSV1 (most cases cause no symptoms) -- in which case you are immune to catching it again (which also partly explains why you never have had your own cold sores despite innumerable kissing and perhaps oral sex events with an Infected partner). In any case, you've had a sexual exposure that is no different than probably a very large number of essentially identical events with your wife, given their nearly identical oral herpes histories.

1) The only STD of potential risk here might be HPV, simply because so many people are infected regardless of their sexual lifestyles. However, it is rarely transmitted by oral sex or, as far as known, by fingering. While I cannot say there is zero risk for herpes, for the reasons just discussed I would discount this possibility.

2) Oral herpes is rarely transmitted in the absence of cold sores. There isn't nearly as much asymptomatic shedding of the virus as there is for genital HSV2 infection.

3) This is a very unlikely scenario.

4) STIs are not transmitted any more efficiently during menstruation than at any other time. The amounts of STI bacteria and viruses are no higher in blood (often lower) than in genital fluids.

I really wouldn't worry at all about this event and do not suggest testing for anything, and would not advise any change at all in your sexual practices with your wife. If you remain concerned about oral herpes and HSV1, it's a far higher probability from your wife than from this one time event. And even if you acquired herpes during that one-off event, there would be no way to attribute it to that event versus from your wife. So I really do not see this as an issue of concern in any way.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Thanks for such a quick reply and amazing service.

Two missing pieces of info, not sure if relevant. I have not had sex with my wife this year due to us having a baby and second according to my other partner this was a true one off in 10 years.

I didnt think of hpv because i heard in 2 years the virus is cleared out by the inmune system but lets go ahead and say she has it, the only way it will reveal my indiscretion would be if i get warts. Could warts be caused by the oral sex I had yesterday?

Also, about herpes, if I happen to get genital sores and I dont tell her anything until the syntomps are gone, could I infect my wife genitally even if she already had oral sores?

And last question, if this events happen again, what meassures would you recommend in order to keep this extra marital acts in secret? Sorry if that is too much of a personal advise to ask.

Thanks

Having oral herpes, undoubtedly caused by HSV1, your wife is immune to new infections with HSV1, anywhere on the body. Just as you are immune from infection by either your wife or your old flame, if you are already infected yourself. (Which, if you wish, you could check with an HSV1 blood test.)

There is no need to do anything different in event of a repeat of a similar episode with the same partner. This assumes, of course, that your old flame isn't having multiple extramarital contacts with multiple partners, perhaps something to confirm with her. If that's actually an issue, then it would be smart to use condoms for vaginal or anal sex.

I think everything is clear and if i'm allowed to do a final follow up question before closing this thread.

Have you seen cases of genital warts caused by an episode of oral sex? I did ask and she confirmed no multiple partners and neither does her husband as far as she is concerned. I only had herpes on my radar but now you imply HPV is possible after oral sex (not mutual masturbation).

From your reply, the takehome message is, even if I develop hsv syntomps on my penis, that will not be passed to my wife genitally because she already has oral hsv and it wont infect two sites, does that make sense?

I'm in Canada and unfortunately there is no test done for hsv unless theres a syntomp where a swab is performed.

Among the innumerable patients I've seen with GWs, most had had vaginal or anal sex in addition to oral; there's no way to know which exposure infected them. To my knowledge, however, I've never been aware of a patient with warts whose only exposure(s) were receiving oral sex. It's safe to say it's very rare.

"From your reply...?" Correct.

That completes the two follow-up exchanges included with each question and so ends this thread. To summarize the most important take-home message, as long as your ex partner doesn't have multiple partners -- i.e. both of you only have sex with your spouses and each other -- that relationship and your sexual relationship with your wife have virtually the identical risks for STD -- identical and exceedingly low.

I hope the discussion has been helpful. Best wishes.