A Wee Bit of Anxiety--Please Help

[jimcasy]

Hey Docs,

After a rather messy break up from a year ago (no intercourse since then), a rather strong dose of cynicism and, of course, desire took over and I visited a CSW today.  It involved deep kissing, protected fellatio, unprotected cunnilingus, and protected sex.  I did notice a certain amount of redness on her lip (mouth) and asked her afterwards if it was, in fact, herpes.  She said no, just acne.  Should I now consider myself at risk for anything?  A lot of my anxiety has to do with the redness on her lip.  Understand, that I don't, at all, consider her some harbinger of disease.  She's a human being just like all of us and deserves as much respect.  Nonetheless, my anxiety for all the activities above including the kissing has me rather worried.  I apologize if, perhaps, my questions are bit redundant within the context of this forum.  Thanks a great deal for your help.  

All The Best,
Jim

[Edward W Hook, MD]

Your risk from the exposure you describe is very, very low.  In general the acts and protective steps (i.e. condoms) you took are highly effective.  When you combine this with the fact that she probably did not have any infection (most CSWs do not) and that most exposures to infected partners do not lead to infection (this is a biological fact), your risk of any STD (HIV Included) is very, very low. Let's work through things on an act by act basis.  

Kissing.  Only concern here is that the redness on her lip might be an unrecognized cold sore.  If this is the case, there is some small risk that you might get HSV-1 from the exposure although the odds are pretty good that you may have HSV-1 yourself in the past and, if this is the case, you are at no risk at all (most people who have HSV-1 do not know it).  Otherwise no risk.

Condom protected fellatio.  No risk.  Condoms work.

Unprotected cunnilingus.  Unless she had visible genital lesions or sores, the only risk here is for getting gonorrhea, if she had it (which is unlikely).  Gonorrhea however is rare and poorly transmitted through cunnilingus.   No other risks including HIV.

Protected genital sex.  Again, condoms work.  Virtually no risk.  Personally, I do not even see a medical reason for you to pursue testing to be sure that you were not infected.

Hope this helps.  EWH

[jimcasy]

Thanks a lot Dr. Hook for allaying my fears and anxieties.  Both you and Dr. Handsfield are really doing gracious and exceptional work that I'm sure can be quite thankless at times given the social stigmas associated with STD's.  

Take Care,
Jim