[Question #6048] Worried about Kissing Exposure

71 months ago

Dear Doctors

I was visiting NYC and on Thursday 12th Sept I met up with a TS escort. I was top, and absolutely everything from sex to being recipient of oral sex was protected with no breakage.We did however engage in some very brief deep kissing (involving tongue). By brief, I mean a few seconds (5-10 at best). This was my only exposure. There were no signs of any lesions on the lips (of course I am unsure if there was anything inside this person's mouth but everything "seemed" clear).

After 7 days exactly, I started feeling strange on the tip of my tongue - irritation, mild burning and there appeared a single tiny swollen white papillae on the right hand side of the tip. We are now Day 9 and this issue is still ongoing and the tip of my tongue is sore (this may have been made worse by me gargling with Betadine mouthwash or by the cigar I enjoyed a few days ago). I also started applying Bonjela to that papillae.

Background about me I am hetero and always use protection and test for everything annually. I thankfully have never had an STD, however there is always a first time! I do have a regular partner (female) and things are no different in relation to protected sex, however I am now afraid that, when I deep kissed my regular partner on Sunday 15th, I could have put her at risk or something!

The whole experience for me was very shady and it goes without saying that Google is giving me numerous panic and anxiety attacks about the risks of acquiring Syphilis, etc from this brief exposure. From what I am seeing online, my condition seems to be what is known as Transient Lingual Papillitis, however I could be wrong.

I would like to seek your professional opinion on whether my worrying is warranted in any way and understand the chances, if any, of me having acquired an STD. I will be testing at the 6-week mark in all cases.

Thank you in advance for your advice.

H. Hunter Handsfield, MD

71 months ago

Welcome back to the forum. Congratulations for continuing to carefully follow safe practices, at least in terms of condom use, if not always in your choice of partners.

Kissing is low risk for all STDs and essentially zero for most. You were at higher risk from unrecognized condom failure -- and that condoms are not 100% protective, due to skin contact above the condom and perhaps genital fluids working their way around the rim and underneath the condom. As for your symptoms, they are not typical for any STD. I also note an apparent similarity with the main question in one of your previous threads, i.e. irritative symptoms at a site of potential exposure (urethra last time, tongue and mouth now). Herpes is the only STD that comes to mind that might explain the symptoms you describe, although I will point out that oral herpes acquired by kissing is not considered an STD; and in any case, without overt open sores and severe sore throat, initial herpes is unlikely.

If the oral irritation continues, all I can suggest is that you see a physician for direct exam. FYI, a current debate in the STD world is whether gonorrhea is more frequently transmitted by kissing than previously believed. A group of highly respected investigators in Australia believe it's a big deal, but the general consensus is that oral to oral gonorrhea transmission is rare. When present, oral gonorrhea rarely causes any symptoms at all; perhaps 5% of the time there is sore throat, but there are no reports that suggest tongue irritation could be due to gonorrhea -- and gonorrhea bacteria do not attack the kinds of tissue found on the tongue surface. But because of the recent concern, if you decide to seek medical evaluation, a throat swab for gonorrhea might make sense.

My main advice that in view of the exposures described both here and in your prior threads, you should not assume that your careful attention to condom use is 100% protective. Don't get me wrong -- usually condoms work. But as noted above, unrecognized failures sometimes occur. You would be wise to have routine STD/HIV testing on a regular basis as long as your sexual lifestyle continues, e.g. once a year testing for gonorrhea/chlamydia (perhaps oral as well as urethral) and blood tests for HIV and syphilis. If you haven't had such testing recently, this would be a good time, while it's on your time -- but not primarily because of this particular exposure.

I hope these comments are helpful. Let me know if anything isn't clear. (FYI, I'm closing your previous still-open thread.)

HHH, MD

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71 months ago

Thank you Dr. HHH for your evaluation of my situation and for your valuable input.

I understand your point about unrecognised condom failure, unfortunately (or fortunately rather) my OCD doesn't allow me to take my eye of the ball (of you'll pardon the pun) so I firstly never go all the way in, and secondly, I constantly check the condom during intercourse to make sure its still covering me. In the end I finished inside the condom and all stayed in so I am sure on this occasion there was no failure.

I am also fairly certain now that my issue last time was an irritation caused by the condom itself! When I use my brand (Durex), I never have an issue, and this was the case this this occasion.

I will do all tests at 6 weeks post for sure (so would be by end of Oct). My last full panel was in November 2018 so I am now due in all cases (I will also do a swab as advised).

Some follow-up if I may:

(1) If my tongue issue was Herpes, would it be HSV1 or could be HSV2? Also, would there have been blisters on the tongue AND other parts of the mouth accompanied by throat pain by now (Day 10)? I don't have any throat pain or anything of the sort. Also my discomfort seems to come and go, at the time of writing, I'm feeling fine-ish, however earlier I was not - perhaps anxiety may play a role at amplifying such sensations as well.

(2) I have read about the Australia Gonn findings I think back in May, has US scientific research produced similar results? Or for all intents and purposes, it is still considered very very rare?

