[Question #4043] Oral Sex HIV Risk

32 months ago
I thought it would be worth clarifying the last question and answer in a closed account (Oral Sex HIV Risk), hence this follow up.  My understanding was that HSV-2 status increased the risk of HIV transmission at the site where there had been lesions, even those that had healed.  My HSV-2 lesions were on my penis and never in my mouth.   Am I to understand, therefore, that even though my HSV-2 lesions were on my penis only, my mouth is more susceptible to a risk (albeit minimal) of transmission?  Thanks.   
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
No, genital HSV2 cannot elevate the risk from oral exposure. But what if it did? Still doesn't matter. As explained in your previous thread, "double risk might sound like a big deal -- but as described above, double risk for oral sex still means only 1 chance in 10,000" instead of 1 in 20,000. I trust you'll agree this doesn't mean very much.

HHH, MD
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32 months ago
Thanks for all of the insight on potential HIV risk.  Although the risk factor seems rather minimal, I will follow your advice and test immediately for the potential of gonorrhea and chlamydia.  My understanding is the 2g dosage of azithromycin I took should knock out any chlamydia, if it existed.  Does this antibiotic by itself have a percentage success rate with gonorrhea?  Since any infection would be in the throat (pharyngeal?), is a throat swab the only way to test?  Does kissing present a risk of transmission?  Can it be passed genital to genital, even thought it is centered in the throat?  Thanks. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Testing was not my advice:  I said there is no need for testing, except that you might consider it for the emotional support you'll get from the negative results. Azithromycin prevents both chlamydia and gonorrhea, the last with about 90% certainty. Yes, throat swab is the only way to test for gonorrhea after oral exposure. Gonorrhea does not travel through the body to unexposed sites, and therefore a) must be tested at the exposed site and b) cannot be transmitted except by contact with that site (not genital to genital, for example).

Interesting you should ask about kissing. For the entire modern era of STD science (50+ years) it has been believed and universally advised in health education messages that kissing carries no risk for gonorrhea transmission. However, a brand new research report, presented recently at a scientific meeting, suggests it may occasionally be transmitted by kissing among men having sex with men. However, that report has not been confirmed, not yet peer reviewed, and not yet published in the scientific literature, so it has to be considered unconfirmed and not necessarily true. If there is is any risk at all, it is miniscule. Certainly in my 40 years in the STD business, I have never seen a patient with oral gonorrhea whose only possible exposure was by kissing. Also, oral gonorrhea clears up on its own, without treatment, within a few weeks. So even if you were infected, you won't be for long.
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32 months ago
Dr.  Hansfield.  I will use my third communication not to ask a question but to thank you not only for sharing your remarkable expertise but for an amazing educational experience.   There appear to be considerable amounts of mythology and less than informed advice (some of it quite scary) being propagated via the Internet.  Among other things, it thus surprises me to learn that oral gonorrhea is self-curing and that azithromycin alone remains a largely effective treatment for gonorrhea generally.   Your authoritative knowledge and stature are powerful antidotes to the overload of misinformation, and your decision to make your service so affordable, attentive, and prompt is a real blessing.  For some of us with bipolar disorders, controlling sexual impulsivity and consequent risky behavior are a lifelong challenge (even though these behavioral tendencies seem unimaginable when not in a manic state).  I believe this dialogue will prove to be a significant adjunct to my bipolar therapy, for which I am doubly appreciative.

PS.  I did not mean to imply you had recommended HIV testing.  What I tried  to indicate was that I would pass on it and do a throat swab for oral gonorrhea (which I also might pass on given the passage of time since the incident and time frame for self cure).
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Thanks for the thanks. To clarify one point, azithromycin in the dose used for chlamydia (1 gram) is not recommended or reliable for gonorrhea treatment; it takes 2 g for reliable treatment. However, 1 g would usually be effective in preventing gonorrhea or aborting a case if taken before or soon after exposure. (The amount of circulating antibiotic to prevent infection often is a lot lower than the concentration required for cure of an established infection.)

I'm glad the discussion was helpful. Take care and stay safe.

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