[Question #1703] Hepatitis B/C Risk

43 months ago
I was exposed to saliva from a heterosexual man (Hep B/C status unknown) on the outside of my mucosal vaginal area which had a small abrasion. Not an open bleeding wound, but the skin was broken and raw. I was not exposed to any of his blood or semen. We did not have any intercourse or oral sex. He was fondling me roughly and it abraised the outside of my vagina and he then spit on the area. Should I have concern that I could have been exposed to Hep B or C which I have read has been found in saliva?
Also with receptive oral sex, a woman receiving from man (his Hep B/C status unknown) with no open sores/bleeding gums in his mouth and no broken vaginal skin on the woman, is there any risk of transmission to the woman of Hep B or C?
I have no history of Hep B or C (tested neg for both) So, I just received my 1st dose vaccination for HEP B but it was after this recent exposure.
Would either of these two scenarios I described above expose me to Hep B or C?
Thank you in advance!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. Thanks for your question.

Many sexually active people today, and some health educators and agencies, have come to believe (or assume) that oral sex is just as risky as vaginal or anal sex for STD transmission. That's wrong. Oral sex can be considered safe sex:  the risk of all STDs is low, much lower than for vaginal or anal sex; and the risk is zero for some of them. Another common myth is that the hepatitis C virus (HCV) is frequently sexually transmitted and that hep C is an STD. Not true. The data are very clear:  the only proved, consistent sexual transmission occurs in men having sex with other men, and then only with anal sex practices that are likely to be traumatic, with blood exposure. In heterosexuals, study after study has shown that the regular sex partners of persons with HCV (with frequent unprotected intercourse) have no higher chance of testing positive than anyone in the general population -- if the couple doesn't also share drug injection equipment. And neither HCV nor hepatitis B virus (HBV) is regularly transmitted by saliva. That small amounts of the virus can be detected in saliva does not necessarily mean high transmission risk. While in theory oral sores, bleeding gums, etc might increase the chance of transmission, in the real world it probably makes little real difference.

Those comments address some of your specific questions, directly or indirectly. I will add that the likelihood any particular heterosexual male in the US has an active HBV or HCV infection is very low. And if your partner were infected, the potential for transmission by saliva is very low, if not zero. So I definitely would not consider this a risky exposure in regard to either of these viruses. And expanding on my comments above about oral sex, cunnilingus (oral-vaginal) is especially low risk. Most oral sex risk comes from fellatio (oral-penile). Because of that, as well as the unlikelihood of transmission of HBV or HCV by saliva, women are at extremely low risk, probably zero or close to it, by receiving cunnilingus.

Having said all that, it's good you are being vaccinated against HBV. It won't make any difference for your recent exposure, but all sexually active people should be vaccinated. (Well, ALL people should be immunized, which is why HBV vaccination is now routine in children world wide.)

Bottom lines:  You needn't worry about this at all, and I recommend against testing for either HBV or HCV.

I hope this information has been helpful. Let me know if anything isn't clear. Best wishes and stay safe---   HHH, MD



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43 months ago
Thanks Dr.! MY GP kinda shamed me by saying,  "Going forward have "safe sex"- Which I thought I really was by what I was engaging in- it was the abrasion that threw me. As far as HIV, am I correct in saying that hetero oral- vaginal cunnilingus is no risk?  What about gonerreah, syphillis and chlymida with cunnilingus?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
I agree you were having very safe sex during this event. A superficial abrasion probably doesn't elevate the already low risk of infection with these viruses. And you're correct about HIV risk:  there has ever been a documented case of HIV transmission by cunnlingus, in either direction. That doesn't necessarily mean it can't happen, but if it does, it is exceedingly rare. Among other things, saliva kills HIV -- hence oral exposre and oral contact always are low risk.

Chlamydia uncommonly infects the oral cavity and is not known to be transmitted oral to genital. Gonorrhea is not uncommonly transmitted oral to penis, but rarely by cunnilings. Syphilis can be transmitted by such contact, but in North America and westnern Europe is concentrated primarily among men who have sex with men, so very low risk in this situation.

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43 months ago
Thanks again Dr. This forum is tremendous. With oral sex in general ( both fellatio and cunnilingus) Out of curiosity and wanting to have the best knowledge I can, which STDs are the risk at zero? ( as you mentioned in the first answer)  You have given me much peace of mind and clarity. Thank YOU!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
True zero is an exaggeration. "Zero for all practical purposes" would be better. Chlamydia, hepatitis B (and C), trichomonas, and Mycoplasma genitalium are some not known to be transmitted by oral sex.

Thanks very much for your kind comments about the forum. That completes the 2 follow-ups and replies included with each question, and so ends this thread. Take care and stay safe!

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