[Question #1696] very concerned.

43 months ago
On friday 1/27, I had sexual intercourse with a new partner, I am a female. We had sex at least 4-5 times, but used a condom every single time. For some reason, which i regret now, i decided to give him oral sex without protection. My partner told me that he had been tested at planned parenthood in Nov, but I know they don't test for herpes during routine checkups.. at least, as far as I know. I did examine my partner's penis before i proceeded without protection, and I noticed this small, hard bump. I freaked out of course. When I asked him about it, he said he's had that all of his life and that he's never had an STD. The bump was very, very small and was flesh colored. He was of african descent, and the bump was the same color as his penis. I scratched it, poked at it and pushed on it to see if there was pain in the area for him, and it didn't bother him at all. The bump did not burst or anything either while I was poking and prodding at it. Other than that, i did not see anything else. Side note- he and i both have hsv 1 on our mouth. 

In relation to this incident, I started getting sick Thursday night. Friday I had pretty much a full blown cold with the congestion and stuffy nose. Then yesterday, Monday, I woke up with severe pain on the right side of my throat, ear, tongue and lymph node. I went to the doctor, a little warm temp at 99.5. They tested for strep, and that was negative but when the doctor looked at my throat he said it was red and swollen with puss patches on it, so he was almost certain it was strep or a bacterial infection. He said the tests are not that accurate. when i looked at my throat, i saw white patches on my right tonsil, but no where else. I'm concerned because I'm afraid I have hsv 2 in my mouth or HIV.  I apologize for all of the questions i'm about to ask, but i'm really concerned here. 
43 months ago
Questions:
1) Does the bump on his penis sound like genital herpes?
2) If so, how likely is it that i contracted hsv 2 on/inside my mouth from this incident?
3) do you believe the white patches on my tonsil is the beginning of a hsv 2 outbreak?
4) do you believe the doctor could tell the difference between a herpes outbreak in the mouth and strep?
5) How likely is it that i contracted hiv from giving my partner oral sex a few times?
6) should i be worried?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. Thanks for your question.

There is little risk her for either herpes or other STDs. Good decision to use condoms for the vaginal sex events. Condoms are not a high priority for oral sex:  the overall risk of STDs is much less than for vaginal or anal sex, low risk for all and zero for some. As for herpes, even if exposed to an active infection, the mouth and oral tissues are less susceptible to HSV2 than the genital area. But most important, your description of your partner's penile skin bump is not at all suggestive of herpes, not even a hint. Finally, your symptoms are far more consistent with a common cold than anything else. No STDs cause nasal congestion and few cause sore throat. And it sounds like your symptom were starting before the sexual exposures took place -- and the symptoms that started later really were too soon. It sounds like you caught a garden variety cold. In fact, I would judge that the main infection risk associated with these events is your partner catching your cold through kissing, which presumably was included in the encounter; with symptoms starting, you probably were at maximum infectiousness. (There's even a risk of sexually transmitted urethral infection:  one fairly frequent cause of upper respiratory infection is adenovirus, and some adenovirus types readily infect the urethra by oral sex, often a rather painful infection, although not particularly harmful.)

Those comments cover most of your questions, directly or indirectly. But to be explicit:

1) It's not possible this sort of bump is caused by genital herpes.

2) There is very little chance you acquired oral herpes by performing oral sex. If there is any oral herpes risk, it probably is a lot higher for HSV1 from kissing than HSV2 by oral sex.

3) This doesn't sound like herpes. Garden variety viral colds cause white spots on the tonsils a lot more often than herpes does.

4) Most new oral herpes infections cause obvious painful sores in the mouth along with especially severe sore throat; and no nasal congestion. Visual diagnosis isn't perfect, but most reasonably knowledgeable physicians would know the difference.

5) HIV is very rarely transmitted penis to mouth. It can happen, but CDC estimates the risk at 1 in 10,000, if the penile partner has HIV. That's equivalent to giving oral to infected men once daily for 27 years before transmission might be likely. In any case, the chance a partner like yours has HIV is low. 

6) It's healthy and proper to be somewhat concerned about STD risk from any non-monogamous sexual encounter with a partner who likely has had other partners recently. Still, the likelihood he was infected is low; and even if infected, all STDs are inefficiently transmitted -- i.e. most exposures don't result in disease transmission. And you took the most important step in sexual safety by using condoms for the vaginal exposures. If you would like extra reassurance, feel free to be tested for gonorrhea, chlamydia, HIV, and syphilis. Based on the details you have provided, I would recommend against testing for herpes or any other STD.

I hope this information has been helpful. If you are in touch with your partner, I would favor informing him about your cold and hoping he hasn't caught it. But if he has, it should help reassure you that you've had a cold nothing more.

Let me know if anything isn't clear. Best wishes and stay safe--  HHH, MD

---
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
I forgot your comment about both of you having oral herpes. Contrary to answer no. 2, there is no risk to either of you for a new HSV1 infection. Prior infection makes you immune, or at least highly resistant.

---
43 months ago
Thank you for your help and clarification, Dr. Handsfield!

You're right.. I did establish a cold before this sexual encounter, i'm just scared because my throat is very sore with white patches on my right tonsil. I do not have any white patches or lesions though, anywhere else inside my mouth. But you do not believe this is an hsv 2 outbreak in my mouth, correct?

do you believe i should be worried about contracting an std such as herpes through protected sex, or do you think this is very low risk?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
I've already answered above:  No, I am quite sure you do not have HSV2 in your mouth; and yes, I believe this was a low risk exposure for HSV2.

---
43 months ago
Dr. Handsfield,

Thank you for your expertise advice and patience. I sincerely appreciate it. By the way, my swollen tonsils went back to normal after two days- the white patches and soreness diminished. Which, i assume hsv would not clear up in 2 days with antibiotics. 

My biggest worry is that i've contracted hiv through giving oral sex. Should i be worried about contracting hiv from this incident or do you think i'm overthinking this?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Thanks for your kind comments. That's why we're here.

True, oral HSV symptoms would not clear up so quickly.

I discussed your HIV risk in my initial reply (no. 5); yes you are overreacting. Not only is the risk low if your partner had HIV, but he probably did not. Assuming he's not bisexual or an injection drug user, there's less than one chance in a thousand he has HIV. But if you remain concerned, feel free to be tested in a few weeks. That is not code to suggest I really think you are at risk. But since you're nervous enough to be asking, my guess is you'll continue to worry about it, and most anxious persons are more reassured by negative testing than by expert opinion based on probablity and statitistics.

That completes the two follow-up comments and replies included with each new question, and so ends this thread. I'm glad the discussion has been helpful. Best wishes and stay safe.

---