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Herpes and HIV transmission.
Jun 3, 2002

Sorry to bother you but I have yet to get a reply from the safer sex area and you seem compassionate enough to help us worried folks to answer when you can. Here goes....First of all, I thank you and your site for being available to all of us. I know that often times you do not even recommend testing for someone that has had oral sex performed on them (insertive). This is my case but with one kink in the mix. I have genital herpes. At the time of the exposure I did not have an outbreak but did have one maybe one or two weeks prior. Everything seemed to be healed up and skin appeared to be intact although I did not inspect it thoroughly prior to getting the BJ. We also performed mutual masterbation and he inserted maybe a quarter of an inch of his finger into my anus although mostly just massaging it with little penetration. Would you suggest testing in this situation? I was not at all concerned about risk until a few weeks later a severe headache and neck pain with a inter-cranial pressure sensation came over me (meningitis-like?). It lasted a few weeks, then I got a bad sore throat with no other cold symptoms that has lasted about 4 weeks with burning mouth/tongue sensation and bad heartburn and acid reflux (candida?). It seems to be getting better but now I have cobweb floaters that I never had before. I did test somewhere around 4 weeks post exposure with a neg result. This was about 2 weeks after headache started and sore throat started the day I got my neg result a week later. I have also had intermitent diarrhea. I am married and this was my first gay experience so guilt and anxiety does come into play. I did find this one article on hivinsite.com that concerned me a lot.

I spoke with one man who believed he became infected with HIV by getting a blow job. He told me that he had a history of picking up STDs in the past from insertive oral sex, claiming to have been infected with urethral gonorrhea this way, as well. We can speculate that either due to his genetics, immune system, or some other biological factors, he was not sufficiently resistant to STDs, including HIV, when exposed during insertive oral sex.

Please comment , if you will, about risk, if I should have tested or should test anymore, and any regards to symptoms and ARS. Thank you kindly.

Response from Dr. Frascino

Hi,

If herpes or other STDs are active, then the risk of HIV transmission increases. However, your outbreak was a week or 2 before your walk on the wild side. Since the blisters were gone, and the skin was intact, your risk should not have been increased. The mutual masturbation and minimal digital butt play are considered "safer sex." So your risk is insertive oral sex, which carries a very low risk for the insertive partner. Your subsequent symptoms - headache, neck pain (no, not most likely meningitis), sore throat with cold symptoms, acid reflux (no, not candida), and burning mouth/tongue are most likely completely unrelated to HIV. Likewise, the cobweb floaters are a red herring as well and most likely normal.

Stress/anxiety can be the cause for some of your symptoms - intermittent diarrhea, heartburn, headache, etc. Should you be tested? Your risk is very low, so the decision is yours to make. I would very strongly doubt you are positive; however, if seeing the negative test result is the only thing that can calm your fears, then by all means get tested, get the negative result, and yell, "WOOHOO!"

Read up on the risk level of various sexual practices and decide what level of risk you are willing to accept. For instance, oral insertive sex with versus without a condom.

If the anxiety/guilt over the incident continue, consider seeing a compassionate therapist who can help you work through these issues.

Stay well. Remember, sex is supposed to be enjoyable, not worrisome!

Best of luck.

Dr. Bob


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