Protected Sex Any Risk?

[Much Needed Help]

I searched the board for hours yesterday and couldn't find but one or two questions from woman about the chance of exposure, everything seems to be from men dealing with unprotected sex from prostitutes.

So, I hope this isn't a repeat question.

I have been dating this guy, not for too long, he told me his HIV status was negative and that he had been tested some time back had a negative test and hadn't had sex since the testing.  I asked if he was an IV drug user or engaged in sex with men.  He told me no, but, there's always people that lie.

We did a lot of deep kissing and he fingered me vigorously, which until yesterday, I forgot that he had a cut on his finger that had pretty much healed.  He went down on me for some time, I never put his penis in my mouth.

Before sex, I put a condom on him, while erect (although I did notice the other day that some of my condoms say they expired in 7/2006) and after sex was over and he had pulled out, he removed the condom.  I held the condom and there appeared to be no breakage and the fluids were nicely maintained in the tip of the condom.  

So, I thought everything was fine, until, two days ago (this encounter happened on August 12th), 9/10 days after the encounter I started getting a sore neck and aching glands and my tounge has a slight burning sensation.  Today, it's only my left side of my neck/gland that's bothering me and my ear and a slightly tingly tongue.  I've had no indication of a fever and I took it this morning, just to see, and it was 97.9.

1) I took all the safety precautions, didn't I?
2) If the condom did expire in July 2006 would that make a difference?
3) Based on the exposure I had, is testing necessarily warranted (I was tested at the end of July and was negative)?
4) Am I probably being overly paranoid and the sore gland/neck and tingly tounge simply coincidental?

Thank you very much for your assistance.

[H. Hunter Handsfield, M.D.]

Congratulations--you had very safe sex!  If my daughter were younger and still single, I would want her to do just what you're doing.  Keep it up and you can expect a lifetime free of HIV (and pretty much from serious STDs in general)--even if you pursue a sexually adventurous life.  You asked your partner about HIV status and risks, which is a key safety measure; yes people can lie, but usually not when asked directly.  And you used a condom for vaginal sex (OK, it's best to use ones that aren't outdated--but even so breakage really isn't a big risk).  Receiving cunnilingus is zero risk for HIV and pretty much zero for other STDs, with the exception of herpes.  (Make sure your partners don't have active cold sores.)  Performing unprotected fellatio on guys is modestly risky for some STDs (e.g., gonorrhea) but still very low compared to unprotected vaginal sex.  And on top of all that, you dated for at least a little while before hopping in the sack.  In general, sex with people who build toward a relationship is much safer than quick pick-ups or with someone you just met.

So to answer your specific questions:

1) Yes, you were about as safe as a sexually active person can be.

2) Condom expiration dates have big margins of safety.  Don't use 10 year old ones, though!  

3) You don't need testing now.  If you date and change partners from time to time, have routine HIV/STD testing once in a while, like once a year during your annual reproductive health exam.

4) You could have caught a cold from the guy.  But don't worry about HIV or other STD.  But of course see a provider if your symptoms continue and concern you.

Best wishes.  Stay safe--  HHH, MD

[Much Needed Help]

In the haste to get my posting done yesterday, I failed to mention that I have herpes (I've had it for 15 years from a boyfriend that cheated on me).  My partner knew about me having herpes, and to the best of my knowledge, I was not having a out break (I've become very aware of when I'm getting ready to have an onset, which usually happens once or twice a year).

Does this put me at any more risk, since he perfomed cunnilingus me?

BTW - the sore neck and throat are pretty much gone now and I've had no fever.

Thanks again and sorry for omitting this the first time.

[H. Hunter Handsfield, M.D.]

Most likely your herpes is due to HSV-2.  People with HSV-2 have a statistically higher risk of getting HIV if exposed.  But your risk is so low, if you maintain the behaviors and practices you describe, that it makes no difference.  The chance you will acquire HIV someday are literally less than the chance you will die of a lightning strike.

As I said before, receiving cunnilingus doesn't risk any STD except for the low risk of acquiring genital HSV-1.  Your genital (presumably HSV-2) herpes makes no difference.

The only additional thought about your overall sexual safety is to consider whether you want to consider taking suppressive antiherpetic therapy to further reduce the risk of transmitting your herpes to a partner.  The risk is very low as long as you avoid sex when having an outbreak and use condoms otherwise.  But it's not zero.  I'm not specifically advising it--but it might be something for you to discuss with your reproductive health provider.

HHH, MD

[Much Needed Help]

Thank you very much for taking the time to respond to my follow-up.  I was concerned that if for some reason I did have an sore, and didn't realize it, that when I received the cunniniligus, I could have gotten it from his mouth and would have put me at risk for contracting HIV.

I understand my risks are higher, incase of unprotected sex when I have an outbreak and my partner having something, that it could get into an open sore.  That's why I always make sure that I have a condom on BEFORE his penis goes near me.  

