Oral aphthae and receiving oral sex

[silviotoni]

Dear doctor

Please don't delete my question since I browesed through archives for hours and couldn't find the answer.

I am a gay male.Yesterday I had sex with another bisexual male. We had protected anal sex (with condom). But prior to anal sex we had oral sex. I received oral sex from him and I gave him oral sex. I tasted his precum in my mouth at the begining. He did not ejaculate in my mouth. When I came home I noticed a had an aphthae at the interior of my lover lip in the mouth mucosa. This aphthae was whitish and redish, from several days ago as I bit myself chewing. You know how you get those when you bit yourself and it takes few days to heal and it stings from time to time but it doesn't bleed.

Since one episode of receiving oral sex without ejaculation carries very very low risk for Hiv transmission, would this mouth lesion in my mouth significantly increase my risk? Do I need PEP and testing ?

Kindest regards
Silviotoni

[H. Hunter Handsfield, M.D.]

The risk of HIV acquisition undoubtedly is higher in the presence of apthous ulcers than otherwise.  However, given how common oral sex is and how commonly people have canker sores, bleeding gums, or other intra-oral lesions, and how rare oral sex explains new HIV infections, the risk must remain very low.  But there are no definitive data on this. Personally I would not recommend PEP in this circumstance, unless you knew your partner had HIV.

Your username is familiar.  Note forum rules, maximum 2 questions in any 6-month period.

HHH, MD

[silviotoni]

correction!

I meant since one episode of giving oral sex (NOT RECEIVING) since I gave him oral sex with my mouth and aphthae in it. I hope I made may correction on time for you to see it . please confrim whether you saw the correction.

[silviotoni]

sorry doctor being so anxious i even made error in the title

TITLE SHOULD BE: GIVINIG ORAL SEX AND ORAL APHTHAE

One gets so easily confused with giving,receiving, geting etc etc.
I will I was asexual, life would be some much easier to me:)

Thank you.

[H. Hunter Handsfield, M.D.]

I knew you were the giver of oral sex.

[silviotoni]

Thanky you very much for your answers and kindness.
P.s. I am aware and will obey the 6 months rule. Thank you.:)

[WorriedWell5]

I'm a little confused -- If his partner was known to be HIV positive you would recommended PEP for unprotected receptive oral without ejaculation??

[H. Hunter Handsfield, M.D.]

Usually not, but that's not the question that was asked. As I have pointed out many times, forum users should interpret my replies strictly as resonses to the specific question. Don't look for meanings in what I don't say! A hair splitter can always find nuance if s/he looks for it, and I don't parse my words in the detail you infer.

[WorriedWell5]

Please excuse my hair-splitting interpretation, I imagine it is a product of anxiety and recent events.

[silviotoni]

Another answer that could be given to worriedwell  could be that various doctors can give various reccomnedations for the patiens in "gray area" and all beiing right. You never said it wasn't a low risk, but taken oral lesion and if he was known positive you would think of PEP.

On the other hand  I found that in San Francisco CIty Clinic they do not offer PEP to people exposed to HIV through oral sex regardless of the circumstances.

Kindest regards and thank you.

[WorriedWell5]

I have seen recommendations vary. Dr. H's reponses seem heavily weighted by sexual orientation which is understandable considering his experience and hiv prevalence among specific populations. If you were a female engaging in receptive oral with a presumably hetero, non injection drug using man I would expect his response to be much different.

In regards to PEP guidelines, please see the below link, specifically San Francisco DOPH Recommendations for Treatment table halfway through the article:

http://www.thebody.com/gmhc/issues/julaug99/pep.html

[H. Hunter Handsfield, M.D.]

Individual providers and perhaps both professional and non-professional opinions on websites etc might recommend PEP after oral sex, but few if any health departments or other prevention agencies do so.  The risk of a serious health outcome from the treatment probably is higher than the chance of catching HIV by oral sex, with or without ejaculation.

Of course my responses are "weighted toward sexual orientation", to the extent that the sex of partners influences the likelihood of HIV exposure.  The chance someone is HIV positive is 100 times greater for a randomly selected man who has sex with other men than for a randomly selected strictly heterosexual man or woman.  But if a person has performed fellatio on someone known to have HIV, gender or sexual orientation would make no difference in my reply.

[silviotoni]

So sir

accoridnig to your opinion an oral apthae would increase the risk high enough to reccommend pep if the insertive parter was known positive, despite the fact that he didn't ejaculate?

Thank you.

[H. Hunter Handsfield, M.D.]

Not necessarily; probably not.  In any case I do not give specific advice about treatment.  These are questions for your health care provider, not me.

End of this thread.

[silviotoni]

Yes sir!! You are the boss here. End of this thread.
Thank you!!