[Question #1152] Unprotected Cunnilingus with cut on bottom of tongue.

48 months ago

Hello, how are you doing today?  A couple of days ago I had an exposure that I would like advice about. A friend (female) and I (male) were hanging out and ended up messing around. All that was done was unprotected cunnilingus two times that night, both reaching orgasm. During the first time I noticed that I tasted a small amount of blood and the bottom of my tongue felt slightly scratched. I discarded this as I was caught up in the moment and preceded to give her oral once again. Apparently what happened was a crooked tooth on the bottom jaw had scratched the connecting part of the bottom of my tongue. After I got home I could clearly see the scratch and could dab a very small amount of blood from it with a tissue. I was now very anxious about the situation. My friend told me that she indeed has had a recent sex partner (unprotected sex, starting 3 months ago and ending 3 weeks ago) and that he turned out to be an alcoholic (side note) and is currently in jail. This increased my concern. I asked her if she had any reason to believe that she had any STDs and she responded no, but quickly got irritated about the questioning. A while back she told me of an instance where she came in contact with blood from a Hep C individual but was tested a couple of months later with a negative result.

Before this even I have not had any promiscuous activity since testing negative for everything except oral HSV-1 from which I have fever blisters every couple of years. I tested negative for HSV-2 and Hep C and have a titer for Hep B. The testing was done many months after the previous risk before this one.

My questions are:

1. Being that there was a scratch in my mouth during the cunnilingus, should I be concerned about blood borne diseases such as HIV or Hep C?

2. Have you ever had a patient become positive of any STDs with an exposure such as this?

3. Is HSV-2 a plausible concern with this exposure?

4. Do you feel that this exposure requires testing?

Thank you for your time and help.

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

We encourage all users to use the forum's search function to investigate other questions similar to their own. In this case, "cunnilingus" identified 50 threads. The main theme of all those questions is that oral sex in general, and cunnilingus in parrticular, is safe sex. It's not completely free of STD risk, but very low risk for all infections and virtually zero risk for some. Although oral STDs may occasionally result from oral-vaginal contact, it is very rare.

As a general comment, I will also say that hepatitis C virus is really not properly considered an STD, at least in heterosexuals. The frequency of HCV infection in the long term sexual partners of infected persons is not elevated at all, even after 20+ years of regular unprotected intercourse (after controlling for other typical HCV risks, such as injection drug use). The only proved sexual transmission scenario for HCV is in gay men who participate in potentially traumatic (i.e. possibly bloody) rectal practices.

Could a "scratch" or other wound in the mouth increase the risk of some STDs? Maybe, but probably not much. If you think about it, at any point in time probably at least 1% of all people (maybe 10%?) have oral lesions like gum inflammation, a bite wound in side a cheek or lip, canker sores, etc. And still no association of any STDs with performing cunnilingus. So any increased risk because of such lesions must be small.

Those comments address most of your questions, at least indirectly. But here are explicit responses:

1) There has never been a reported case of HIV transmission by cunnilingus, in either direction. That risk is nil. I would also consider the chance of HCV transmission to be zero or close to it, regardless of cuts in the mouth. In any case, the information provided about your partner does not suggest she is at elevated risk of either of these infections.

2) To my knowledge, in my 4 decades in the STD business, I am unaware of any patients who acquired any STD by performing cunnilingus. I can't say it never happened, but for sure it is rare.

3) Even with unprotected intercourse, the chance of HSV2 from any single exposure of this sort would be under one chance in many thousand. Your risk is even lower, since HSV2 doesn't readily infect the oral area. 

4) I would not recommend testing for any of these or any other STD, unless and until your partner informs you she has one of these infections. Even then, testing would be optional, by no means required.

I hope this has been helpful. Let me know if anything isn't clear--   HHH, MD