I do use Valtrex, so, that might be why I only have 1 outbreak a year.  It's a shame all the extra things I have to do, because of an unfaithful boyfriend.

Thanks again for your assistance.

[H. Hunter Handsfield, M.D.]

HIV rarely is in peoples' mouths or oral secretions, and it is probable that nobody in the world ever acquired HIV by receiving cunnilingus--with or without genital ulcers.  Don't worry about it.

HHH, MD

[anotherdummy]

Does an std not have to be present (ie, herpes outbreak/sore)to increase risk or do you simply have to have it in your system?

[H. Hunter Handsfield, M.D.]

In theory, the infection has to be "active", i.e. causing genital inflammation.  But for HSV-2, just having a blood test doubles the risk of getting HIV.  That's because most outbreaks are asymptomatic; that is, infection often is active and can increase HIV acquisition without symptoms.

HHH, MD

[skerdstraght68]

But for HSV-2, just having a blood test doubles the risk of getting HIV. That's because most outbreaks are asymptomatic; that is, infection often is active and can increase HIV acquisition without symptoms.

Can i dumb this down a little... How does hiv get in your body without any symptoms or open wounds?  Where would the entry point be?  IS HSV-2 obtained through the urethra?

[Much Needed Help]

What does "But for HSV-2, just having a blood test doubles the risk of getting HIV," mean?  I dont' understand this and it's making me nervous.  If  have my blood taking, I'm chancing getting HIV?  Sorry for being naive, but I'm really confused by this.

Thanks in advance.

[H. Hunter Handsfield, M.D.]

SG:  Isn't it obvious I meant having a *positive* blood test doubles the risk?  Sorry for the mistake, but SS68 understood it correctly.  Of course having blood drawn is not a risk for HIV or any other infection.

SS68:  The large majority of HSV infections are entirely asymptomatic, which has been addressed innumerable times on the STD forum.  This isn't the place to repeat all that.  Search that forum and read up on genital herpes.  

HHH, MD

[anotherdummy]

Yikes. That really worries me.  I have never had an outbreak but as you say many people have HSV2 without outbreaks (I have never had the blood test for it either).  This doubles the risk of getting hiv even if it is just in your system?  The STD clinic told me without lesions or open skin or gonnorhhea/ chlamydia then hiv is an almost nil risk.?  oh boy.  

[Much Needed Help]

Ok - I know that you indicated I don't need to be tested because my encounter was pretty much no risk, since the condom stayed and didn't break etc.  

However, my tounge is still burning (I didn't perform fallatio (?) on him).  Could this be linked to my encounter?  I can't get a doctor's appointment until tomorrow and I'm freaking out.

My sore glands and sore neck are gone and I haven't really had a fever, around 99.3 (and I just started my monthly on Saturday, so I think that could have raised it).

Should I be worried that the burning toungue has anything to do with my sexual encounter?

Thanks.

Sorry.

[H. Hunter Handsfield, M.D.]

There is no way your burning tongue is related to the sexual encounter you described, unless you got some sort of virus by kissing.  It's not HIV or any other STD.

HHH, MD

[Much Needed Help]

Thank you very much for responding.  

I've never encountered this kind of pain and dry mouth on my tongue before and was petrified it was connected somehow.  The only thing that seems to ease the pain is gargling with salt water.

And the encounter was exactly how I described, I didn't leave anything out.

Thank you very much, again.  I guess I will have to wait until tomorrow to see the doctor.

[Red Fish 88]

I'm very interested in finding out what you are told from your Dr.  I'm in a simiular situation.  I'm a male who had preformed oral sex on a female and also had oral to oral contact.  I then started having a burning feeling in mouth,throat and tongue(also white tongue).  I tested for hiv at 4.5 weeks and all STD's and 7.5 weeks for hiv, all neg.
I then went to an ENT Dr., who said I had an oral yeast infection or thrush.  He had said that I could have got it from either contact and they see normal and healthy people who have oral yeast infections on a regula basis.
Please let me know what you are told from your Dr.

Good luck

[Red Fish 88]

I also wanted to add that I had the sore and swollen lymph glands as you did to add to my worries during this period.

[Much Needed Help]

Red Fish

I did not perform oral sex on the guy (I'm a woman), he only performed oral sex on me.  For my case, I had a cut on my tongue, the doctor believes it was cut from an over-toasted bagel I had eaten.  It cleared up a couple days later with Glyoxide (OTC solution).

Based on what I've read over these last few months, if you tested negative for HIV at 7.5 weeks, it's pretty close to 100% reliable.  Many of Dr H's responses indicated by 8 weeks, you don't need further testing, unless you were in a high risk situation and that he's never had anyone have a test come up positive AFTER the person tested negative around 6-8 weeks.

Good luck to you.