Risks - cunnilingus with "extenuating circumstances"

[DanielGwen]

Root canal was done on two of my left front teeth; Healed up after a day or so; don't recall any pain or bleeding in the gums on top of the teeth.  I don't think there was any inflammation of the rear inside gums on top of the teeth that were worked on; rest of my overall oral health is excellent.  Two days later (Wednesday), I visited a massage parlor where the woman also allowed me to perform cunnilingus on her; her HIV status is unknown to me, although she mentioned that she tried anal sex with her boyfriend once.  I penetrated her vagina with mostly just the front quarter of my tongue for 2-3 minutes, during which time my open mouth dried up.  Then I put my tongue back in my mouth, (now realizing I probably had her secretions on my tongue touching the inner top gums on top of the teeth that were worked on two days earlier.  I noticed that my throat was sore the next day.  So, I took 3-4 penecillin pills I had the next day (Thursday), which seemed to clear it up and the throat was just a little hoarse over the next few days.  On Tuesday afternoon, (6 days later), I started to feel fluish.  No fever, no rash, just felt like I had the flue.   Really felt horrible (fluish) most all day on Wednesday (7th day).  Woke up on Thursday morning and generally felt much better.  Felt fairly well on Friday and today, other then occasional severe anxiety  just about every day.  I'm concerned about my risks from this one time exposure, and if possible seroconversion occurred on that 7th day after my exposure to her secretions on my tongue that then touched the back gums on top of my teeth.    Would this scenario (cunnilingus at 2 days post root canal), put me at a much greater risk for contracting HIV?  Could ARS and seroconversion have occured on the 7th day, and come/gone so quickly like a 24 hour virus?

[Edward W Hook, MD]

I repeat (one last time), your root canal does not change my assessment.  There is no medical reason for concern.  EWH

[DanielGwen]

Thank you Doctor; that is very re-assuring.  Reading up on root canals, it appears that it is necessary when one has an infection of the inner teeth pulp and canals, most often caused by bacteria.  My worry is the gum area that covers the canals and roots of the teeth that had the canals cleaned out and filled in with new filling.  Appears the gums covering the infected canals coud get inflamed prior to root canal work, but I'm not sure if they get infected also.  Anyway, my incident was 2 days after the procedure and the root canal work seems to have been successful.  (I also was on penecillin for 7 days prior to the root canal work).  So my worries are that the gums covering the roots were not what could be called infected sores?  Not sure what a infected sore really is.  With no brushing, any concerns about vaginal fluids contacting the teeth and gums?

[Edward W Hook, MD]

Welcome to our Forum.  There really is no meaningful risk to you from the exposure that you describe.  It is unlikely that your partner had HIV.  It is uncommon in commercial sex workers, including masseuses.  In addition, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  This includes situations such as yours in which there was recent oral surgery.  The healing process in your gums began almost immediately following completion of surgery (there are few places in the body that heal faster than the mouth).  Further, the only open sores which have been conclusively shown to place persons at increased risk for acquisition of HIV are those do to infection, not surgical ones or scrapes. This is because infectious sores have a concentration of the target cells for HIV ( activated CD4 lymphocytes) present in them in response to the infection that provide increased opportunity for infection.

Finally, the timing of your illness is wrong.  The ARS typically begins 2-3 weeks following exposure, not so soon as you began to experience symptoms.

Bottom line, this was a low risk exposure and there is no real reason for concern.  I suspect that your recent illness was coincidental and unrelated to the exposure you described.  Whether you get HIV tested in relationship to this exposure is up to you.  I do not feel it is critical to do so.  EWH