[Question #2011] Oral sex concern

Avatar photo
83 months ago

Hello,I dated someone for two months. We did not sleep together but oral sex happened once. I had a rough dental cleaning at 2 pm one day and this took placeat roughly noon the following day. I know my gums bled after the cleaning even when not brushing them because I spat out and saw blood in my saliva. This continued for several days. I feel very stupid to have performed oral sex when my gums were like this. I also had an ulcer on the tip of my tongue when this incident occurred. NO ejaculation but I think there was pre cum. The episode lasted around a minute or two. Two weeks later I got a bad cough with phlegm that was yellowish/greenish. I may have had a mild temperature. It was more cold like symptoms, which lasted a bit over a week. I don’t know if he has hiv but he seemed reluctant to test when I mentioned it. He is straight, aged 26, has a few tattoos and smokes weed. He said he only slept with Caucasian and Puerto rican women. He seems unknowledgeable about sexual health. He didn’t know what hiv was. He said he tested a few months ago at a clinic for “everything” and was fine but I asked him about hiv specifically and he didn’t seem to know. I suspect he slept with some of these girls unprotected. Not sure if it helps but he lived in Albany, NY and now LA.

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

Oral sex is safe sex. It's not completely free of STD risk, but all infections are far less frequent from oral than vaginal or anal exposure, and the risk is zero for some. You can consider yourself at low risk for gonorrhea, but really not much else. Any theoretical risk for others, including HIV and syphilis, is extremely low. And this remains the case in presence of oral inflammation, such as gum trauma from cleaning or other procedures. If you think about it, you'll agree that various cuts or sores in the mouth are very common, and hence there have been billions of oral sex exposures in their presence -- and yet even the busiest HIV/AIDS or STD clinics rarely see patients in whom oral sex was the only opportunity for infection. The chances of other things (herpes, syphilis, chlamydia, HPV, etc) really are zero to miniscule.

As for your symptoms, there is no STD that causes caught or sputum (phlegm) production; as you imply yourself, almost certainly you just had a garden variety cold virus, probably unrelated to the sexual exposure. 

All in all, if somehow I were in your situation (or if I were counseling a family member), I would not recommend testing. Among other things, oral gonorrhea, the single most common (but still rare) possibility, rarely causes symptoms and generally is cleared by the immune system, without treatment, within a few weeks. However, for reassurance you could consider visiting an STD clinic or other doctor for a throat swab to test for gonorrhea. (Genital/urine testing can't detect oral infection.) And for additional reassurance you could have blood tests for syphlis and HIV once 4-6 weeks have passed from the exposure.

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

---
Avatar photo
83 months ago
Ok. I was tested for hiv in October, 2016 and it was negative and this was my only exposure since then.  I was tested for all stds in October in fact and they all returned negative apart from hsv2 which was a low positive. I know that is a different topic but I am assuming that doesn't increase any risk for hiv if only exposed orally. I believe a partner who I only had protected sex with gave me hsv2 as I was in a lot of pain following an episode of protected sex. This was someone I really cared about so I kind of just let it go and didn't say anything to him. The symptoms I have had of hsv2 are hard bumps under the skin of the labia. It is always in the same spot. I find it confusing because they are not blisters, but under the skin and hard but the recurrent in the same spot is also a feature of herpes I know. They are sore. Anyway my main concern is the oral exposure. What do you think about having had the ulcer on the tip of my tongue, as well as the bleeding? Is that worrying. I also have felt fairly fatigued for the last few weeks, but it maybe stress.
Avatar photo
H. Hunter Handsfield, MD
83 months ago
Thanks for the additional information.

What were the exact numbers for your low-positive HSV2 blood test result? Many low positive are false, and your symptoms are not typical for genital herpes. So my guess is you do not have HSV2. But if you can provide the numerical results, both for HSV1 and HSV2 (and ideally other details of your test, such as the trade name of the particular test that was used), we may be able to sort this out. All this information likely is available on the lab report, if you have that or can get it from your doctor or the laboratory.

