[Question #2301] FREAKING OUT!

98 months ago

Thank you in advanced for providing your excellent advise and expertise!

I have a new partner, and last night we hooked up for the first time. NO sex took place, but he did perform oral on me and vise versa. I did perform oral on him for about 2 minutes before I stopped. I freaked myself out- I've had hsv 1 since grade school but I rarely get outbreaks. I've maybe had 3 cold sores my entire life and they are very subtle. So subtle that even my doctors can't suspect an outbreak when I have one. Last week I got a cold sore around last Tuesday; by Sunday it had already scabbed and was falling off. As of yesterday and this morning, you cannot even tell where the cold sore was and it was just above my top lip. The cold sore seemed to have healed. HOWEVER, i'm worried that I just passed my hsv 1 virus to my partner when I gave him oral. As i've stated before, I rarely ever get cold sores so I forget that I even have the virus. As soon as i remembered that I had a cold sore that was healing, I stopped- which is why the event was only 2 minutes. You know when a scab falls off an injury and then red, new skin is whats left? Thats exactly how the cold sore was. There were no symptoms, no scab- just new, red skin. Now, i'm not sure if a cold sore is still contagious after the scab falls off but I genuinely care about my sexual health, as well as my partners. I have never really been the recipient of oral sex and from reading several forums, I have read that if you have hsv 1 already, it gives you a significant barrier to contracting it on another part of your body- which is why i felt comfortable doing it.

Questions:

1. What is the likelihood that i just passed hsv 1 to my partner's penis from oral sex?

2. What is the likelihood of contracting hsv 1 on my genitals, even though i already have it orally?

3. How likely is it that I could contract HIV from performing oral on my partner for for 2 minutes?

4. What other STD's am I at risk for from this event?

Edward W. Hook M.D.

98 months ago

Welcome to our Forum. I'll be glad to comment. This was a low risk encounter. Oral sex only relatively rarely leads to bacterial infection. When it does, the most common problems are either gonorrhea of non-gonococcal urethritis NGU) caused by mouth organisms introduced in to the urethra during sex. As far as transmission of HSV, the risk is quite low for a number of reason including the fact that whether he knows it or not, your partner is more likely than not to already have HSV-1. About 60% of U.S. adults have HSV-1 and many of them do not know it - thus it is statistically more likely than not that your partner already has HSV-1, whether he knows it or not.. Further, in your case, even if you were shedding the virus, we conservatively estimate that less (and probably far less) than 1% of direct exposures by infected persons to uninfected sex partners lead to infection. I would worried. Thus comments to your specific questions are:

1. What is the likelihood that i just passed hsv 1 to my partner's penis from oral sex?

Very, very low.

2. What is the likelihood of contracting hsv 1 on my genitals, even though i already have it orally?

Once you have an HSV-1 infection anywhere, you are almost certainly not going to get it at a second location on your body, even if exposed.

3. How likely is it that I could contract HIV from performing oral on my partner for for 2 minutes?

Again, very, very low. If your partner had HIV (and it would have been appropriate for you to have asked him, see comment below). Current estimates are that if your partner was infected (unknown) the risk for acquiring HIV from either giving or receiving oral sex is less than 1 in 10,000 (i.e. like performing or receiving oral sex once a day for more than 27 years). Neither of us on this forum have ever seen of heard of a case of HIV acquired form receipt of oral sex.

4. What other STD's am I at risk for from this event?

Please see above. Low risk and if you were to acquire one of these, they would likely be symptomatic in a week or less.

Finally a comment. I would encourage you to consider asking your partner and future partners whether they have HIV or not and when they were last tested. This is not a matter of trust, not need it influence the decision about whether or not to have sex. Rather it is a matter of maintaining your and your partners'' sexual health. Most people do tell the truth when asked.

I hope these comments are helpful. EWH

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98 months ago

Thank you so much for your thorough, and rapid response Dr. Hook!

I did talk with my partner about being tested and HIV, and he said he was tested a few months ago and that he does NOT have HIV. It's not that I don't believe, I just worry about all the "what ifs". Its more so my personal problem, but i'm working on it!

As far as hsv 1 goes, when is a cold sore no longer contagious? As i stated before, my cold sore was healing but the scab already fell off and everything. Red, new skin is whats starting to emerge.

Questions:

1. How likely is it to transfer hsv 1 to my partners penis from me performing oral on him if my cold sore was healing? Once again, the scab already fell off and new, red skin was starting to emerge by the time I gave him oral.

2. When is a cold sore no longer contagious?

3. Have you or any of your colleagues seen someone acquire HIV from performing oral on someone? I just recently heard on the news that Arizona has had a spike in HIV infection rates and that thought keeps scaring me.

Edward W. Hook M.D.

98 months ago

As far as HSV-1, persons with the infection do shed the virus and can potentially infect others for years (decades) after infection. Things are most infectious when a lesion (cold sore) is present but the virus can also be shed asymptomatically without a cold sore being present. The amount of virus shed and frequency of shedding declines very gradually over a period of years (decades) and thus the potential for transmission is longstanding but low and declines further with time. There are not good, precise answers to your follow-up questions. I have made some comments:

The amount of virus present in a healing/healed lesion is much lower than when the cold sore is "fresh" but there is still a slight risk of transmission, given the qualifications I mentioned in my original reply.

2. When is a cold sore no longer contagious?

When it is completely healed but, thereafter, transmission can still occur due to asymptomatic shedding of the virus.

Current estimates of acquiring HIV IF your partner had untreated HIV (unlikely given his history-most people tell the truth) at that the risk for infection is less than 1 in 10,000 exposures (i.e. on average, once in performing oral sex on an infected partner daily every day for over 27 years).

I think your concerns are out of proportion to your risk. If I were you, I would not be worried. EWH

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98 months ago

Questions:

1. Oh no, when you say there's a "slight chance" i could pass on the virus, do you have any statistics? Is this "slight chance" worth worrying about?

2. I read up on several articles about cold sore scabbing and this is what I found "After the scab has fallen off, there will be a pink skin on the healing area. This is a good sign of a successful healing final stage". To me, this sounds like exactly what I explained with the scab falling off and there being a pink area. To me, this sounds like my cold sore was completely healed, am I right?

3. My partner performed oral on me when I was getting off of my period- I was spotting. Does this put me at a higher risk for an STD?

4. Lastly, how likely is it to contract gonorrhea from my partner performing oral on me? I thought that kind of transmission was rare??

Edward W. Hook M.D.

98 months ago

1. You are overreacting. Please re-read my earlier responses. the majority of people already have HSV-1 and most contacts, even with lesions do not need to infection I cannot give you a precise number but it would be less than 1% and probably far less. Further, HSV-1 is just not that big a deal.

2. Yes

3. No, having sex during your period does not increase your risk for acquisition of STIs

4. Few people have oral gonorrhea, when they do, transmission through oral sex is biologically very inefficient although I cannot provide a precise number. Acquisition of gonorrhea from receipt of oral sex is very rare.

I hope my comments have been helpful. AS this is my 3rd response, this will end this thread and it will be closed later this evening. That said, my sense is you are worrying entirely too much about STIs. Try not to. Most people do not have STIs, when they do, most exposures do not lead to infection. EWH

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