Going Crazy Here

Question

Hello Dr Bob. First off, kudos, props, and congratulations on being such a brave and giving gentleman. I just read your bio on your foundational website (concertedeffort.org) and was inspired by its content. I had no idea you were a 21st century Van Cliburn! This is the third time I am writing you, Doctor, and my question deals with potential risk of unprotected insertive oral sex with a sex worker of unknown HIV status, but with me already infected with genital herpes. This happened a little over three weeks ago and I have had white coating on my tongue and now have red, swollen skin on the back of my neck.... Thanks again for your time, Doctor Frascino.

- Jack 

Answer

Hey Jack,

Thanks for your kind comments. Me a 21st century Van Cliburn? Well we both play many of the same pieces, but I doubt I'd ever be mistaken for a tall lanky Texan!

Regarding your HIV-acquisition risk, I assume the genital herpes was not active, right? In this case the skin would most likely be intact and consequently your risk (unprotected oral with partner of unknown HIV status), extremely low. If the herpes was active, the risk would only increase marginally, because we don't know the HIV status of your "worker." Furthermore he or she would have to have some type of oral trauma, infection or other condition to allow HIV-infected blood to come into contact with the non-intact skin of the herpetic lesion. All in all your HIV risk remains remote at best. However, if you're worried, get a single rapid HIV test at the three-month mark. I'm quite confident the result will be negative.

Regarding your symptoms, they are not worrisome for or suggestive of HIV ARS (acute retroviral syndrome). Remember, symptoms, even when consistent with HIV ARS, are notoriously unreliable in predicting who is and is not HIV infected.

Good luck Jack. I see no reason for you to "go crazy." Pour yourself a nice glass of Merlot and put on an old Van Cliburn CD and relax. (If you choose to listen to my performances instead, be prepared for a few additional wrong notes here and there.)

Be well! Good luck.

Dr. Bob