In the event you do have HSV2, you are correct that it is not likely to raise the risk of HIV infection by oral exposure.

Finally, having an oral ulcer on your tongue might in theory increase the risk of HIV if exposed. But not by very much; and anyway, the chance any average sexually active heterosexual male has HIV (in the US) is very low. So this does not change my assessment or advice. There is no realistic chance you caught HIV from the exposure you have described.

I look forward to hearing the details of your HSV blood test.
---
Avatar photo
83 months ago
Hi Doctor,

Ok. This was the situation with the HSV2. I was very upset about it at the time so tried to forget about it as much as possible. Basically, I came back from visiting my ex boyfriend (who broke up with me for long distance reasons) in SF in october. Two or three days later I was in excruciating pain but I did not examine with a mirror. It took me a few days to actually feel like I could walk without discomfort. Eventually I went to urgent care and had testing done. I had never been tested for herpes in my life at this point, all other stds, never herpes. The test came back at 2.7 reading for HSV2 and below reading ie negative for HSV1. Now I do not have those results in front of me, I maybe able to find them but I have a very good memory and I know this was the reading and it was a herpeselect test at urgent care in LA. Ok. Now after that I went away for a few weeks because I was very upset and also upset about the relationship ending but because I read your forums about the low positives, I then went back to my primary doctor and tested again for everything. I have the sheet and am copying it here. It is a high reading which I had forgotten about but assume from this I have it. I think I am going to be tested once more to make sure though. Now if this recurrent bumps are not herpes, is there anything else they could be? They are under the skin and they are sore. There are only one or two each time also, usually one. THIS IS THE EXACT COPY FROM SHEET. THE LAB IS QUEST DIAGNOSTICS.  IT'S TOO LONG TO PASTE:

HSV 1/2 IGG, TYPE SPECIFIC
AB HERPESELECT
HSV 1 IGG, TYPE SPECIFIC.            <0.90
AB
HSV 2 IGG TYPE SPECIFIC.                                                  4.73 H
AB

                                                                        Value.                          Interpretation

<0.90 negative, 0.90 -1.10 equivocal, >1.10 positive - AS GUIDELINES ON SHEET

So the first time I had a low positive reading but the next time, three weeks later I had a much higher reading




Avatar photo
H. Hunter Handsfield, MD
83 months ago
OK, thanks for all the detail. Your results are definitely positive:  you are infected with HSV2. Sorry this is not what you were hoping to hear. From your initial comment about a low result, I was hoping (and semi-expecting) something between 1.1 and 2.0 or thereabouts. 2.7 is getting pretty close to the conclusive positive value of 3.5, and your second result is definitive at 4.7. The initial result of 2.7 only a few weeks after your symptoms was highly suggestive, and the rise to 4.7 three weeks later e typical for a newly acquired infection.

As for your symptoms, they may indeed be recurrent herpes outbreaks. Recurrence in more or less the same place each time is typical, as is multiple lesions, which I assume from your description of "bumps" (plural). However, you are correct that hard bumps that do not become blisters or open sores is atypical. How often do these episodes occur? How long does each last? Are they preceded by any pain, tingling, or numbness in that general area? If so, how long ahead of the bumps? In any case, the way to sort this out once and for all is to see a doctor or clinic promptly (within 2 days) for professional exam and to have the area swabbed for PCR testing for the virus. (Alternatively, you can contact Terri Warren, who manages most herpes issues on this forum, at www.westoverheights.com. They can arrange for you to collect your own specimen at home. However, this approach misses the opportunity for an experienced professional examination.)

In the meatime, you need to go forward on the assumption you have it. Mostly this means taking steps to protect future partners by informing them (or not having direct genital contact -- perhaps the reason the exposure described above was oral only?). Also consistent condom use for vaginal sex, and perhaps ongoing anti-herpes treatment with valacyclovir (Valtrex), which would reduce outbreak frequency (if that's what you have) and the risk of transmission.

Having said all that, none of this alters my advice and comments about your recent oral exposure and HIV risks from it.

Normally threads are closed after two follow-up comments and replies, but I'll leave this open for another round in case you have further questions about all this, or if anything isn't clear.

