STDs Expert Forum
Protected Oral - Risk Factor (HPV/Herpes)
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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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Protected Oral - Risk Factor (HPV/Herpes)

A few days ago I had a sexual contact (erotic massage).  She gave me protected oral sex with/condom she put on with her mouth and I completed within the condom. There was no unprotected oral, nor vaginal/anal sex of any kind.
I have no visible symptoms of any kind.  I do have spots on my penis & testes that resemble Fordyce’s spots, but I have had those for years.

1. I have read other posts that most STDs (HIV, etc) are very low risk from receptive oral sex and almost 0% from protected oral sex. No testing is required, correct?

2. Herpes or HPV (skin contact diseases).  I see no effects for herpes 3 days later, I saw no open sores, and I believe she did not go past the rubber line with her lips, even though she did lick the testes at one point.  Question: If I see no symptoms in the next day or so, herpes is unlikely correct?

3. What is the risk of receiving HPV via this encounter?  Again, I think it is unlikely via receptive oral (especially protected), but it is worth mentioning.  I know that this can’t be reliably tested in males.

4. Am I safe to have sex with my girlfriend at this point without exposing her to risk of herpes or HPV?  

  a. Background:

    1. We are having relationship problems & undergoing counseling about our sex life.  I have discussed this encounter with my psychologist and she has said that, as a one time failing, this is a thing to simply not tell her & not do again.  

   2. I am loath to have sex with my GF due to exposing her to risk if it is a real concern.  However, our primary relationship problem has been her inability to have sex, so I don’t want to miss a (rare) opportunity while we are undergoing counseling…

5. Any risk factors that I am missing here?

6. Prognosis, any testing?  Proceed as normal with my girlfriend?
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239123_tn?1267651214
Welcome to the STD forum.  The bottom line is that you were not at significant risk for any STD, including HPV and herpes.  Directly to your questions:

1) Oral sex is very low risk even without a condom.  With a condom, it isn't just "low risk", but zero.  No STD can be transmitted through an intact condom membrane.

2) HSV has to be massaged into the tissues in order for infection to take hold.  Brief contact with your scrotum doesn't risk anything.

3) Zero risk for HPV, which is generally not transmitted by oral sex even without a condom.  Even people at highest risk for STD, and those with genital HPV infection, usually don't have the virus present in their mouths.

4) Since it was not possible to catch an STD from this exposure, obviously you cannot have an STD from that event that you could pass to your partner.

a 1 and 2)  No comment.  These are relationship issues.  This forum deals strictly with STD risks.

5, 6) These are the same questions as above, in different words.  The replies are the same.

Here is a thread that explains the biology of STD/HIV transmission, which includes the scientfic reasons that exposure like this carry no risk.  Start reading with the follow-up comment dated December 14:  http://www.medhelp.org/posts/show/1119533

Regards-- HHH, MD
7 Comments
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Avatar_n_tn
Doctor, thank you for your analysis.  It is much appreciated.  

I only ask for one point of clarification.  

I did some research online through the CDC and found this website (http://www.cdc.gov/hpv/WhatIsHPV.html) with the quote "HPV may also be passed on during oral sex and genital-to-genital contact."

and a similar page (http://www.cdc.gov/std/HPV/STDFact-HPV.htm#common) with the quote that "condoms may lower the risk of HPV... But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV."

Now I also read the thread that you linked.  Very informative thread (thanks for that).  It says the real issue is that skin diseases of the herpes/hpv nature "they must be massaged vigorously into susceptible tissues, often with microscopic trauma (syphilis, HSV, HPV)."

So I see a potential disconnect between the CDC's position and the one you (as a highly respected expert in your field) are stating.  However, the more I read about it, I think the CDC's position has more to do with unprotected oral sex and or prolonged exposure to the area below the base of the condom (not a fleeting glance).  This makes both positions reconcile (to this lay person)

>>>>>>>

Clarifications:

A. So would it be correct to say that you do have a small chance of catching HPV through receptive oral sex, but it is very unlikely do to the (1) condom and (2) the provider knowing to not drift below the line of the condom?

