[Question #8021] HIV from recieving oral sex and kissing with small canker sore

49 months ago

So for a few months I was dating a girl, from April 2021 until a few weeks ago (early june 2021). I have health related OCD, so I'm very on top of making sure i get tested for STDs and maintain regular health screenings. She as well is on top of her health. She was tested for HIV and other STDs with he regular physical in April of 2021 and I for my physical in Decemeber 2020 and was negative for all STDs. I subsequently went back in Ealry June 2021 just for and STD pannel and was Negative for all again, including being negative for HIV. Anyway, so at the end of June, she tells me that she slept with one of her ex-boyfriends. I ask her about wether or not it was protected, she said yes and tells me that after her doing that with him we did not have any sexual intercourse. The night she tells me this, I made out with her, (kissed her) and she perfomed oral sex on me. I may or may not have had a small canker sore under my tounge and I do have some minor gingivitis in some areas, (nothing that bleeds unless agressively brushed) so no active bleeds in my mouth, just possible the small canker sore under my tounge and her oral health is better than mine, and spectacular so no bleeds in her mouth at all. As such, the only activities I did with her after her sleeping with her ex were kissing, with possibly the cancker sore under my tounge and she performed oral sex on me, that was all we did. The only other things we ever did we to have protected vaginal/penile intercourse (always protected) and sometimes oral( I would give her oral, she would give me). These activities however, we only done prior to her sleeping with her ex. The only actitives we did after were the kissing (with possible the small canker sore in my mouth) and her giving me oral sex. What are the risks of getting HIV from these acts?

H. Hunter Handsfield, MD

49 months ago

Welcome to the forum. Thanks for your question.

Your concerns seem to boil down to your partner's having had sex with her ex-boyfriend soon before your most recent sexual contact with her. That doesn't necessarily make that event particularly high risk for STDs, and certainly not for HIV. In particular, there is little or no risk if the ex-bf doesn't have sex with other men, isn't an injection drug user, or otherwise at high risk for HIV. So the chance your partner has HIV is exceedingly low, probably zero. And on top of that, kissing is zero risk for HIV for all practical purposes, with or without canker sores or gingivitis. In addition, there has never been a scientifically proved case of HIV transmission by oral sex, mouth to penis. So even in the extremely unlikely scenario that your partner has HIV, there is no realistic chance you were infected. For those reasons, I do not recommend testing for HIV or any other STD on account of these events. You really needn't be worried at all.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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49 months ago

Thanks Dr. H (I hope its ok that I call you that here) this was what I suspected, but I wanted to hear a professional’s take. This puts me at ease and I think really resolves it for me. Just for my general knowledge, I’ve seen conflicting information about hiv being spread possibly through deep kissing with both individual’s having sores or wounds in the mouth, and I have also seen information stating this is not at all a viable way to transmit HIV. Why do some sources indicate that it is possible to transmit it via deep kissing, is it possible only with the presence of high amounts of blood in the mouth in order to circumvent saliva’s ability to inhibit the virus? Is it just theoretically possible but not practical? Essentially I’m trying to suss out the circumstances as far fetched or ridiculous as they may be that hiv could transmit via deep kissing in order to better educate myself. It seems like many sources gloss over this and leave people wondering if their small canker sore or small cut that isn’t bleeding that they notice later etc… puts them at high enough risk to be concerned. Thank you for your answer below, it really helped. This one is just so I can better understand and can expand my base of knowledge in this regard.

H. Hunter Handsfield, MD

49 months ago

Whether kissing or other zero- to low-risk transmission risks for HIV, it's important to distinguish between theoretical routes of transmission and actual documented risks in the real world. There are any number of events that in theory might be risky but for which there are few or no documented cases of such transmission. Out of an abundance of caution -- and in the US, medicolwegal worries -- many agencies make no distinction: if there is any plausible risk, the activity is listed as "risky" without qualification.

Kissing is in this category. Ditto for oral sex, for exposure to sharp instruments in the environment, coughing by an infected person with possible exposure of the eyes to spittle, and so on. I am unaware of any proved cases of HIV transmission by kissing, and we know in general that oral exposure to HIV is very low risk. (For example, performing oral sex on an infected male, with ejaculation in the mouth, has been calculated to carry a risk of 1 in 10,000, which is equivalent to performing BJs on infected men once daily for 27 years before virus transmission might be likely. Also, when babies are nursed by infected moms, swallowing a few ounces of HIV infected milk per day, only about 15% become infected within 6 months -- indicating the extremely low risk for any single swallow.)

Is kissing truly zero risk? Probably not. But is it high enough to measure or be worried about? Definitely not. Could canker sores or other inflammatory conditions in the mouth raise that very low risk? Maybe -- but given the frequencies of both kissing and of canker sores, there must have been billions of open-mouth kisses in the presence of canker sores, and still few or no scientifically documented cases of transmission by kissing.

Does that help?

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49 months ago

Yep that helps tremendously. Thank you for extrapolating in that very clear way, very much appreciated. I confident that I no longer need to worry. Thank you again. All the best.

H. Hunter Handsfield, MD

49 months ago

I'm glad to have helped. Thanks for the thanks. Take care and stay safe.---