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Desperately anxious: HIV and cold sores?
Dr Hook,
My story started about 5 weeks prior when I gave someone with unknown serostatus a dry ** that last for 1 or 2 minutes. I did taste of what could be presumably precum. There was no ejaculation though. The guy reported that he is disease free. There did not seem to be any ulcer on the penis. Since that exposure, I have been excessively worried, and anxious. I have not been eating or sleeping properly. The anxiety over the last 10 days has been progressivly improving. On the 8th days after the exposure I had my first cold sore outbreak over my upper lip, however a couple weeks later I had another outbreak at 3 seperate spots on my lower lip, and this has made me more anxious that there is something wrong going on. The lesions healed relatively quickly over 3 days when I applied Acyclovir ointment. 8 days later (yesterday), I woke up on another outbreak over my upper lip that are now healing. I used to get these cold sores every now and then and occasionally used to have a couple outbreaks back to back.
I did post my question on the HIV prevention forum; the answer came from Mr Teak that there is no concern at all for HIV transmission.
I did my search actually, and found out that recurrent chronic herpes labialis if they have to occur in an HIV patient, the CD4 count less than 100; otherwise HIV patients usually get their herpes outbreaks in a similar rate to the general population.
I am really concerned these recurrent outbreaks can be related to a dperessed immunity. I haven't gotten though any concommitant symptoms, except for an aphthous ulcer around 3-4 mm in diameter and it cleared within 10 days.
The entire situation is draining me. I haven't thought at all before this incident that fellatio carry a potential risk for HIV transmission.
Please help and advise.
Question:
1- How common is frequent cold sore outbreaks in the general population?
2- What do these outbreaks indicate?
My story started about 5 weeks prior when I gave someone with unknown serostatus a dry ** that last for 1 or 2 minutes. I did taste of what could be presumably precum. There was no ejaculation though. The guy reported that he is disease free. There did not seem to be any ulcer on the penis. Since that exposure, I have been excessively worried, and anxious. I have not been eating or sleeping properly. The anxiety over the last 10 days has been progressivly improving. On the 8th days after the exposure I had my first cold sore outbreak over my upper lip, however a couple weeks later I had another outbreak at 3 seperate spots on my lower lip, and this has made me more anxious that there is something wrong going on. The lesions healed relatively quickly over 3 days when I applied Acyclovir ointment. 8 days later (yesterday), I woke up on another outbreak over my upper lip that are now healing. I used to get these cold sores every now and then and occasionally used to have a couple outbreaks back to back.
I did post my question on the HIV prevention forum; the answer came from Mr Teak that there is no concern at all for HIV transmission.
I did my search actually, and found out that recurrent chronic herpes labialis if they have to occur in an HIV patient, the CD4 count less than 100; otherwise HIV patients usually get their herpes outbreaks in a similar rate to the general population.
I am really concerned these recurrent outbreaks can be related to a dperessed immunity. I haven't gotten though any concommitant symptoms, except for an aphthous ulcer around 3-4 mm in diameter and it cleared within 10 days.
The entire situation is draining me. I haven't thought at all before this incident that fellatio carry a potential risk for HIV transmission.
Please help and advise.
Question:
1- How common is frequent cold sore outbreaks in the general population?
2- What do these outbreaks indicate?
Thank you very much for this reassuring answer, I really appreciate your patience.
Previously, I used to get cold sores almost anywhere on my lips, lower or upper. I am not sure if stress, fatigue and sleep deprivation can be the sole triggers.
By the way, I know it may look non sense, but I did check my HIV antibody a week after my exposure, just to check my status after my very few previous encounters; months' back.
Thank you again doctor, I will certainly keep you posted.
Regards
Previously, I used to get cold sores almost anywhere on my lips, lower or upper. I am not sure if stress, fatigue and sleep deprivation can be the sole triggers.
By the way, I know it may look non sense, but I did check my HIV antibody a week after my exposure, just to check my status after my very few previous encounters; months' back.
Thank you again doctor, I will certainly keep you posted.
Regards
MEDICAL PROFESSIONAL
OK, now we're on the correct forum. Sorry to be a stickler, but the disclaimer message are clear and we like to keep the topics separate as best we can.
First of all, oral sex carries little or no risk for HIV. For transmission from penis to mouth, if the penile partner has HIV, one estimate from CDC is a risk of one transmission for every 10,000 exposures. That's equivalent to receiving oral sex from infected partners once daily for 27 years before infection might be likely. And your risk probalby is even lower, since a) most people don't lie about HIV status, so your partner probably doesn't have it; and b) the exposure was brief, without ejaculation in your mouth.