(3) I also note that you have not mentioned something like Syphilis, was my kissing exposure so brief that this would be unlikely considering exposure, timing and symptoms? Is this also not commonly transmitted in this way?

(4) As a specialist in the field, in your opinion, how worried should I be about this particular exposure given my symptoms?

Thank you again.

H. Hunter Handsfield, MD

71 months ago

1) As I said above, almost certainly this isn't herpes. If it were, it almost certainly would be HSV1, since oral HSV2 is rare and thus rarely if ever transmitted by kissing or oral to genital.

2) Many research groups around the world are looking again at old data, and undertaking new studies, to either refute or confirm the conlcusions of the Australia investigators. New results could be forthcoming at any time, but my guess is that it will take a few years until the controversy is resolved one way or the other. I'm strongly in the camp that gonorrhea is rarely transmitted by kissing. In fact, at the recent meeting of the main international STD research conference in Vancouver 3 months ago, I publicly debated the chief Australian proponent of gonorrhea transmission by kissing. But as a scientist, I am prepared to change my views based on data.

3) Kissing can transmit syphilis, but rarely. Very few patients with syphilis ever show up in STD clinics whose only potential exposure was kissing.

4) If somehow I were in your circumstance, I wouldn't be tested for anything and would continue unprotected sex with my wife without worry. That doesn't mean the risk was zero, but it's very low. I recommend you consider testing primarily for reassurance, not because of serious likelihood you are infected.

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71 months ago

Greetings Dr. HHH

I trust you are well.

By way of update, on September 23rd (11 days post encounter), I did full panel blood work for HIV (4th Gen Ab/Ag), Syphilis (VDRL by RPR), Hep C (Ab), Hep B (Surface Ag); all of which came back negative. I know this is not conclusive for this particular encounter, however at least I can rule out all previous encounters. I will repeat this test again at the end of October, 6-weeks post this encounter for final reassurance.

On the same day, I also did Urine tests and Throat Swabs for Gonorrhea, Chlamydia, Ureaplasma Urealyticum, Ureaplasma Parvum, Mycoplasma Genitalium, Mycoplasma Hominis, Trich and culture for proteins, RBCs, WBCs, Epithelial Cells, Bacteria, Fungus; all of which came back clear and sterile. I believe that these would be reliable at 11 days post my encounter having read some of your previous advice to forum users, however please advise if you think otherwise.

As for my tongue, well the soreness/burning sensation continued until and including 2 days ago (26th) with the appearance of 1 more white-colored inflamed papillae / taste bud on the tip of my tongue. From yesterday, at 15 days post encounter, I am feeling more or less back to normal again. I have had no painful blisters on my tongue, lips or anywhere else in or around my mouth. I have not had any fatigue, muscle pain, sore throat, malaise or any other abnormal feeling like that. So in summary, this issue started on Day 7 post-encounter, and went away more or less by Day 14/15 (lasted 7 days) - does this sound suspicious at all? I guess if not HSV, it could be anything or nothing.

I just want to be clear, I know you said in your previous advice to me that you do not believe that this sounds like HSV, however if it WERE, should I have expected more in terms of symptoms other than simply soreness/burning/sensitivity on the tip of my tongue? Basically, my question is does HSV come as all-or-nothing (ie either produces several symptoms together OR will remain asymptomatic)? Or could it just cause some discomfort (on the tongue say) without anything else happening?

I am considering, when I return to the lab to repeat my blood work for HIV, Syphilis, etc… at the end of October, (6-weeks post this encounter), that I also do blood tests for HSV1 and HSV2. Do you see this as being worthwhile (or recommended)? If not, then I would appreciate if you could kindly provide me with reasoning behind your answer.

By way of background, my regular partner has HSV2, she has had it since before we met. She has not had an outbreak in years and I personally have never had an outbreak. Last year I did urine tests for HSV1/2 which came back negative, though I read online that urine tests for this are not generally very accurate.

The reason really why I am trying to be as thorough as possible in terms of testing for everything and understanding risks is because I would like to now settle down and be completely monogamous with my partner.

I understand the forum rules and I will not have any further questions relevant to this encounter beyond this post. If you do choose to keep the thread open, I will happily post results of my tests at the end of October, to perhaps benefit any other members/readers.

If any of my results at that time are positive, then I may return again in a new thread with questions about those results, however I hope that this will not be needed!

Thank you again Dr. HHH for all your support and guidance, and I look forward to hearing from you.

H. Hunter Handsfield, MD

71 months ago

The reason we have two follow-up opportunities is for clarification of the original question. My replies are brief -- thanks for your understanding.

You were seriously overtested for this sort of exposure. Ureaplasma urealyticum and U. parvum and M. hominis are normal bacteria in the genital tract -- ti was a waste of money (yours or somebody's) to have such tests. Same for most others as well. UU and UP testing isn't done in most responsible clinicx and labs, so I cannot comment on the reliability of the results -- but it doesn't matter.

If you had new oral herpes, you would have open sores, severe sore throat, and maybe fever.

Please do not return to tell us about any negative test results! And ignore positive results for UU, UP, MH.

That concludes this thread. Best wishes. Please no new questions about this exposure, test results, etc. Thanks.

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