Oral sex, Herpes, HIV......the lot

[sillybugger2]

I'm really sorry about repeating questions which I have seen answered previously, but, I suppose like everyone else, there are differences in my case.
I am currently in Singapore on business, and 5 days ago, I got completely drunk out of my head and had protected sex with a prostitute, but gave unprotected oral to her and she also gave unprotected oral to me. The session lasted a couple of hours, I don't really remember. The following day I felt a burning sensation down the shaft of my penis as if there was fluid down there. I also had a coated tongue and sore throat.
I went to the doctor who told me I had a yeast infection and not to worry. He gave me a wash and a cream to be used twice a day.
Yesterday I noticed that I now am developing cold sores (Herpes) around my mouth. I went back to the doc who gave me zoral cream. He has given me an appointment to go back to be tested for everything. I have also now noticed some bumps on my penis that I'm not sure whether they were there before or not. I have read somewhere that the existence of herpes can make a person more infective when they are HIV positive. I'm not sure about the yeast infection. I am going hme to my wife in two weeks time, who I have never cheated on before and I really am at my wits end. I'm not sure if I need counciling or medical reassurrance or facts. Can you tell me what you think. What are the chances first of the tests being accurate after 10 days? Also what do you think of the chances of HIV infection, considering the presence of herpes and yeast infections?
I much appreciate you time on this.

[H. Hunter Handsfield, M.D.]

Your risk for HIV was about zero, since your genital intercourse was condom-protected; fellatio rarely transmits HIV; and cunnilingus never does.  It is true that having genital herpes due to HSV-2 increases the risk of HIV if exposed to it; but you describe no symptoms to suggest genital herpes, and anyway, doubling a near zero risk still leaves near-zero risk.  HSV-1 infection has not been found to be associated with increased HIV risk.

Whatever caused the smptoms the following day had nothing to do with the sexual exposure you describe.  No STD causes symptoms in less than 24 hours, ever.

I cannot judge whether you actually have oral herpes; if you have had recurrent oral herpes and are having a typical outbreak, your self-diagnosis probably is accurate, but that's all I can say.  I also am not sure about the yeast infection; oral yeast infections are not common in healthy people, although they occur from time to time. I also cannot comment on the "bumps" on your penis; you'll need to be examined for diagnosis.

You don't specify which STD tests you are concerned about at 10 days.  That's plenty of time to test for chlamydia or gonorrhea; but too early for HIV (4-6 weeks), syphilis (6 weeks), or herpes (2-3 months).  But you can relax about HIV; there's no chance of it from the exposure you describe.

Good luck--  HHH, MD

[carnageofthepast]

Your risk for hiv is zero.

You could have acquired other STDs but the risk is really low since you used a condom.

[sillybugger2]

Thanks you very much for your comments.

I do actually suffer from cold sores on occasion, however, at the moment, the outbreak on my face is alot worse than before. I am also suffering from what could be called "flu-like" symptoms. All this said, I think I have to resign myself to the fact that I have picked up HCV-2 orally at least, but I guess this will also have to wait for the tests along with everything else.

In short, if anyone else is reading this, the only advice I can give is, "DON'T DO IT, IT'S NOT WORTH THIS"

Thanks, and keep up the good work

[monkeyflower]

I seriously doubt you've picked up HSV2 orally at all. While you can contract it orally, it's not common - HSV2 doesn't really "like" the mouth. I think you're just way overstressed and anxious as a result of feeling guilty.

[sillybugger2]

Apologies, should have said HSV-2 not HCV-2 in my last post.

I'm hoping that it's just the stress of it all that has triggered an exaggerated oral herpes HSV-1 episode.

My fingers are crossed on this one.

If the thread stays open long enough, I'll let you all know how I get on.

[sillybugger2]

Thanks Monkeyflower, you are correct (not that I doubted you).
I found a great article called "The Truth about HSV-1 and HSV-2" http://www.herpes.com/hsv1-2.html

I'm just hoping that I am not one of these exceptions to the rules.

