oral sex with mouth ulcer

[gwenk]

I have a question about the risks of performing oral sex. I had an encounter about a week ago where I performed fellatio on someone for about 3 minutes. He did not ejaculate in my mouth & I didn't taste any precum. My concern is that I had a mouth ulcer on the inside of my lower lip from the previous day. It wasn't bleeding , but it was definitely sore. I was wondering if this would be considered a "portal of entry" for HIV or hepatitis, though?? Does it take a substantial amount of fluid (like something I would notice) for the virus to transmit or is it like getting pregnant where all it takes is 1 sperm??

A month earlier, I had another encounter with a man where I performed oral sex, he did *** in my mouth and I spit the *** out immediately. I got tested for HIV with a rapid test & hepatitis 1 month after this encounter. Do you think that's sufficient to say I was not infected by this incident?

I had decided for myself about a year ago that to lower the risk of STD transmission & my subsequent panic every time I had intercourse (with or without a condom), I would just stick to oral sex. I seem to panic whenever I have oral sex, too, though. Are my anxieties about these 2 incidents realistic or am I over-reacting??

Please let me know your thoughts.
Thanks!

[H. Hunter Handsfield, M.D.]

Your risk of acquiring HIV by oral exposure to guys' penises is low, with or without ejaculation.  But it isn't zero, and you are right that exposure when you have an oral ulcer probably raises the risk.  But if you double a teensy risk, the actual chance of infection remains teensy.  And presumably you don't have any particular suspicion that your partners are HIV positive; obviously the risk is higher if the guy is bisexual, an injection drug user, etc.  Presumably the risk of disease is slightly (but only slightly) higher if there is overt exposure to semen.

Most ulcers inside the mouth are canker sores which, as far as we know, aren't due to an infection and can't be transmitted.  Still, you should avoid oral sex when you have such lesions.  My concern is less for your health than your partner's:  if your oral lesion actually were herpes or syphilis, you put him at risk.

So yes, you're probably over-reacting a little bit.  On balance, remember that oral sex indeed is safer than genital intercourse, both respect to STD/HIV risk and, of course, pregnancy.

[gwenk]

Hi Dr,

OK..I had an oraquick test done at 30 days past exposure. It was negative. I am still concerned, though. Are the Oraquicks conclusive after 6 weeks, or do I need to wait longer? I got tested at GayCityHealth project & they said the window period was 3months. The CDC says it was 6 months when I called them a few days ago. I'm confused.
Gwen

[gwenk]

Thank you,

I know that the mouth ulcer was because I bit my lip the day before...not because of Herpes or Syphilis. I freaked out & we both got tested for HIV 1 & 2 a few days later. Both test results were negative, so that is probably an extremely low risk , right?

Do you feel that a negative test result 1 month after an oral sex incident with a heterosexual, non IV-drug using male should be considered conclusive? Or should I  keep testing out to 6 months?

Also, does it take a substantial amount of fluid to transmit the virus, or is it just a teensy bit??

Gwen

[H. Hunter Handsfield, M.D.]

There are no data on "amount of [infected] fluid" that changes the risk of HIV infection.  It makes sense, but no data exist.

See many other threads about timing of HIV tests.  Over 90% of HIV infected persons will develop a positive test within 4 weeks.  Since your risk of HIV from the exposures you describe probably is no higher than 1 in 100,000, a negative result at 4 weeks will make your odds of having HIV around 1 in a million.  If you want even greater reassurance than that, get tested at 3 months as well.  No matter what, 6 months isn't necessary.

HHH, MD