Mouth ulcers

[ScottKang]

I am a 40 year old male who 14 months ago had oral sex (giving/receiving) with a high end female escort in London. After the incident I had a full battery of tests done, including testing for HIV using both PCR/DNA and antibodies (for HIV 1, 2 and o) at 3 months and 8 months. All of my tests were negative excluding HSV-1 which is something I know I have had since my late teens. From time to time I will get mouth ulcers which I have been told by doctors is due to the HSV-1. They last no more than 7-14 days. The last 6 weeks I have gotten 4 of them which I believe is a higher frequency for me. They each go away again after a few days to at most 14 in one case. The higher frequency has gotten me worried that maybe it is related to the incident. Over the exact same 6 week time frame I began to take daily NSAIDs for arthritis pain in a number of joints which I have read online can trigger these types of outbreaks, but my doctor says he doesn't think it is that, though suggested I stop to see. Of course it got me worried as reading online HIV is listed as one of the causes. While I know my results should be conclusive I started worrying about whether my tests missed some form of HIV? Could there be anything else from the incident causing this? Could this just be the NSAID? Again I have had HSV-1 since my teens so this isn't unusual for me, but I'm worried about the pickup in frequency, especially reading about the HIV connection. Sorry if I sound crazy. Any help will be great.

[Edward W Hook, MD]

Your additional description souns more an more like aphous ulcers.  Please do not worry about them or about HIV based on the exposure you have mentioned.  EWH

[ScottKang]

Thank you very much. Yes they are entirely inside the mouth and usually small, going away quickly but annoying and painful!! They are also not the biggest deal as long as I don't have bigger things to worry about. I thank you for your comments and for putting my mind at ease.

[Edward W Hook, MD]

Welcome to our Forum.  I have several comments which I hope you will find helpful.  First, please believe your test results.  It is unlikely that your partner had HIV- very few commercial sex workers do, particularly high end ones.  Further, despite the misinformation so prevalent on the internet, there is no meaningful risk of HIV from receipt or giving oral sex.  Putting this together with a negative HIV test at both 3 an 8 months following event, there is simply no conceivable way that you acquire HIV through the exposure you describe.   I say this with complete confidence.  

Second, your oral ulcers are not a sign of HIV.  While persons with HIV do have oral ulcers these are severe and troublesome only when the isease is advanced an has been present for years.  Your ulcers may or may not be HSV-1.  they could also be "aphous ulcers", common ulcerations which occur within the oral cavity of unknown origin.  If the ulcerations are only inside the mouth, I suspect they are more likely to be aphous ulcers than HSV-1.  Aphous ulcers are more common when person are under stress and I believe that taking NSAIDs may increase their frequency as well.  Either way, I am confident they o not reflect HIV infection.  

I urge you not to worry further about HIV.  There is really no need for concern an no need for further testing.

I hope my comment is reassuring.  It is intended to be.  EWH