[Question #1103] STD / Herpes through biting/licking nipples

81 months ago
Dear Doctor
Hoping you can provide a risk assessment for me. I went to an erotic massage parlour and met an English girl. 

During the session:
- we had protected intercourse. I notice the condom split but believe this only happened when I removed it from myself (i.e. after intercourse not during it) but always difficult to tell. Presumably, I should get a regular screening for this - I tend to have an STD screening here in Australia once a year but please could you advice the soonest I can have this for the results to be effective.
- she also bit and licked my nipples. The only reason I mention this is that afterwards I noticed she had a mark that looked like a healing cold sore or a burn from hot food on her lip. Should I be concerned about getting a cold sore on the nipples from her biting and licking them?

Thanks for your help and for providing this invaluable resource.

H. Hunter Handsfield, MD
81 months ago
Welcome to the forum. Thanks for your question.

My first reaction is to congratulate you on having safe sex for this sort of exposure. Since you used a condom for the vaginal exposure, your overall STD risk was very low, assuming the condom indeed was intact during the exposure. There is skin to skin contact above condoms, which provide incomplete protection against STDs transmitted skin to skin (herpes, HPV, syphilis). I don't mean that your risk was high; it was not. But it wasn't zero risk either. However, testing for herpes or other infections is rarely necessary after any single condom protected vaginal sex event.

If your partner indeed had a cold sore, there could have been risk of transmission of her oral herpes to your nipples, or if you kissed her, to your mouth. But the chance was low if the skin of your nipples wasn't broken. Also, if the area on her lip appeared to be healed -- i.e. the skin was intact, but still pinker than normal -- it is unlikely she was infectious. Another factor is that there is a good chance you have already had an HSV1 infection (with or without symptoms of oral herpes); among adults in most industrialized countries, half or more have had HSV1, in which case they are immune (or at least highly resistant) to new HSV1 infections, anywhere on the body.

In summary, I cannot say your risk of herpes of your nipples is zero, but it's very low, and I do not recommend testing unless you develop blisters/sores. In that event, see a doctor ASAP for testing of the lesions for herpes. But I would advise against having a blood test if no symptoms develop within the next 10 days or so after the exposure. As for other STDs, it sounds like you get routine testing from time to time, in which case it makes sense to do it now, when on your mind. But not because of this particular event.

I don't know where you get your routine STD testing, but I would suggest you consider your local government-funded sexual health centre. Australia's SHCs, collectively, offer probably the world's very best STD/HIV prevention services. (If you happen to be near Sydney or Melbourne, those SHCs are the best of the best.) You would not go wrong to visit there both for general STD testing and for professional advice about this particular exposure.

I hope this has helped. Best wishes and stay safe--  HHH, MD

81 months ago
Dear Dr HHH

Thanks for your very detailed reply. I really appreciate it.

Please could you clarify a couple of things for me:
- I suspect I am due for a STD screening anyway. If I want to ensure any STD exposure from the possible split condom issue, how long should I wait? (I know you mentioned approx 10 days for herpes, but presumably different for other conditions). 
- With regards to her possible cold sore, it looked like it had scabbed over and was a different colour to the rest of the lip. There was no kissing and no oral sex on me (even covered) and the nipple would be the only concern. When you say the skin on the nipples not being broken, would this mean not open or bleeding?

The sexual health service here in Sydney is very good but they refer you to your local doctor for routine screenings unless you have symptoms.

Thanks again for your help.

H. Hunter Handsfield, MD
81 months ago
Times to conclusive STD testing:  Gonorrhea and chlamydia (DNA test on urine or urethral swab), 3-4 days. Blood tests:  HIV 4 weeks  with 4th generation or "duo" test, 6-8 weeks for standalone blood antibody tests, 3 months for oral fluids test. Syphilis 6 weeks. HSV 12-16 weeks. Viral hepatitis 6-8 weeks (but not recommended, less frequently sexually transmitted than most people assume, and essentially no hep C sexual transmission except among men have traumatic rectal sex with other men). My 10 day comment about herpes was for symptoms, not diagnostic testing.

There's probably a 50:50 chance you already have HSV1 and immune to new infection. In any case, probably little or no risk if her teeth didn't break the skin (with bleeding). And this would be a trivial problem anyway, which would be easily treated, unlikely to cause recurrent outbreaks, and rarely if ever transmissible to anyone else. So I really wouldn't worry about it unless you get blisters/sores of the nipples within the next 10 days. Otherwise, let it go.