[Question #3959] Nick/Sore under lip, unprotected oral and and HSVII fear

31 months ago
Dr. Hook,

       I apologize for buying and asking two questions in such a relatively short period of time. I am working in Beijing and was hoping my ex from the US and I might get back together. It didn't work out and I went out drinking with some friends. I was pretty drunk and called the Chinese escort I mentioned in my prior post. We didn't have sex, but did have unprotected oral. Before the oral she put some liquid (maybe a lubricant) on my penis.

        She had a small nick under the left side of her lower lip. It was not on the lip itself. It was about two millimeters long and one millimeter wide and there was just some irritated skin around it like when you cut yourself shaving or get a paper cut. The location, however, has me terrified since she definitely doesn't shave her face and it seemed an odd place for a small cut. I asked her about it and she said it is no problem and she also pointed to a small pimple on her forehead, but this didn't look like a pimple; it looked more like a small cut. Because of the location I am terrified of HSVII. I had HSV I as a teenager so I am not concerned about that. I know there may be some slight risk for bacterial infection like NGU, but my main fear is because of the cut/sore.  I did ask her about it again before she left and she said no problem, but again the location was odd and scary because it seems an odd place to get a small cut unless you shave.

         1. Does this sound like it might be HSV II and if it was how high is the risk that unprotected oral might have transmitted it?

         2. Would the lubricant/liquid she put on first have helped as a barrier? 

Finally, I am grateful for and have taken your advice from the last post and made an appointment to see a psychologist about my sexual behavior. I think it must have to do with unresolved issues about my breakup, but I obviously need help sorting this out and changing my behavior. Thanks to you and your colleagues for your expertise and kindness.

        
Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
Welcome back to the Forum.  Sorry your reunion with your GF did not work out.  With regard to your more recent, prepeat exposure withthe Chinese escort:

Receipt of oral sex is almost never a risk for acquisition of HSV-2.  The most important reason for this statement is because HSV-2 only very, very rarely infects that mouth.  The major herpes risk from receipt of oral sex is for HSV-1, the virus which causes cold sores and your risk for this is also low for several reasons:
1.  You may already have HSV-1/cold sores.  Over 50% of adults do, even though many of these persons do not experience cold sores.  If you already have HSV-1, you will not get it again.
2.  Most exposures to infected partners do not lead to infection.  Thus, if the lesion you saw on your partner's lip was HSV, it was likely HSV-1 and may have already been healing, reducing the likelihood of acquiring infection.  You don't say how long it has been since your exposure but if you had acquired a new HSV infection you would be expected to develop lesions at the site of exposure (your penis) within two weeks of exposure.

Thus, I doubt that you acquired HSV from the event that you describe.

Second question.  I have no idea what this person put on her lips before performing oral sex on you.  there are no data however to suggest that such a practice would act as a barrier to prevent infection.  Sorry I can't help more on this one.

EWH 
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31 months ago
Dr.  Hook,

        Thank your answer and kindness! She put the liquid lubricant stuff on my penis not her lips. Would that make a difference as a barrier? For the very low HSV II risk does it make difference that she is an escort? As you correctly note, I had HSV I when I was younger so I am not concerned about that. 

        I don’t know if this makes a difference, but I bumped into her at a coffee shop 3 days before the encounter and she didn’t have the small cut then, or any mark there, although yesterday it looked like it was healing. Does that suggest anything?
Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
No matter where she put the liquid- her lips, your penis, there are no data to suggest that such activity would change the risk (which as noted above is very low) for infection.  That she was an escort does not change that oral HSV-2 is vanishingly rare.  That the lesion had resolved, similarly does not change things.

My sense is that you are overthinking things.  Bottom line, given that you already have HSV-1, the chance that you are going to get HSV-2 from the receipt of oral sex you describe is negligible and not something that you should continue to worry about. That you continue to do so, may be an element of the concerns and behaviors for which you plan to see a psychologist (soon I hope).  I would suggest you incorporate this into your discussions with him/her.  EWH
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31 months ago
Dr. Hook,

       Thank you!
31 months ago
Dr. Hook,

        Just a quick update and quick follow up question (I never asked the follow up). As you predicted everything was fine after two weeks. I also want to thank you for the amazing information to be safer in the future; although I don't plan to be engaging in much for a while that is where my follow up comes from. I have met with the therapist and understand why my libido was out of check (my breakup) and how to avoid that, but since it seems I will now be single for the foreseeable future I want to be as safe as possible for when I begin dating again.

        The one question I did not ask and have developed a fear of even for the future is I read there is some risk of HSV II, even if one engages in protected sex with someone (the only kind I would engage in when I am ready again), but how high is that risk if the person has no visible sores and the condom is fine? I understand that if there no sores shedding could be the issue, but I saw wildly varying statements as to the actual risk.  
Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
Final responses.  As per forum guidelines, with this3rd response this thread will be complete and will be closed later today.

Regarding your final question, HSV-2 can be shed by infected persons without visible lesions.  Even most unprotected exposures to such persons do not lead to infection however.  The data on risk for infection is limited but in general we believe the risk of infection during unprotected sex with an HSV-2 infected partner is less than 1 infection per 100 and perhaps per 1000 sex acts.  Condoms, while not perfect, are the most effective means of reducing risk for infection and further reduce any risk for infection by about 60%.

I hope this information is helpful.  Take care.  EWH
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