B. Also, do most people that actually have HPV also have it in their mouths as well?

Thanks for the follow up, very sorry on the length.
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Avatar_n_tn
Also, please note that the clarification request above should not reflect any lack of faith in the abilities of your diagnosis as a highly respected doctor.  This is a great service for people with somewhat private health problems.  Thanks again.
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239123_tn?1267651214
There are lots of uncertainties about HPV and its epidemiology, and research could make some aspects of today's knowledge wrong.  And in the absence of definitive data, alternate opinions are easy to find.  The harder you search for information, the more likely you will find potentially conflicting replies.  As for your two additional questions:

A) Any risk of HPV transmission from mouth to genitals is theoretical.  I am unaware of any reported proved transmissions by that route, even without a condom. Probably it doesn't make much difference whether or not the oral partner is "careful" to avoid contact above the condom.

B) See my reply to no. 3 above.  Only a few percent of people with genital HPV have the same infection in their mouths, and usually in small amounts that may not be transmissible.

Thanks for the thanks about the forum.  But that will do it for this thread.
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Avatar_n_tn
Closing issue for anyone who reads the thread on a search:

1. To double cover, went to both free clinic in city and my general practicinor in the city to talk about my exposure and my symptoms.  Both heard the same account as Dr. HHH and said the same thing.  Any risk was, at most, theoretical and I was cleared medically and ethically to pursue normal sexual relations with my partner.

My GP (in the course of my yearly checkup) said that if I was still worried, we could do the Herpes blood test at 3-4 months, but he felt that my risk exposure was so low that it was a theoretical point anyway.  He would encourage it only if I was worried.

2. The point was also raised that a CSW would probably know the score and not drift below the condom line b/c they are probably just as aware as the rest of us of STD risks and would be loathe to expose themselves unnecessarily.  This is a further risk downgrade.

3. A quick search of the Herpes experts forum will also explain that this is a low risk encounter that has a theoretical exposure, but not a mathematically significant one.

4. 8 days past, no symptoms of any STD.  So I should be safe.

>>>>>>

My only concern left is the point is raised that some herpes contractions can be asymptomatic.  With this in mind, I may get blood tested at 3 months (November).  Anybody want to comment on whether or not this is even a good idea?

MY GP says I worry too much.  But this already knew.

Best to all,

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Avatar_n_tn
I have curiosity on this question.

I DO have fordyce spots and shaved my penile shaft for the first time 12 days ago (day after, I have shaved lower and rest of area before) and experienced some razor burn along the shaft and the fordyce spots.  

So, my questions are:

1. Herpes first outbreaks, usually occur in the 7-10 days after exposure, and are marked by sores and intense itching, NOT low grade razor burn / itching, so we're still not thinking herpes correct?

2. Since I've never shaven this area before, is it normal to have some razor burn on fordyce spots?  

I'm just curious b/c usually I will get razor burn in I trim the genital area, but it usually doesn't last for more than a few days.  However, on a visual inspection, my GPractioner said (7 days after, 6 days ago) that there was no evidence of anything besides the fordyce spots.  I think I would know that the difference between fordyce spots and herpes.  There has been no change of condition since this visit.

'm guessing it's just razor burn (that I am more aware of due to the concern I am showing the area), and not herpes (since the pain would be FAR more, there would be visible evidence, and there would be a change in the appearance of the area.  I am using cortizone cream to help out the itching.

Any thoughts on this theory as it relates to the original post?

Thanks!
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239123_tn?1267651214
"That will do it for this thread" meant what it said.  I have no other comments.  The answers to these additional quesitons are obvious; since you could not have caught herpes, any symptoms you have are not herpes.  I have no way of judging razor burn; only you can do that.

Any more comments and the entire thread will be deleted.
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