---
Avatar photo
83 months ago
Hi. Thank you. It's ok, that's what I had thought. So you think the timing is all accurate, with a new infection, the symptoms and the value of the result rising like this a few weeks later, meaning I was definitely infected from this encounter? Now I have a few more questions. In terms of moving forward with this, firstly if I someday wanted to test again for HSV2 even though I definitely have it, if the value went down, would that just be because a new infection has a higher value. What does the value usually stay at for a year long infection and older? I would like to test just one more time, even though I know it doesn't change anything.  Secondly, no I only had oral sex with this person because I decided I needed to take things more slowly with dating and then when I got to know him, realized he was completely wrong for me so it just ended there. Now unless I have a partner who does have HSV2 as well, what does this mean for me. I have dreams of marrying and children. I have always wanted this. Does this mean I should forget all of this, or can only be with someone with HSV2. I am not a selfish person but it is very embarrassing to have to tell someone you have this, I am assuming this is why my ex boyfriend didn't tell me he had it, since I did ask him about stds, I always ask. I never don't use condoms because I have a large fear of hiv infection. I have only slept with one person unprotected in my whole life, and I knew, without a doubt, that he had nothing. Is there anyway of avoiding telling someone but protecting them still. If I got this with condoms being used, then it seems it is possible to contract it with condoms? So where does that leave me. Either being selfish or never having a relationship. I am just confused at how I deal with this exactly. And if I do eventually marry and try to have children, my partner will then definitely get it? I read unless you contract herpes in pregnancy it will not harm your baby, is that correct
Avatar photo
83 months ago
Oh. And sorry, I didn't answer any of your questions. I got caught up in my thing. No, it is usually only one bump, sometimes two but it is SORE. But it is hard and feels under the skin. It comes on suddenly, there is nothing preceding it. I would say half the time it is one bump, and then other half, two bumps. It is inside the labia area and lasting a few days. They have been occurring quite frequently, every few weeks. But i have looked at photos of herpes, and it is NOT A BLISTER. A blister looks like a bubble correct? IT is not a bubble.
Avatar photo
83 months ago
Also, I don't like to take pills but I was prescribed the equivalent in a cream form. I did have an exam but they were almost gone and the urgent care doctor said she couldn't tell if it was herpes or not. But I told her I tested positive for herpes and she prescribed that. But she said she didn't know if those bumps were herpes. She couldn't tell. I will go back when they happen again and have the swab.
Avatar photo
H. Hunter Handsfield, MD
83 months ago
There is no point in future HSV blood tests. From here on out, the numerical result will make no difference:  it often varies substantially from test to test, but means nothing about how active the herpes infection is, potential for outbreaks or transmission, or anything else.

Some people with HSV2 take steps to find similarly infected partners. But I don't recommend it and it really isn't necessary. With avoidance of sex during outbreaks, plus condoms, plus antiviral treatment, transmission is uncommon. And some couples don't even take these precautions, knowing that most infections aren't all that severe and symptoms can be easily controlled with treatment. As you apparently are experiencing, the main fear in herpes is infecting new partners -- but in a committed, long-term monogamous situation, that often becomes a minor issue. Of course this doesn't make dating easier, and you do need to be open and honest with potential partners.

The frequency of your apparent/possible outbreaks probably will decline. They tend to be most frequent during the first 6-12 months, less frequent thereafter. But there still remains slight doubt about whether these really are herpes episodes -- see my comment above about confirming it with PCR testing.

Finally, the anti-herpes ointments are virtually useless. They barely speed healing of recurrent oubreaks, whereas oral treatment is quite effective. And oral treatment, but not ointments, help actually prevent outbreaks and reduce transmission risk.

That will have to complete this thread. If you have continuing questions about your herpes, feel free to post a new question about it, which will be answered by Ms. Warren. Or even better, have an in-person discussion by going through the website noted above. Also ASHA, the sponsor of this forum, can help you find professional expertise by phone or in person.

I hope the disucssion so far has been helpful. Best wishes.

---