[Question #535] Level of Risk?

103 months ago

Hi, I'm a 37 year old male. I recently saw 12 female CSWs in a month. I did NOT have intercourse. I received protected oral sex from 8, and handjobs from ALL...sometimes they used saliva or touched their vagina beforehand. I did deep french kissing with 6 of them (probably 10 minutes each), and light kissing on the lips with all of them. (By their admission and online "reviews", these CSWs have NEVER used condoms for oral sex, until me).

1) What is my risk of oral HPV due to kissing?...should I inform future partners I may have oral HPV?

2) What is my risk of oral HSV2 from french kissing?...what is the probability? I read Dr. HHH's post about not having seen a case of genital HSV2 from oral to genital contact in 40 years...is it equally unlikely to contract oral HSV2 from french kissing??

3) About 4 days after my most recent kissing encounter, I developed a slight sore throat with redness in the left tonsil, that seemed to "mostly" go away in a day. Could this be oral HSV2? (I already have oral HSV1, so maybe it is a "lesser" version of it?)

4) Aside from slight sore throat/redness, I've had no other symptoms. Do I need HSV2 testing, and should I warn future partners before kissing them?

I deeply regret these encounters and worry about passing oral HPV and oral HSV2 to future partners since I'm not in a relationship (given I know these CSWs never use condoms for oral). Thanks!!

H. Hunter Handsfield, MD

103 months ago

Welcome to ASHA's Ask the Expert forum. Thank you for your question.

You had entirely safe sex. No STDs are transmitted by kissing or by hand-genital contact. You had entirely safe sex, even if some of your CSW partners might have been infected with one or more STDs. To your specific questions:

1) HPV is not known to be transmitted by kissing. You shouldn't say anything about it to future partners.

2) HSV2 infrequently infects the oral cavity, and when it does, the virus usually isn't present in the absence of an obvious outbreak. Therefore, HSV2 is rarely if ever transmitted by kissing, or by oral sex (from mouth to genitals). (In addition to no genital HSV2 from oral sex, I've never seen oral HSV2 acquired by kissing.)

3) Far and away the most common cause of sore throat is a garden variety upper respiratory viral infection. Such infections are far more common than oral herpes, and unlike oral HSV2, easily and often transmitted by kissing, and 4 days is typical timing. Of course you also could have caught it from any other person with a cold or viral sore throat who you were around at about that time. Anyway, an initial oral HSV2 infection would be much more severe and would have lasted for 1-2 weeks.

4) It would be a mistake to be tested for HSV2. The chance of an atypical or falsely positive test result is much higher than the possibility you acquired HSV2.

So no worries from these encounters about HPV, HSV2, or any other STD. I hope these comments have been helpful. Best wishes and stay safe--

HHH, MD

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103 months ago

Hi Dr. Handsfield, thanks so much! I don't know if this changes things, but my sore throat (which began 4 days after deep french kissing CSW) has gotten slightly worse. It doesn't hurt any worse (and doesn't hurt much at all), but I looked inside my mouth with a flashlight and both tonsils are coated with a white coating. What concerns me more is that there are a couple of herpes blisters on the inside of my mouth toward the front inside of the cheek (one on each side). I ALREADY have oral HSV1 as confirmed from previous testing, so it could just be the usual HSV1 blisters. BUT it seems weird I would develop tonsillitis at the exact same time as these two herpes blisters. Perhaps the stress of a cold virus or strep throat could cause HSV1 blisters to emerge? However, in the past I have never had tonsillitis at the same time as herpes blisters as far as I know. Given the coincidental timing (4 days later) with recently deep kissing a CSW who never uses condoms for oral sex, I am worried this is a new oral HSV2 infection. I am going to an urgent care clinic tomorrow (Sunday) to see if they can swab the back of my throat and the blisters. If they can't culture the blisters for specific HSV type, I'll go to a more specific STD clinic on Monday to get the blisters cultured. Do you still feel I don't have oral HSV2 and this is just cold virus or strep PLUS two HSV1 blisters? Should I get the blisters cultured or not? (Is there risk of a false positive with a culture?)

H. Hunter Handsfield, MD

103 months ago

Something doesn't compute here. Recurrent oral herpes rarely causes lesions in the mouth. If such "blisters" are what you have been calling your recurrent cold sores, then I am inclined to doubt the diagnosis. (I'm not doubting you have HSV1, since a blood test was positive. But it probably isn't the cause of the blisters you mention.)

Could new oral HSV2 therefore explain your current problems? I still doubt it very much. Initial oral herpes is generally a lot more severe than this, even with the continued mild sore throat. And it sounds like the "blisters" are similar to something you have experienced previously, which strongly suggests they are due to the same problem (whatever that is, not herpes).

Based on all information provided, I doubt you have anything more than a garden variety minor respiratory viral infection and I cannot imagine you have herpes. The "coincidence" of these symptoms with your sexual exposures almost certainly is just that, a coincidence; or the result of catching a cold virus from kissing, and not herpes. That said, I can't examine you. If you remain concerned about it, the professional evaluation is the way to go. If or when you do so, ask for a PCR test for HSV, not culture; PCR picks up many more infections than culture does. That said, not all STD clinics have routine access to HSV testing by either culture or PCR. Anyway, if by the time Monday comes the "blisters" are gone and also there are no open ulcers, then testing for HSV probably won't help.

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103 months ago

Hi Dr. Handsfield, to clarify, there are about 3 "blisters" on the inside of my cheek near the front of the mouth. On one side, there are two clustered together. On the other side, there is just one by itself. Each "blister" is a tiny vesicle filled with clear fluid. I notice these vesicles occasionally (and then they go away), typically around the same area of the mouth. Right now, I have these vesicles, along with very mild sore throat, inflamed white coated tonsils, and lymph nodes a little sore when I press them. I went to an urgent care clinic today and was negative for strep. One of the vesicles was swabbed for a PCR test, the doctor thought it looked like a herpes vesicle.

1) Given I have oral HSV1, could that make an initial episode of oral HSV2 less severe perhaps?

2) I'm hoping it is just a combination of mild respiratory virus plus oral HSV1 together...does that sound right?

3) If it is only oral HSV1, would it be possible that an outbreak could be MORE severe than previous ones, and include sore throat?

4) Does the fact that these vesicles are in the same place they typically appear make it less likely to be HSV2?

5) Since my only exposure was deep french kissing with CSWs (2 in the past 3 weeks, one 6 days ago now), would you recommend just assuming I'm free of oral HSV2 and asking NOT to receive the results of the PCR? What is the risk of a false positive (for HSV2) or lab mistake?

H. Hunter Handsfield, MD

103 months ago

Thanks for the more detailed description of your oral blisters. They are definitely not herpes. You have recurrent mucoceles -- transliently blocked mucus gland openings. (They're painless, can be popped, and clear up in a day or two, right?) Not herpes and entirely unlrelated to your positive HSV1 blood test. If you ever have blister like sores on the outside of your mouth that become pus filled then scab over, taking a total of 1-2 weeks, that will be oral herpes. But not what you have.

1) Apparently you don't have oral herpes outbreaks. Like HSV1, HSV2 would not cause such symptoms.

2) Mild respiratory virus plus mucoceles, not herpes.

3) Irrelevant.

4) EVERYTHING makes it impossible that these are HSV2 lesions.

5) On top of everything else, HSV2 is almost never spread by kissing -- as I said in my initial reply.

That completes the two follow-up comments and replies that come with each new question, and so ends this thread. Best wishes and stay safe.

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