[idiotparty]

Sorry for asking but when you mean genital herpes increases the risk of HIV, what about unprotected fellatio after a recent herpes outbreak (cleared up)??

[H. Hunter Handsfield, M.D.]

SB2:  You probably have a recurrent oral herpes outbreak that by coincidence happens to be worse than most of your other ones; it has nothing to do with the sexual exposure you describe.  Oral HSV-2 is rare, so is unlikely.  Contrary to popular beliefs, stress does not increase the risk of herpes outbreaks and probably does not make them more severe.

IP:  The relationship between HSV-2 and HIV acqusition probably is all related to vaginal and anal sex; there is no evidence herpes increases the almost zero risk of HIV acquisition by oral sex.

HHH, MD

[idiotparty]

Thankyou Doctor this forum for me has been absolutely amazing, such strong support from everyone, it really does help.

Regards

[sillybugger2]

Just another question.
If I already have HSV-1 infection orally, can kissing someone who has oral HSV-1 or having oral sex with someone who has HSV-1 genitally, worsten your infected area i.e. can this further spread the herpes around your face or would you have a certain amount of immunity to this?

Sorry for dragging this out, but I'm finding it hard to believe in the coincidence that just 5 days after having oral sex with a prostitute, I get my worst (that I remember) outbreak of coldsores.

[sillybugger2]

Sorry about this, but could you also confirm the following please:

A. If I already had HSV-1 Orally, then I cannot get HSV-1 Genitally?

B. It would be unusual that I was infected by HSV-2 genitally from oral sex received by me from someone else because oral HSV-2 is both rare residing in the mouth and infections don't usually reoccur?

C. It would be unusual that I was infected by HSV-2 orally from oral sex given by me on someone else because it is rare that HSV-2 is transmitted to the mouth.

So the big risk is from genitals to genitals for transmission of HSV-2?

I'm sorry for being so pedantic about this.

Thanks again.

[moet]

Hi: Sure Dr. will answer shortly but will take a crack at it. Sure he will agree, since I have also been concerned with all of this and there are lots of threads to become quite proficient:

1.) You cannot get herpes genitally if you have it orally for the reasons you describe.

2.) I suppose it is possible to be infected with HSV 2 genitally as you describe but very unlikely for the reasons you describe.

3.) ditto for orally but I suppose possible.

Hey, I recently got HSV 1 vaginally (never an outbreak yet) after 1 rendevous of unprotected sex including oral. He did admit to me later that he gets "cold sores" once a year but didn't have one. That was my "good fortune" after 10 years of condoms ;(

Hey, really appreciate that website you refer to, think it is VERY informative. Don't need more than that!!

Good luck to you!!

[sillybugger2]

Hi Doc

Unfortunately things have got worse for me.
I have started to have discharge now from my penis both clear and white/yellowish fluid.

The bumps I mentioned in a previous post have now (I think) started to get bigger and weep and the area is generally stinging and sore, even though I have been applying zovirak on both penis and mouth. It really does look like herpes, although the outbreak on my mouth is clearing up without scabbing over.

I'm really starting to panic now as my mind is racing.
If I could have picked up thrush, gonorrhea and/or chlamydia, and herpes from just unprotected oral sex, what else could I have picked up?

I have got two more full days before my appointment on Tuesday morning and I'm not sure how I'm going to get through them.

With all 3 STDs present, do you still think HIV is a low risk for me?
Considering also that thrush seems to be an early sign of HIV so it's possible that the girl that I was with was infected.

Hope to hear from you soon on this. Thanks very much for everyone who contributed on this thread.

[w20870]

Please I want your Kind opinion on the below data regarding insertive oral sex as many people including me are freaking out.

