[Question #1121] Risk assessment

99 months ago

Hi Doctor,

I'm worried because I had an exposure a week ago, I went to a massage parlor, and the woman offered oral and mutual masturbation. The oral was unprotected, and I just shaved before so I had some shaving cuts on shaft and scrotum both were in contact with the inside of her mouth. Also, I had an active cold sore on my lips that was open meaning no crust and I accidentally touched it with my hands immediately after touching her wet vaginal.

I'm anxious because I read that cold sore increases the chances of getting HIV and that the virus die in contact with the air but can stay alive for some seconds and I'm afraid It was immediate contact.

What are my chances of getting any viral std from this encounter ? I'm over thinking it and loosing sleep, I have a very difficult to keep on a leash mind, if it's not too much to ask can you argument your answers with scientific facts.

Thank you doctor I really appreciate the work you are doing.

H. Hunter Handsfield, MD

99 months ago

Welcome to the forum. Thanks for your question and for your kind comment about our services.

HIV is rarely if ever transmitted by oral sex; there are no proved cases of mouth to penis transmission. The shaving cuts do not increase the risk significantly and your oral herpes (cold sore) also does not matter. The indirect contact with your cold sore makes no difference. The same applies to other viral STDs as well, such as hepatitis B or C. No risk.

It does not matter how long HIV can survive outside the body. The important thing is that nobody in the world ever caught HIV from events like you had, and probably not viral hepatitis either. You were not at risk, even if your partner was infected -- which is unlikely (depending in part on what country you are in).

The biggest STD risk from this event is for gonorrhea or nongonococcal urethritis (NGU) from the unprotected oral sex. However, if no symptoms (discharge from the penis) within 10 days, you can be confident you didn't catch either one. There also is a potential risk for syphilis, but that also is extremely unlikely if no penile sore develops in the next 2-3 weeks. You can be accurately tested for gonorrhea (a urine specimen) any time more than 3-4 days after the exposure.

On the basis of this exposure, there is no need for blood testing. However, for reassurance purposes you might consider an HIV test in a few weeks. A 4th generaiton blood test (antigen-antibody, or "duo" test) will be conclusive any time 4 weeks or more after the exposure. (This does not mean I believe there was any risk for HIV. I do not. I mention it only because you might find the negative result more reassuring than my advice based on scientific probabilities.)

I hope this has helped. Let me know if anything isn't clear.

HHH, MD

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99 months ago

Thank you for your quick response, to give more information it happened in the U.S (east coast).

Your answer is reassuring, I don't have any real symptoms (I'm fairly certain most of what I feel is due to anxiety and over checking myself) so I guess I'll try to wait 3 more weeks and go for a full STD check (that makes it 4 weeks after exposure) would it pick up Hep B ?

I'm confused regarding the cold sore, I'm not questioning your answer I just want to know for my own benefits why would it be risk free ? I read that CD4 cells are at the base of herpes blisters and that they are the main cells attacked by the HIV virus. Maybe I'm making connections that shouldn't be made, can you clarify for me please ?

Thanks again for your time.

H. Hunter Handsfield, MD

99 months ago

I strongly recommend against testing for hep B. We never test for it in my STD clinic after any single heterosexual exposure and certainly not after an event like this. And don't get a "full" STD check. You already have HSV1 (your cold sores), so that would be positive, and you can't get HSV2 from oral sex, and there is no risk for viral hepatitis of any kind. Have a urine gonorrhea test (which will include chlamydia, although that also is no risk from this event) and the HIV and syphilis blood tests only. Anything else will be a waste of money.

You are indeed making theoretical connections about herpes lesions and HIV risk. Trust me on this: nobody EVER gets HIV in situations like this. It doesn't happen and you won't be the world's first case. Don't worry about the biology -- the fact that there have been no such transmissions should be sufficient. And in any case, in multiple research studies HSV1 infections have never been found to be associated with increased risk of HIV, only HSV2.

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