[Question #1582] Very Scared and Hoping for Hansfield...

92 months ago

Dear Dr,

Thank you very much for offering this service. Here is my situation, forgive the narrative. This past year, my soon-to-be ex husband and I lost 3 pregnancies-- one from a car accident and 2 as a result of Trisomy 13. In late September, he indicated he no longer wished to try to conceive as at his age (nearing 50, 12 years older than myself). He felt the risk was too great and he was content with the child he already had from a previous marriage. I was devastated and after counseling failed to change his mind, I left him at the end of October and filed for divorce. After I left, I discovered a friend of mine was also going through a divorce after 10 years of marriage, and we leaned on each other through the holidays, etc. Well, early last week, after one too many glasses of wine, it progressed to an unprotected oral sexual encounter (reciprocal) and nothing more. The encounter lasted only a few minutes and he did not ejaculate. As luck would have it, on December 26th, my ex husband sent me a heartfelt email indicating he wanted to stop divorce proceedings and would be willing to continue try to have a child. I love this person very much and would want nothing more than to go back and pick up our lives, but I am so terrified that this singular experience with my friend could have put me at risk for HIV. Mind you, I have no reason to think my friend is HIV positive-- he was a faithful husband for 10 years, but I am unsure of what his ex-wife may or may not have done during the marriage, etc. Can you offer some perspective on my situation and my risk for HIV or other STDs after this encounter In my situation, would you be concerned with an HIV exposure, infecting your spouse or potential child, etc? I know if I told my husband what happened, despite our separation, reconciliation would be impossible. Thank you very much for reading my story and offering your advice.

H. Hunter Handsfield, MD

92 months ago

Welcome to the forum and thanks for your confidence in our services. FYI (mostly for other readers who might be considering their own questions) non-herpes questions are answered randomly by me and Dr. Hook; it is only by chance I am responding. Dr. Hook and I have been close professional colleagues for 3 decades and our replies never differ significantly in substance, even if our styles aren't always the same.

You really needn't be worried at all. First, the statistical chance a partner like your friend has HIV is almost zero. Second, oral sex should be viewed as safe sex in regard to HIV: there has never been a proved case transmitted by cunnilingus, and for fellatio the risk has been calculated at one chance in 10,000 for penile to oral transmission. That's equivalent to giving oral to infected men once daily for 27 years before transmission might be likely; and even that assumes ejaculation in the mouth. Taken together, these factors translate to zero risk of HIV.

As for other STDs, the risk is almost as low. Here too cunnilingus is extremely low risk and fellatio perhaps a little higher, but you really were at trivial if any risk for anything. You could reduce even this trivial risk by clarifying with your partner that he hasn't didn't have any STD symptoms involving his penis in the 1-2 weeks before the event, and none since then: specifically, discharge from the penis (suggesting gonorrhea, chlamydia, etc) or penile blisters or sores (consistent with herpes or syphilis). You might also ascertain -- if you don't already know -- whether this sort of exposure is common or rare for him, and whether he has sex with other men (higher risk for STD).

Assuming you don't learn alarming information from your partner, I don't think you need to do anything at all. Proceed with reconciliation with your husband and don't worry about this any further. If I were in your situation -- or if I were your husband and were aware of your exposure -- I wouldn't be at all worried and would not be tested for anything. That said, I understand that some people are more reassured by negative test results than by even the most expert scientific opinion. If that applies to you, see a doctor or clinic for a urine or vaginal swab test and throat swab for gonorrhea, and blood tests for syphilis and HIV in a few weeks. (Vaginal/urine chlamydia testing also would be done, almost always automatic along with gonorrhea -- but there is virtually no risk of chlamydia in this situation). Gonorrhea testing can be done accurately any time more than 3-4 days after exposure. And the chance of syphilis or HIV is sufficiently low that I definitely would not recommend delaying reconciliation on this basis.

Having said all that, I stress again I wouldn't be tested myself and really do not think you are at any significant risk of anything -- again, assuming you don't learn your recent partner is at particularly high risk.