Risk Estimates published by the CDC in their new PEP guideline document (January 21, 2005):
(http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm)

Exposure Route Risk per 10,000 exposures
to an infected source

Blood Transfusion 9,000
Needle-sharing 67
Receptive Anal 50
Percutaneous Needlestick 30
Receptive Vaginal 10
Insertive Anal 6.5
Insertive Vaginal 5
Receptive Oral 1
Insertive Oral 0.5

Primary Source of the estimates:
Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW
Quantifying the reduction in risk for HIV infection by choice of partner, sex act and condom use

METHODS: We constructed decision-tree models to calculate the overall relative risk (RR) for HIV infection using estimates of HIV prevalence; risk of condom failure (5%); sensitivity (97.9%) and specificity of HIV test for infection (99.9%); per-act RR of HIV transmission from an infected partner: insertive fellatio (1, referent), receptive fellatio (2), insertive vaginal sex (10), receptive vaginal sex (20), insertive anal sex (13), receptive anal sex (100). Absolute risks were calculated using our RR estimates, based on a per-act risk of 0.1% for male-to-female HIV transmission during unprotected receptive vaginal sex.
================================================================

  
The authors state "Although there are few data on relative risks of fellatio (oral-penile contact), most investigators suggest that it is safer than vaginal sex. We assumed that insertive fellatio was 10 times less risky than insertive vaginal sex and receptive fellatio was 10 times less risky than receptive vaginal sex, per act." Thus, they categorized insertive fellatio as the safest of the sexual acts they were addressing, giving it a relative risk of 1. That makes it the comparator against which other acts were compared, so that receptive anal intercourse had a relative risk of 100, making it 100-times riskier. Then, in order to convert the relative risks to absolute risks, they "estimated" that the per-act transmission from an infected male to an uninfected female during unprotected vaginal sex was 0.1%, so the risk for all other sexual acts was then calculated base on the relative risk they had previously assigned, which is how they came up with 0.5 per 10,000. By the way, on their relative risk table, where they assign a relative risk of 1 to insertive oral sex, there is a footnote that says "best-guess estimate."

That means we are all dreaming of no risk related to insertive oral sex ?

[H. Hunter Handsfield, M.D.]

The MMWR article the generally accepted expert opinion of essentially zero risk of HIV transmission from mouth to urethra by fellatio.  The authors (2 of whom are close colleagues of mine at CDC) arbitrarily assigned a value of 1 to the exposure believed to have the lowest risk of all possible routes of HIV transmission.

HHH, MD

[H. Hunter Handsfield, M.D.]

The MMWR article documents the generally accepted expert opinion of essentially zero risk of HIV transmission from mouth to urethra by fellatio.  The authors (2 of whom are close colleagues of mine at CDC) arbitrarily assigned a value of 1 to the exposure believed to have the lowest risk of all possible routes of HIV transmission.

HHH, MD

[sillybugger2]

I'm hoping that little bit of thread hijacking hasn't distracted the good doctor from my concerns. Sorry to be pushy.

[w20870]

Thanks Doctor for your precious time,
I posted the CDC report just because i was wondering  why the hell not all doctors are great like you and just say  insertive oral sex carries zero risk of HIV  infection and put our minds at ease, why they name it low risk in many forums?.

Specially in one of the most famous forums
The PHD said to one guy : you should wear a condom while having sex with your wife until you get tested after 1 insertive oral sex incident with a stranger .
What raises my concern that the answer was by the most famous Italian American HIV+ doctor who is having scene of humor as many people think.
That’s why i went through CDC site and i posted that information

Silybugger2 believe me I was living your same nightmare may be more as I am a husband to a wife and waiting a new baby and pregnancy happened after my insertive oral sex incident with a stranger, until I visited that web site yesterday and the doctor H.Hunter put my mind at ease, so don’t ever think that I am trying to drop a bomb and run a way, I wish you all the luck and nice meeting you.

Thank you doctor I really can’t find words that i can thank you with.
And sorry for my poor English

[sillybugger2]

No worries w20870, it was a very interesting posting anyway.
Congrats on your baby by the way.
Hopefully soon I can put my foolishness behind me like you have and pick up the pieces of my life.

