French Kissing, Bleeding Gums, mouth ulcer, cut on finger

Dear Doctor,

I have had a long history of periodontal disease with bleeding gums requiring scaling procedures.
Last time I had such a procedure was probably 1 yr ago. About one week ago, I brushed my teeth & noticed some bleeding especially my lower frontal gumline. My gums are swollen in the lower frontal area.  About one hour after brushing my teeth, I stupidly ventured into a strip club. After a few drinks, I had lap dances which may have included 20-30 minutes of kissing involving her inserting her tongue into my mouth. I also sucked on her nipples. When I came to my senses I stopped. She was older and may have had gum disease herself. Given this experience with her and her line of work, I am presuming she has HIV +.

The next day I noticed an oral ulcer, whitish, on the inside of my lower lip in close proximity to the lower gumline. It was one small whitish area measuring 1mm  followed by another area about 5 mm. Both were surrounded by inflammation. There was what appeared to be an area of dried blood less than a 1mm in size.  I don't remember her biting me, and I'm not sure how she would have bit me inside my mouth. I don't usually bite my lips but that may be a possibility. Looking it up on wikipedia it looked like an aphtous ulcer. There was no tenderness associated with it.

Now 6 days later, the ulcerated area is healing. I have noticed that my lower gums look more inflamed and bleed. I had cold sweats last night.

Also, I had a cut on my ring finger which happened about 10 hours before. I don't believe I inserted my fingers into her vagina but they may touched her labia and been in contact with vaginal fluids.

I am worried about HIV risk due to the deep kissing with bleeding gums, and the possibility of my cut finger being in contact with vaginal fluids. I do not want to put my wife at risk. I have not engaged in any other risky activities. Should I be tested? If so what would be the fastest and most accurate, ultrasensitive RNA?

[H. Hunter Handsfield, M.D.]

Welcome to the HIV forum.

There are numerous reasons why you should not be at all concerned about catching HIV in this situation.  First, your assumption ("I am presuming she has HIV") is wrong.  Statistically the chance such a woman has HIV is probably under 1 chance in 1,000 -- maybe higher if she is African American , an injection drug user, etc, but still low.  Heterosexually transmitted HIV remains more rare in the US than you might assume from media reports.  Second, HIV has never been known to be transmitted by kissing.  Your assumption is correct that periodontal disease and/or oral ulcers might, in theory, raise the risk -- but probably not much; and given how common such problems are, there must have been billions of kissing events with HIV infected partners in the presence of these conditions, and still no known transmission by ksssing.  Third, and similarly, fingering or hand-genital contact has never been known to transmit HIV, even with cuts on the fingers.  Unless a cut is fairly deep and actively bleeding, there probably is no significant increased risk.

From a risk assessment perspective, you don't need to be tested for HIV on account of this event.  But of course you are free to do that if my reassurance doesn't calm your fears and you would like the additional reassurance of knowing you have had a negative test result. If so, have a standard HIV antibody test about 6 weeks after the event, or a duo ("combo") test for both HIV antibody and p24 antigent at 4 weeks.  I recommend against the higher expense of a PCR test.  But if you insist on it, and want to spend a couple hundred dollars unnecessarily, you could do that at 10 days or so.

Really, you're overreacting to a non-risk event.  Don't worry about it.

Regards--  HHH, MD

[H2k]

Sorry, the sequence is a bit off. I also had a cut on my ring finger which happened about 10 hrs before. Am worried about contact with vaginal fluid.

[H2k]

Thank you for your advice. I wish the CDC was as forthcoming about French/deep kissing and gingivitis as you are. The one case report 26 years ago remains haunting.

[H. Hunter Handsfield, M.D.]

You're welcome.  Agencies like CDC have legal and cultural reasons to be hyper-cautious, and it is true that they don't sufficiently distinguish between real risks and unlikely or theoretical ones.  However, One case report almost 3 decades ago, among the billions of HIV exposures and millions of infections since then, certainly should not be "haunting".  That there is only one reported case should be highly reassuring.  How many people have been killed by lightning since then?  Those occurrences probably don't make you worried it could happen to you, right?  And yet the odds of getting struck by lightning probably are far higher than the chance you caught HIV in these circumstances.

[H2k]

Thank you again for the wonderful service you provide for idiots like me who put themselves in these situations.