I hope this information has been helpful, but let me know if anything isn't clear. Very best wishes to your for success in reconciliation and successful conception and pregnancy someday! Happy new year--

HHH, MD

---

92 months ago

Thank you, Dr. One follow-up question and a comment. I have an impacted wisdom tooth that cannot be removed and keeps my back left molar's gum-line inflamed. Would the presence of this change your assessment of my HIV risk?

In terms of my friend, his last sexual encounter of any kind was over 6 months ago with his now ex-wife. I know he theoretically could be misleading me with that information, but I doubt it. Certainly no to sexual activity with other men and no issues with his penis to speak of. I can attest to no visible sores, etc. from our encounter.

If your assessment of my HIV risk and need for any testing remains the same given this information, I will put this episode in the rearview mirror and move forward with my life. Thank you again for offering this service. It is very easy for anxiety and fear to take hold--especially with everything you can read on the internet.

Happy New Year to you as well!

H. Hunter Handsfield, MD

92 months ago

Your dental problem doesn't change the risk of HIV. And in any case, with this additional information about your partner, there is even less chance he has HIV. So my risk assessment is unchented.

Thanks for the kind words. I'm glad to have helped.

---

92 months ago

Thank you, Dr. I believe I am allowed one additional follow-up correspondence. I was rather alarmed to read that 1 in 5 adults is infected with HSV2, and apparently many do not realize they are infected. Can you comment on my risk of HSV 2 from a single encounter such as this assuming no lesions present? Should I be tested? Also, is Hepatitis a concern at all?

Lastly, I phoned a clinic and can't get in for swabs for 9 days. From a vaginal standpoint, I can go to a lab and get urine for Gon/chlamydia tomorrow while I wait to get in for oral swabs. Is this just as effective from a testing standpoint? Also, on Thursday, I completed a z Pak for an ear infection--could that give me false negative results?

92 months ago

Hi Dr, I'm unsure if I was allowed two correspondences poat my original question, or just two questions. If you require me to pay again to address the second correspondence, please let me know. Happy to do so. Thank you.

H. Hunter Handsfield, MD

92 months ago

Sorry for the delayed response. You're still covered for this follow-up question.

It's dangerous for anxious persons to troll the internet for answers. There is a strong tendency to see and misinterpret information that inflames anxieties and to miss the reassuring bits, or of just making assumptions based on data that don't really apply. I suspect that's what's happening here. The rate of HSV2 is lower in males than females, and from what you have said, your partner's sexual lifestyle puts him at lower than average risk for all STDs. And most people with known herpes would inform their partners. So it's a fair bet there's under one chance in 10 your partner has HSV2. But if he were infected, the chance of transmission to the mouth by oral sex is under one chance in many thousand. And if you'd been infected orally, you probably would have had obvious (and painful) symptoms by now. Any herpes risk to either of you was more from transmission of oral herpes (HSV1) to the other's genital area. But here too, you probably would have had symptoms. All things considered, the chance you caught HSV of either type is extremely low. Similar considerations apply to viral hepatitis, with even lower risk than herpes.

Having taken azithromycin (Z-pak), there is no point in testing for either chlamydia or gonorhea. Had you acquired either one, the drug would have cured it by now, and negative test would say nothing. Don't waste your money on either urine or throat swab testing. Almost certainly you didn't catch either one, but if you did, it's gone now. (This isn't a false negative result. It would be a true negative, meaning you were not infected at the time the test was done.)

I would advise you to carefully re-read all my comments above. They were meant to be highly reassuring. Do your best to separate your guilt and shame over a sexual decision you regret from the infection consequences of that event. They aren't the same. Deal with the former as you need to, but you really needn't worry about the latter. You had a safe sex exposure with a partner who almost certainly wasn't infected with anything, and your miniscule risk is lower still because of the antibiotic. Do your best to move on without worry about HIV or other STDs.

Best wishes to you for successful reconciliation and eventually a healthy child!

---