Good luck for the future

[w20870]

Sillybuger2 by the way thank you for the advice i agree with you 200% (DON'T DO IT, IT'S NOT WORTH THIS")

Good luck buddy, just let us dont think about it.
The good news is that :there isn't a single 1 documented case in CDC for such incident and i don't think we will be the first 2 :)  

[sillybugger2]

Thanks bud, that's most sensible, reassuring thing I have read all day.
The best thing about the Internet is the amount of information available.
The worst thing about the Internet is the amount of information available.

[Scared Sick?]

Hey Sillybugger2.  First, my best wishes go out to you in your situation.  I am in a similar situation, except that my incident took place in Shenzhen and not Singapore.  It does sound like you will come through this OK.  Please keep us posted on your outcome.  One thing to keep in mind is to carefully monitor your alcohol intake.  Asia is amazing for the numerous young, attractive gals who want to earn a living by being a prostitute.  When you drink too much alcohol, your defenses and judgement go away.  As males, it is simply too hard to say no when we are drunk and loney on a business trip thousands of miles from home.  So...  I suggest that you stop drinking while on business in Asia.  Easier said than done, I know.  If you can't stop all-together (as I am going to do), then you should stay away from rice-wine, saki, and other hard liquors often served in Asia.  Drinking Tsing-Tao or some other beer will likely take much longer to get you drunk and should allow you enough time and sense to stay away from another dangerous situation.  

Anyway, that is my only advice to avoid a similar situation in the future.  Like you, I have to go back to Asia on occasions and I need to change my behavior to avoid a repeat incident.

Best of Luck!

[sillybugger2]

Thanks for your kind words and support.
I'm still not convinced that from a risk perspective, I am out of the woods yet, and there is a long way to go until I am sure.
I still cannot believe how stupid I was to do the act and also how unlucky I have been with the symptoms I am showing now.
I have stopped drinking altogether since the episode 8 days ago which is very good advice, but unfortunately I am eating very little also. I just cannot bring myself to take food.
I am sick with worry and guilt.
I have already got herpes now from this incident so i will have to definitely tell my wife what happened and am not sure whether she will leave me as a result.
The HIV test will be 12 weeks away and I don't know how I will cope over Christmas with this hanging over me.

I'm totally crushed.

Of course I will let you all know how get on. There are such great people who are memebers of this forum, I thank you all and especially Dr HHH.

Before the thread ends, hopefully the doc will come up with a cure for HIV, Herpes and maybe cancer if he has the time :)

[H. Hunter Handsfield, M.D.]

SB2:  If you really are having urethral discharge, get examined immediately to check for gonorrhea, chlamydia, and NGU.  But you need not wait 12 weeks for HIV testing.  Almost all persons with newly acquired HIV develop positive tests by 6 weeks, and most do so within 4 weeks.  Waiting 12 weeks is silly.

w2:  You ask why don't other experts "just say insertive oral sex carries zero risk of HIV infection and put our minds at ease, why they name it low risk in many forums"?   It is impossible to prove a negative:  Absence of proved transmission does not prove it cannot occur, only that it hasn't been well documented yet; if there is risk, it is unmeasurable, low enough to consider it zero.  But scientists and lawyers generally avoid making absolute statements in the absence of absolutely reliable data.

HHH, MD

[sillybugger2]

Hi Doc

I have been getting headaches, shivers, hot flushes and my arms and legs are aching all day.
I went to the doctor yesterday and he took blood, urine and swab tests. The test results should be back tomorrow afternoon, hopefully.
I know it's too early for herpes, HIV and Syphillis tests to return anything, and over here, they will not treat you until they see symptoms or test results.

My questions is, do the symptoms I am demonstrating, indicate viral seroconversion of some kind?
Also, should I insist that I am treated for Syphillis before I leave or will waiting make any difference?

Thanks again.

[idiotparty]

I have been reading this post as it is very much like the scenario i was involved in....i have had genital herpes for some time now, are you saying that this has increased the risk of hiv infection even if there were no symptoms at the time? or does it matter at all?? im worried more now