Unprotected Oral with Canker Sore

[pavlik406]

Hello Doctors,

I have posted about this in another section but have not received a reply yet and am not sure it's the right section. Two nights ago, I went home with a guy of unknown status (22 years of age) I met at a club. We mostly just masturbated each other, but unprotected oral sex was also involved. I only very briefly performed it on him - I only put the head of his penis in my mouth twice, for no longer than 10 seconds. I am concerned, however, because I had a two-week old canker sore on my lower lip. There was no ejaculation with the oral, and I could not see nor taste any pre-cum either.

Should I be concerned about this episode and get tested? I last got tested two months ago, but am actually in a long-distance relationship and I am visiting my boyfriend in two weeks and wondering whether I should be worried? I tend to get paranoid about HIV and oral sex, even though I try to limit the risk by not doing it for long (mostly just licking) and never having ejaculate in the mouth. I am feeling guilty about this episode and don't want to have ruined my relationship by having put my health at risk.

Thank you very much for your help.

[H. Hunter Handsfield, M.D.]

No change in my opinion or advice.  Even if your partner had said has HIV, it wouldn't change anything.

[pavlik406]

Thank you very much for the reassurance. You are right about me having to deal with my guilt as a separate issue. I saw the guy again - though nothing happened - and asked him if he knew his status. I think he's never got tested but claims he always uses condoms. He seemed to behave in a rather promiscuous way with a lot of guys at the bar, however, so I'm not extremely confident he is as clean as he claims to be.

If you confirm this does not change your opinion, I will start tackling my sense of guilt separately and move on in terms of HIV fear...

Thanks again, you've been extremely helpful!

[H. Hunter Handsfield, M.D.]

Thanks for the clarification; I'm satisfied your oral lesion was aphthous stomatitis (canker sore) and not herpes.  However, it doesn't change my opinion or advice.  Not only do I not recommed PEP, on the basis of the risk level I don't even recommend HIV testing.  And I certainly would recommend against testing if you speak with that partner and he confirms he doesn't have HIV.  Any HIV testing you do is strictly for its reassurance value, i.e. if a negative test result will help convince you that you weren't infected.

That said, there is a slightly higher risk of STDs, especially oral gonorrhea.  It would not be unreasonable to see your local STD clinic, or your personal physician, for a throat swab to check for gonorrhea.  However, this too is very unlikely.

As for your "I just can't cope" statement, don't confuse your emotions about a sexual choice you regret with HIV risk.  They aren't the same thing.  Deal with the former as you need to, but don't worry about the latter.

[pavlik406]

Thank you very much for the prompt reply.

I'm sorry I explained myself badly, it was inside my lip, I got it two weeks ago after I bit myself whilst eating. I get canker sores fairly often, I'm afraid, but I definitely don't have oral herpes (unless I got it from this encounter).

I promised myself I wouldn't get too paranoid about this incident, because I only put the actual penis in my mouth for seconds and there was no visible pre-cum, but now I'm super concerned and am struggling to cope with the possibility of infection. I am always very careful, always use condoms - and generally only have anal sex with people I have been seeing for a while - and never let someone come in my mouth. I normally ask the status too, but this time I did not for some reason...

Would you recommend to get tested on this occasion? I am guessing PEP would not be warranted? I just can't cope with the fact I might have done something very reckless...

Thanks again.

[H. Hunter Handsfield, M.D.]

Welcome to the forum and thanks for your question.  The advice on the HIV international forum and on this one is always pretty much identical. You didn't need to pay for both, but what's done is done.  In any case, you can expect to receive a similar reply there.  The bottom line is that you are not at significant risk for HIV from this event.

Canker sores do not occur on the outside of the mouth, e.g. on the lip.  I am concerned your lip sore is oral herpes. Have you had similar sores before? Did it start as a blister-like or pimple-like lesion?   Also, canker sores typically heal before 2 weeks, but herpes can last that long.  If indeed you have oral herpes, then by far the main risk here is the possibility of genital herpes for your partner.  After two weeks, likely it was healing and you may not have been infectious.  Still, you'll need to tell your partner.

While you're at it, you can ask him about his HIV status.  Most likely he would have told you if he has HIV, so probably he isn't infected.  But even if he is, oral sex is extremely low risk for HIV; for the oral partner, the average risk has been estimated at one transmission for every 10,000 events -- equivalent to fellatio by infected partners once daily for 27 years before transmission might be likely.  Given the brevity of the exposure and no ejaculation in your mouth, probably your risk is lower still.  Oral herpes (due to HSV-1) does not increase the risk of HIV, and probably canker sores also do not.  So that aspect doesn't change your low risk.

My final advice is that in the event of future sex with men other than your regular partner, you discuss HIV status before having sex, even safe sex like oral -- and avoid contact with those who are positive (and not on effective treatment), don't know, or seem evasive about it.  In the long run, this is almost as important to prevent HIV as avoiding unprotected anal sex.

I hope this has helped.  Best wishes--  HHH, MD