Risk Assessment

[4walnut90]

I've gone through these boards and I believe I know the answer but I believe I had a slightly elevated risk and wanted to ask the doctors directly.

I had intercourse with a korean CSW in Los Angeles. We performed the following:

- Deep french kissing with plenty of saliva on her lips to mine
- Unprotected oral sex (she took my penis into her mouth for about 5 to 10 min)
- Unprotected cunnilingus (I licked her vaginal area for about a minute)
- Protected vaginal sex (she licked my penis throughly and then put a condom on)
- She washed my genital area with soap and water prior to and after sex

I wouldn't normally worry, but I had two oral conditions that I'm concerned about as well as one other concern.

--- I had a split lip right in the middle of my bottom lip about a day prior which hadn't fully healed

--- I had what I believe is a canker sore on my gums (bottom gum, right below my bottom front teeth). It literally looks like someone took a pen and punctured a small hole in the bottom of my gums. It stung for about 3 days and the day I met with the CSW, it still stung slightly.

1) Would these oral conditions put me at risk of exposure for HIV (from the cunnilingus or deep kissing)?

2) Was the fact that her saliva was "trapped" inside the condom while we had vaginal sex an additional risk factor? i.e., was it risky that she licked my penis AND then put on the condom.

Thank you for your assistance.

[Edward W Hook, MD]

Welcome to our Forum.  the tone of your question suggests to me that indeed you o know the answer which I'm about to provide.

This was a no risk exposure.  To begin with, the chance that your partner had HIV is very low.  Even if she was, this was a no risk exposure:

There is no risk from kissing, including French kissing with lots of saliva exchange..
There is no risk from giving or receiving oral sex, even with a split lip and canker sore.
There is no risk from condom protected sex, even if some of your partner's saliva was caught in the condom as it went on.

I see no medical reason for concern or for testing.  

I realize that sometimes , when you are the one with an exposure, it is nice to hear directly that your activities di not put you at risk. Your activities did not. I hope my comments are helpful to you.  Take care EWH

[Edward W Hook, MD]

There is no change in my assessment of response.  

This will end this thread.  Further questions will be deleted without comment.  EWH

[4walnut90]

1) The lip chancre healed itself in about 8 days. From researching the forums, I assume this is not syphillis as the chancre would last much longer?

2) I still have post nasal drip (mucus dripping down back of throat) that does not appear to be getting any better. Could this be ARS? Should I test now with the NAT test?

Thank You. I won't ask any more questions.

[Edward W Hook, MD]

The chance that this is a chancre (syphilis) remains tiny. On the other hand, what you describe sounds like a cold sore (HSV-1).  If you are going to have the lesion (not blood) tested for anything, it should be for HSV.  A syphilis blood test might also be reassuring to you.  There is simply no way that this is a manifestion of HIV and I would not worry about it.  EWH

[4walnut90]

I woke up this morning with what looks like a chancre right in the middle of my upper lip. It's circular, stings slightly and looks like the top layer of my skin is missing. It also oozes a clear liquid ever so slightly.

I've also had a throbbing headache for the past few days and continuous mucus Dow the back of my throat.

Could this be HIV ars related? Or syphillis?

There's a place that does early HIV testing that's rather expensive. Should I test now for HIV or syphillis?

Thank you for your assistance.

[Edward W Hook, MD]

No change in my assessment. Your post however suggests that you are overly nervous about this and perhaps examiing yourself more than you might otherwise.  EWH

[4walnut90]

Apologies for another posting, but I seem to have developed the following symptoms.

- Rash on my chest and stomach. They look like small faint red pimples and do not itch.
- Constant post nasal drip

This started this morning (10 days after possible exposure).

Is the rash consistent with what an HIV ARS rash would look like?

Does this change your assessment in any way (since I had a lip sore and canker sore) at the time I kissed and performed cunnilungus on the CSW.

Thank you.

[Edward W Hook, MD]

No, this would not change your risk at all. The increase in risk associated with herpes has to do with genital transmission.  As I said, oral sex is not a risk.  You need not worry.  EWH

[4walnut90]

Wow! Talk about quick service!

There may be a chance that the split lip was actually a herpes cold sore. I've never been tested for herpes but about a week prior to this I had what appeared to be small sores on the top of my lips and I'm concerned that the lesion on the bottom of my lip may have been a herpes sore, rather than a split lip. I read that herpes increases the chance of HIV infection.

Does this increase my risk dramatically?

Thank you for the quick reply.