[Question #46] Sti from unprotected oral

40 months ago
Hi dr hands field,

About a month ago I (male) made a terrible mistake and received unprotected oral from a female stripper. It did not last very long (a few minutes) and we did not kiss or have vaginal/anal intercourse. I was very drunk but did not see any signs of oral lesions

Two weeks after the incident, I got tested (blood and urine) and was negative for all stis (gonnoreah, chlamydia, syphilis and hsv1). However my hsv2 test was unequivocal (igg 1.06). I would also say I have had no obvious symptoms of genital herpes (blisters, sores, etc) since potential exposure (4 weeks now) and I have been checking fairly regularly

I am naturally very worried but have read the chance of getting genital hsv2 from oral sex is very low, pretty much close to zero (from your previous medhelp posts).

I would also like to add I was tested over a year ago (was negative hsv1 and 2) and am currently in a monogamous relationship where my partner gets tested annually for everything (she was tested earlier this year and was fine)

Thus I am pretty confident any sti would be from this brief oral encounter. What would you suggest I do? i very much want to protect my partner who I care about deeply. Do I need another herpes test (igg or straight to western blot)? I know the 1.06 is very close to 1.1 which is considered positive and was taken only 2 weeks after the incident. Given all this information, what are the chances you think I could have acquired genital herpes 1 or 2 from this exposure?

Thanks so much, I really appreciate your advice
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome to Ask the Expert. Thanks for your question.

Oral sex is safe sex. It's low risk for all STDs and zero risk for some -- far safer than unprotected vaginal or anal sex. Therefore, the chance of any infection from any single exposure is very low and I would not have recommended any of the tests you had. Jumping ahead to your closing question, the combination of the nature of the exposure, your lack of symptoms, and the test results so far, there is no chance at all that you acquired HSV of either type.

As for HSV2, your own research is accurate: there's no way you caught that from this event. Since that was a virtually impossible outcome of that event, you shouldn't have been tested for it. Now that you have, however, you'll need to deal with an equivocal result that you would likely be better off not knowing about. This is a textbook example of an instance when HSV2 testing should not have been done. I could use it to teach medical students (in fact, maybe I will).

The large majority of equivocal HSV2 blood test results prove to be negative, and from a strictly medical standpoint, you don't need any further testing, but can go forward in confidence you don't have it. If somehow I were in your shoes, that's what I would do, and I would continue unprotected sex with my wife with no worry about infecting her.

However, if you want 100% reassurance, further testing is necessary. You could start with simply repeating the routine test. If clearly negative (ELISA ratio under 0.9) you can take it to the bank, with no further testing. If still equivocal or weakly positive, the next step should be a confirmatory test. Quest Labs has an "inhibition" HSV2 antibody test, the most readily available confirmatory test.

Whatever path you choose, in the meantime stay mellow. There's really no realistic chance you caught either HSV1 or 2 from this event.

I hope this has helped. Best wishes--  HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Probably it's obvious, but I meant to point out that in the slim chance you in fact have HSV2, it is from some other past sexual exposure, not the oral sex event a few weeks ago.---