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Hepatitis B - STDs, Oral Sex and Symptoms
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Hepatitis B - STDs, Oral Sex and Symptoms

Thank you for your wonderful work here it is invaluable to many.

CIRCUMSTANCE:
- Risk: 30sec to 1 min of gentle unprotected oral sex (plenty of saliva) as insertive male partner by female CSW from SE Asia, where Hep B is more prevalent.
- No sores or blood evident on CSW mouth, inside unknown.
- No sores/blood present on penis after. Washed and urinated few minutes after.
- No other exposure aside from brief deep kiss.
- 28 days since event, no typical symptoms, (no swollen lymph, no sores in genital area, no discharge)
- 100% Clear of all STD's prior to event above

AREAS OF CONCERN
- History of  Oral HSV-1 couple times/year on right side of lip, occasionally  under nose, so outbreak location sometimes varied.

- 24 days after above exposure - small, slightly raised, pea-size irritation/swelling behind front right tooth on hard palate (after a night of very little sleep).  Slight pain typical of herpes outbreak usually on lip. 2 days in, area is now slightly uniformly red, as opposed to being slightly white tinted before. No swollen lymph nodes/fever.. otherwise feel fine aside from major anxiety. Guessing, it would seem typical of the usual herpes outbreak but on palate. In retrospect, MAY have had similar feeling before on hard palate but never examined area visually, as symptoms were mild and went away in about 4-7 days, and at that time there was no worry of any STD exposure risk hence no paranoia.

VARIOUS QUESTIONS:
1. Risk for acquiring HEP B/HIV? What if asymptomatic HSV-2 were present?
2. Would HEP B or HIV PEP have been recommended by a doctor?
3. Can primary Syphilis sore occur in the mouth if exposure was genital?
4. Is mild Herpes outbreak on hard palate so very rare normally, that it could indicate primary HEP B or HIV infection with absence of other classical symptoms (fever, ect.)
5. Would you personally recommend testing for HEP B or HIV for JUST the above risk, setting aside any psychological reasons to test.

Thank You Kindly!







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Welcome to the Forum. having just reviewed your interactions on other MedHelp sites, I think much of what I am about to say is conformation of what you've already heard.

You are correct that hepatitis B is more common in SE Asia however there is virtually no risk of HIV or hepatitis B from the exposure you describe.  It is really not likely on a statistical basis that your partner had either HIV or hepatitis B.  IF she did, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  As for hepatitis B, while perhaps theoretically possible, there are no reports in the medical literature of this EVER happening and it is not even mentioned as a theoretical possibility in medical textbooks (I looked).  You have nothing to worry about and no medical indication for testing for either infection.  As for your specific questions:

1.  Effectively zero risk, with or without oral HSV.
2.  No.  When PEP is given it should be given in hours, not days post exposure.  Further, you have not mentioned anything that provides a medical reason for PEP of any sort.
3.  Very rare and in your case, not a realistic possibility.
4.  No, you are worrying to much and getting to far into the realm of "what if"
5.  No, as I said, you have no medical reason for testing.  If you choose to get tested, be clear that it is for your peace of mind, nothing else.

Hope this helps.  EWH
3 Comments
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Avatar_n_tn
Hello Doctors,

Forgot this: have history of few cherry angiomas (little red pinprick capillary moles) here and there on body.. but counted about 20 all over my body now, i have no idea if i had this many 1 month ago (probably).. but read that it could be sign of bad liver function/HEP infection... the internet is a terrifying place when one is paranoid... sorry, and thanks again.
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Avatar_n_tn
Thank you very much, your answer was clear and helpful.

I do realize its mostly re-confirmation of what I already know and im being a bit irrational given that I am been fairly well educated on these matters...

Nevertheless it helps to hear it from you, and I am happy to have donated some cash to a good cause.

Take care and thanks again!


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H. Hunter Handsfield, M.D.Blank
University of Washington
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