Oral Herpes/Hiv

[Kumar642]

Hello Doctor, this is my another thread as I was told by doctor to start a new thread for a new question

I am 26 years old male living in Canada,On February 3 I had sex with a South Korean CSW which is all protected but I kissed her vagina few times and that is unprotected. But 2 hours before the encounter I shaved my pubic area I had little cuts on my finger. But I got sore throat after 9 days of the encounter, I went to the doctor and prescribed amoxycillin 500mg tablets thinking it as bacterial throat infection. Sore throat gone away in a week and then I started feeling uncomfortableness in my throat after I stopped taking medicines. Except this I had no other syptoms. Do you think this sore throat is coincidence or an HIV sore throat?

On March 1st again I visited a massage parlour just to get a erotic massage but things turned around we started having sex. She performed unprotected oral on me and then we had protected sex. In both the encounters condom was intact. But the next day I started feeling a burning sensation on my lower lip where its meets the upper lip and I found a little bump which is located little inside of my lower lip, as far as the information I gathered herpes doesn't show up in less than 24 hours of my last encounter. Also I find it really odd to show up a month later of my second last encounter. I went to the doctor yesterday he wasn't sure whether it is cold sore or some thing else, there are also some tiny painless protrusions inside my lower lip but he prescribed  Valacyclovir 500mg for 7 days. I took the medication last night and there is no pain in my lower lip and little bump on my lower lip is so tiny now that I can't even see. Does this sound like a typical herpes? If it is herpes does it go away overnight? If it is oral herpes did I put myself in any(HIV) risk by receiving unprotected oral from the massage parlour girl? Also the massage parlour is a licensed establishment. Thank you.

[Edward W Hook, MD]

While I congratulate youon your desire to learn more about safe sex practices this is a new and different question.  I will provide a single, brief answer and then this thread will end.  As you have now asked two questions this month, no further question please for six months in order to allow others access to our Forum.

There is not a right or wrong side of a condom- they are made of a single layer of latex.  Condoms with a tip area for ejaculate work better when the tip is in a position to receive ejacualate but even if put on "inside out" they should work fine.  As long as the condom is worn throughout sex and does not break, it will protect against STIs.

This will conclude this thread.  EWH

[Kumar642]

Hello Doctor, I have been reading a lot about right and wrong side of condom recently, I want to ask you this question to clear my doubts.

1) How do I know I have used right side of condom? In my case condom rolled properly and stayed intact so can I believe I have used the right side of condom?

2) Even if some body used wrong side of condom and it stayed intact  a condom should protect from STD's since it is made of latex both the sides. Am I right?

  Thank you.

[Edward W Hook, MD]

I agree with the doctor you saw on all points.  EWH

[Kumar642]

Hello Doctor, I went to planned parenthood yesterday as they deal with STDs more and also to get a second opinion on the blister also. Doctor looked at the blister and said that doesn't look like a cold sore might be a blister caused by friction. Also doctor told me to stop taking the medication valacyclivir 500 mg,as I am taking two 500mg tablets 3 times a day. She also said that dose is usually for people with shingles. Now I am confused, I would like your opinion on continuing the medication until 7 days or 3 days of 500 mg thrice a day is good enough for a cold sore? Thank you very much for your help.

[Edward W Hook, MD]

No, the superficial cuts from shaving do not put you at risk.  EWH

[Kumar642]

Hello Doctor, only reason I wanted to test for HIV is I shaved my pubic area two hours before the encounter. There were two or three bleeding nicks  during shaving and stopped immediately and there were non bleeding cuts on fingers. I did put my finger into her vagina few times. I have read other threads you said no risk for these kind of cuts but those cuts were happened few hours before the encounter and mine were only two hours. Does this put me at any risk? Or these superficial cuts doesn't transmit HIV? Thanks.

[Edward W Hook, MD]

I agree with your doctor that there is almost no meaningful risk for HIV from the activities you describe.  

While HSV infections are lifelong infection they are not usually torublesome and with appropriate precations such as avoidance of contact when outbreaks are present and use of condoms, transmission can usually be prevented.  You do not even know tha tyou have HSV- I would not spend a lot of time worrying.  There is no evidence that you have HSV from what you describe.

Testing for HSV is a waste of time. If you wish to test for HIV a month from now to prove to yourself that your doctor and I are right and that you did not get HIV, testing at 4 weeks would be strong evidence that you were not infected.  Testing at that time would detect at least 90% of re4cent infections and probably more, depending on the test (testing with a combination HIV p24 antigen/HIV antibody test would be completely conclusive),  EWH

[Kumar642]

Hello Doctor, you said "I doubt that it was hsv". You mean you think it might be hsv or probably not. My doctor said I don't need to test for HIV. Do you agree with him? If I want to get tested for reassurance a month from now would be a good indicator? Thank you.

[Kumar642]

Thank you doctor for your response, my doctor doesn't want to test for HIV since its unprotected oral both the times. Do you agree with him? If I have to get it tested does 4 weeks from now would be a good indicator? One other thing that worries me is no cure for oral herpes, how often does a person gets these breakouts?

[Edward W Hook, MD]

Welcome back to the Forum. I'll address your new questions now.  The short answer to your question is that you are not at any meaningful risk for HIV from any of the activities that you describe.  There is no risk for infection from condom protected sex, no risk for HIV from receiving oral sex from an infected partner, and the risk for HIV from performing oral sex on an infected partner in the unlikely circumstance that she had HIV is less than one infection in 10,000 exposures.  Thus your risk for HIV from the exposures you describe is miniscule- somewhere between 1 in 100,000 and 1 in a million at least (far lower than your risk of being struck by lightning).  

As for your lip lesions, without a culture or PCR test taken from the sores before you started the acyclovir, there is no way to know if this was HSV or not.  Probably not.  As I have told you and as you heard on the HSV community site- a new HSV infection would not appear a day after contact with an infected partner; similarly, for new HSV to appear 30 days after exposure would also be most unusual.  If this were a recurrence, even with therapy it would be unusual but not impossible for the lesions to go away following less than a day of therapy.  If the lesions are gone, you may not know what caused them unless they recur and you can have a more knowledgeable health care provider take a look and perhaps test if needed.  Given the multiple unusual aspects of the lesions on your lip you describe, I doubt that it was HSV.

Even if the lip lesions you mention were HSV, this is not a major reason for concern.  Over 60% of adults have HSV-1 (usually oral infections) and the infection is usually not transmitted following a single exposure, even to an active lesion.  I would not worry too much.  

I hope these comments are helpful.  EWH