Oral Herpes

[el_worried]

Dear Dr.,

I recently engaged in an encounter with a transex massage worker. We were both nude & engaged in body rubbing & mutual masturbation. She was naked & her genitals where rubbing against my thighs & over my genitals. She then sat on me with my penis against the back of her but, in-between but just resting against that 'crack' area. We also engaged in pretty deep french kissing. As per my understanding, Im pretty sure the risk for HIV & other STDs is zero or pretty low based, correct? I'm mostly worried about oral herpes (HSV-1) from kissing. Now my understanding is that 50% of Americans have HSV-1, meaning that it's a pretty close figure in Canada. And seeing as how the transex worker mentioned she'd been working there for just over a year, my guess is she has HSV-1. So, did I most likely get infected? I'm looking now (the day after, this was yesterday) at my lips & they are cracked (small red slit like cuts X2). I don't remember feeling they were cracked yesterday, it could have happened on the way home after, but that just increases my worry, as that may have increased the chances of infection.

Now this wasn't the only episode I've ever had in my life obviously, I've had various encounters (sex workers & others) with various experiences. Most vaginal or anal sex was protected - and I was tested for HIV 2 years ago and came out negative. But I've had many kissing encounters & quite a few unprotected oral sex encounters (give & take).

So I'm stabbing in the dark here & saying that I probably have HSV-1 (judging from the 50% stat). My worry is that I have a girlfriend I live with & I genuinely don't want to give her genital herpes during oral sex - or oral herpes during kissing for that matter (if I do have it). So I'd like to get tested as soon as I can, to include my latest encounter in the results. How long need I wait before doing that to eliminate it? & what test? & if Im positive, should I never perform oral sex on her? Or kiss her? That sounds bad.

[el_worried]

Dear Dr Edward,

Thanks again for the reply. I will take your educated & experienced advice then and not test unless symptoms arise. I'm a little more worried now as my partner has developed an ulcer inside her mouth today (not on her lips), but I will take the benefit of the doubt and assume it is unrelated.

Thank you on advising on the best tests, much appreciated.

[Edward W Hook, MD]

Although I advise against testing, if you feel you need to test, since there is no particular event which you need to worry about, you can test at any time.  In doing so, the right test to do is a type specific, gG-based test for HSV-1 and HSV-2 IgG such as the HerpeSelect.  I would recommend against testing for IgM antibodies since, no matter what people say, these tests do not provide useful information.  EWH

[el_worried]

Dear Dr Hook,

Thank you dearly for your speedy & very helpful response.

I actually was not that concerned about the cracked lips as a symptom of oral herpes, just as concerned that it may have increased my risk of infection yesterday.

It makes sense (noting the research you reference), that my risk is no higher for this than my other encounters.

And yes you're right, my partner should test too. That does sound like an unfriendly can of worms that could be very messy if opened.

Sorry, may I just re-ask though, can you advise on the testing? How long before testing (to include my last encounter in the results) & what type would I need?

Thank you again, hearing that little herpes is acquired through sexual contact is comforting.

[Edward W Hook, MD]

Welcome to the forum.  I'll provide some information which I hope you'll find helpful.

First, I agree, the encounter you describe should not have put you at risk for HIV or any of the typical STDs.  No penetration, no risk.  HIV and other STDs are not transmitted by kissing either, even deep kissing.  

Now, for the possibility of oral herpes.  What you describe does not sound like oral herpes, it sounds like cracked lips, perhaps because you have been, consciously or unconsciously, licking them or perhaps are in a low humidity environment (or both).  Oral herpes presents as oral blisters and open sores, not cracks.

So, finally, about your risk of oral herpes. I suspect you have kissed others and if so, your risk of getting oral HSV-1 from this encounter is no higher than from other persons you’ve kissed .  Research shows that oral herpes due to HSV-1 is not more common in persons at high risk for STDs than it is in the general population.  This is because relatively little herpes is acquired through sexual contact and most is acquired through other sorts of oral contact, most often in childhood.  If you have not worried about oral herpes before, I see no reason to do so now.  Further if you are going to test because of concern about your partner, then shouldn't she test too, just in case.  After all, if you don’t have it and there is a 50% chance of her having it, you could be at risk to.  this is a "can of worms" which I would not open if I were you.  EWH