What do you feel the actual risk of acquiring hiv would be from this incident?  I have HSV2 but have not had a breakout in two years.

How about risk of other sti’s? 

As always I appreciate this forum, thank you

Oral sex is safe sex. It's not completely free of STI risk, but far lower odds of infection by unprotected oral than from vaginal or anal sex. Your likely exposure to her blood really doesn't mean much. First, the chance she has a blood borne infection like HIV is exceedingly low. Second, there has never been a proved transmssion event for HIV oral to penis. And the blood makes little difference, even if she did have HIV. Among the billions of oral sex events that occurred from HIV infected partners over the years, surely millions included blood (recent dental procedures, oral sores, bleeding gums) -- but still no known transmissions of HIV.

Having HSV2 roughly doubles the risk of HIV if sexually exposed, and it doesn't depend in herpes outbreaks. Just having a positive HSV2 blood test confers the risk. However, double isn't nearly as dire as it might sound. If the baseline risk someone will get HIV during their sexually active years is, say, one chance in10 million, double means one in five million -- still near zero.

Other STIs? The main risks from oral sex are gonorrhea, herpes due to HSV1, syphilis, and nongonococcal urethritis. All these are rare in this situation. Of these gonorrhea is the only one worthy of consideration, and simply lack of symptoms (pus dripping from your penis) within 4-5 days would make it nearly certain you weren't infected. I don't advise testing except maybe for reassurance, not actual risk. If so, feel free to have a urine test for gonorrhea/chlamydia and, after a few weeks, a syphilis blood test. But if somehow I were in your situation, I wouldn't do it -- and I woiuld continue unprotected sex with my wife without worry.

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

HHH, MD