Oral sex with thrush

[tmntfan]

HI DR. Hook and DR. HHH,
First,
Let me start off by thanking you for having such an amazing service here and for the great advice you give.
I'm not 100% sure that this is in the correct forum, but I couldn't think of it fitting anywhere else.
Three days ago I was the insertive partner in penile-oral sex with a gay male of unknown serostatus. He told me he was HIV-, but that's only so reliable. I noticed that his toungue was a a bit white (I don't remember it being patchy, but more of a coating). I immediately though thrush (and that it can bleed) and asked him if he thought he had any blood in his mouth, he said no (indeed, I don't remember seeing any blood, but I suppose there could ahve been some). I know that receptive oral sex would theoretically only be a risk is there was actually blood. I also know that saliva even inactivates HIV. My question I suppose is so outthere theoretical that it's just that, theoretical, but it revolves around the potential of thrush.

-He didn't seem to be in any pain and he didn't think he was bleeding.

1) If he DID have thrush, could the white patches rub off and start to bleed from something as simple as oral sex?
2) Would it not be logical to assume that he would have noticed bleeding if his potential thrush lesions started to bleed?
3) Does thrush usually hurt and if not, if bleeding were present you would probably know and it would probably hurt, right?
4) Assuming the VERY worse and there was a little blood, it is safe to assume that mixed with saliva such little blood would probably pose no risk anyways, correct?
Thanks in advance!

[Edward W Hook, MD]

Correct.  A white tongue is not always thrush.  Far from it.  Many smokers have "gray" tongues

If the thrush plaques are dislodged, sometimes they bleed, often they do not.  Either way, with or without removal, thush is commonly uncomfortable for those with it.  EWH

[tmntfan]

Thanks for your comments! Just to clarify, a white tongue is not always thrush, correct? I know he was a smoker, and after posting this I searched the net and found many, many pictures of thrush. He had what looked like just a bit of a white film on his tongue, and not white patches. You stated that thrush would suaully cause discomfort, but if it was to the point of bleeding (or if a white patch was removed), would it not be logical to think that such lesions, if bleeding, would be painful and you would know?

[Edward W Hook, MD]

From your preamble it appears that you are well informed about HIV transmission risks and for that I congratulate you.  Knowledge is power but, sometimes it is insufficient to overcome anxiety over potentially risky exposures.  Having acknowledged this, I will do my best to answer your questions, asking you do to follow with a long stream of "what if" questions.

Before we do however, let's also acknowledge that most people do tell the truth when asked and there and many more non-HIV reasons for having a white appearing tongue than there are HIV-related reasons.  Let's also acknowledge that most people with thrush do not have HIV.  Finally, let's also state out front that even persons with oral bleeding are unlikely to transmitt HIV through oral sex - it remains a low risk activity for HIV transmission.  Now to your questions:

1.  Unlikely.  It would have to be a very unusual situation.
2.  Absolutely
3.  Persons with thrush tend to be uncomfortable and would likely know if they have anything more than minimal bleeding in the mouth.
4.  Correct, minimal risk

Hope this helps.  The exposure you describe was very low risk, if there was any risk at all.  EWH