Cunnilingus confusion

[Shea1012]

So I foolishly had cunnilingus and fellatio with a CSW earlier this week and though wasn't worried about it, anxiety got the best of me and after too much Internet reading, I found what appears to be a documented case of transmission between a lesbian couple (a woman from Philadelphia in 2003). This seems to contradict what I've read on this and other forums for years. I'd love to know if the Dr. has any comments?  Also, any reason to test for anything and can I safely have sex with my wife.

You guys do a great job and it has helped tremendously to read the archives. I am very curious on this specific issue.

[Edward W Hook, MD]

final answer.  Yes, since you already know you get cold sores, there is no reason to test futher.  EWH

[Shea1012]

So this cold sore is just bad luck to exasperate my guilt! I had a feeling. I have had occasional cold sores in the past (I've tested positive for hsv1 yets ago) so assume the pcr is not warranted then?

Thank you for helping. I will resume normal relations with my wife (once the cold sore is gone) after reading all you said. Also, I think it's extremely noble that you read what I sent, rather than dismiss it out of hand. Many experts would just dismiss what didn't jive with their knowledge.

[Edward W Hook, MD]

I reviewed the internet site you listed.  Please note that in all of these cases there were other factors involved including the sharing of sex toys which, when used immediately, may rarely lead to transmission of HIV.  None of this report in any way changes that there are no scientifically proven cases in which HIV was transmitted through cunnilingus.

Oral HSV would be quite unusual in this situation.  If you have not had cold sores in the past, you could get a PCR or HSV culture taken from the lesion (a blood test will not help).  If you have had cold sore in the past, then this is most likely a recurrence.  EWH

[Shea1012]

One more follow up: I have hsv1 orally. This act of stupidity was Wednesday night and now today (Saturday) I seem to be developing a herpes sore on my outer lip. Any real risk this is oral hsv2. Promise that's the last question. Thanks again

[Shea1012]

Please seethe attached link. You're comments have helped me relax, but this case is still a bit concerning:

http://mobile.aidsmap.com/Female-to-female-sexual-transmission/page/1323529/

[Edward W Hook, MD]

Thanks.  I'd be happy to review the internet link to be familiar with is since I anticipate that other clients may come across it as well.

Take care.  EWH

[Shea1012]

Thanks so much Dr. That really alleviates my worries. Simply due to what you do, if you would like, I can provide a link to that case discussion regarding the 20 year old in Philadelphia. Otherwise thank you for resolving my fears!  $22 well spent!

[Edward W Hook, MD]

I'm sorry, I mis-understood.  I am not aware of any cases of HIV acquired through cunnilingus.  The literature on transmission of any sorts of infections between women who have sex with other women is quite limited.  I am not aware of any scientifically proven cases of HIV transmission through cunnilingus or males receiving orals sex.  I would consider things read on the internet suspect.

I see no reason for you to either seek testing or to abstain from unprotected sex with your wife.  EWH

[Shea1012]

Dr. Thank you for the reply but I was not clear. The Philadelphia case was regarding transmission of HIV thru cunnilingus which this site says is not a risk. That's what I was questioning.

Separately my final question regarding intercourse with my wife. Would you care to address that? I have seen the dr's state that they would or wouldn't if they were in similar positions.

Is any testing recommended for anything at all?

Thanks again.

[Edward W Hook, MD]

Welcome to the Forum.  There has been a great amount of increased research on oral sex in general over the past few years and, as might be expected, the more one looks, the more one is likely to find infection.  This holds true both for cunnilingus and for oral chlamydial infections.  We now know that both do occur however the research has also confirmed that while such infections DO occur, they remain very rare.  At present, we can say with confidence that:

1.  Oral gonorrhea is much more common than oral chlamydia.
2. That cunnilingus is much less likely to lead to infection than fellatio.
3.  That oral infections of any sort are less efficiently transmitted to partners than genital infections (and always through direct contact).

Good questions.  I hope this comment is helpful.  EWH