Second, as you already have learned, HIV infections don't significantly increase the frequency of herpes outbreaks. Even late HIV infection (e.g. overt AIDS with very low CD4 counts) is associated mostly with increased duration and severity of herpes outbreaks, but little if any increased frequency.
Third, I'm not sure all your oral symptoms are herpes. In most people with oral herpes, every recurrence is in more or less the same area. If past outbreaks have been on one side of the upper lip, that's where most or all outbreaks will be. If you have previously had confirmed outbreaks on your lower lips, that might be what's going on -- but this would be unusual. Also, once an HSV outbreak gets to an overt blister or ulcer, it cannot heal in only 3 days, with or without antiviral treatment. Finally, aphthous ulcers (canker sores) usually are not due to herpes (it seems you already know this).
The frequency of recurrent oral HSV-1 outbreaks can be as low as once every few years or as often as every 6-8 weeks. Some outbreaks, but not all, are triggered by other infections (hence "cold sore", "fever blister") or localized trauma, like sunburn.
For all those reasons, there is really no reason to be suspicious you caught HIV. But I recommend you have an HIV blood test -- for reassurance, not because I believe you have it. Almost certainly you do not, and you can expect a negative result. If you have a duo or combo test (for boht HIV antibody and p24 antigen), you need not wait; the results are conclusive after 4 weeks, and you're well beyond that window. Or you can wait another week and have a definitive antibody-only blood test.
Feel free to return with a follow-up comment to let me know the result. Stay mellow in the meantime. There is no realistic chance it will be positive.
Best wishes-- HHH, MD
First of all, oral sex carries little or no risk for HIV. For transmission from penis to mouth, if the penile partner has HIV, one estimate from CDC is a risk of one transmission for every 10,000 exposures. That's equivalent to receiving oral sex from infected partners once daily for 27 years before infection might be likely. And your risk probalby is even lower, since a) most people don't lie about HIV status, so your partner probably doesn't have it; and b) the exposure was brief, without ejaculation in your mouth.
Second, as you already have learned, HIV infections don't significantly increase the frequency of herpes outbreaks. Even late HIV infection (e.g. overt AIDS with very low CD4 counts) is associated mostly with increased duration and severity of herpes outbreaks, but little if any increased frequency.
Third, I'm not sure all your oral symptoms are herpes. In most people with oral herpes, every recurrence is in more or less the same area. If past outbreaks have been on one side of the upper lip, that's where most or all outbreaks will be. If you have previously had confirmed outbreaks on your lower lips, that might be what's going on -- but this would be unusual. Also, once an HSV outbreak gets to an overt blister or ulcer, it cannot heal in only 3 days, with or without antiviral treatment. Finally, aphthous ulcers (canker sores) usually are not due to herpes (it seems you already know this).
The frequency of recurrent oral HSV-1 outbreaks can be as low as once every few years or as often as every 6-8 weeks. Some outbreaks, but not all, are triggered by other infections (hence "cold sore", "fever blister") or localized trauma, like sunburn.
For all those reasons, there is really no reason to be suspicious you caught HIV. But I recommend you have an HIV blood test -- for reassurance, not because I believe you have it. Almost certainly you do not, and you can expect a negative result. If you have a duo or combo test (for boht HIV antibody and p24 antigen), you need not wait; the results are conclusive after 4 weeks, and you're well beyond that window. Or you can wait another week and have a definitive antibody-only blood test.
Feel free to return with a follow-up comment to let me know the result. Stay mellow in the meantime. There is no realistic chance it will be positive.
Best wishes-- HHH, MD
Doctor,
so I understand from you my question is going to be transferred to the HIV question? Am I going to continue following with you?
so I understand from you my question is going to be transferred to the HIV question? Am I going to continue following with you?
Thank you very much, I will be waiting for the advise of the expert then. I apologize for the confusion
MEDICAL PROFESSIONAL
Users don't get to choose which moderator will respond. This one came to me. Dr. Hook's and my views never differ significantly; the advice would't be any different.
MEDICAL PROFESSIONAL
Welcome. Unfortunately, this is the wrong forum for HIV questions; I'll have it transferred there and then will reply. In the meantime, don't worry. Oral sex is virtually zero risk for HIV, and increased frequency of oral herpes or aphthous ulcers are symptoms that suggests an early HIV infeciton.
HHH, MD
HHH, MD
I haven't heard from you
I forgot to assign my problem to you Dr Hook
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