Boy, did I screw up!

[lackofunderstanding61]

Hi Doctor and thank you in advance for helping me.
I meet a promiscuous woman at a bar this weekend and went home
with her. she said she is bisexual and it turned me on initially but now
it's causing me great stress!
I asked about STD's and she claimed she was negative and
gets tested because she has endometriosis. I went down on her for a
very long time (unprotected) and then put on a condom and had intercourse
for about one minute. I was wearing cotton underwear and my penis was sticking out
the slat in front--- i was in such a hurry to have sex that I didn't take off my
cotton briefs. I rolled the condom down inside the underwear. when i was
finished, i went to the bathroom to clean up and noticed vaginal secretions
and mucus at the base of my penis. and the cotton underwear were very wet.
I am concerned about herpes and hpv transmission. I am positive that there was
no skin-to-skin genital contact.

1) I have read that cunnilingus is low risk, but i was down there for a long time and
really got into it! What is the probability of oral std's from this? can you please give
me a statistical probability to get oral herpes from going down on her?? Now I'm
worried to kiss or go down on my steady girlfriend!

2) please tell me what is the probability of catching hpv or herpes from the secretions
i noticed at the base of my penis? I am certain there was NO direct skin-to-skin contact.
I was on top and made sure of this. everything was protected with the condom rolled into
the underwear (but somehow the secretions made there way to my bare skin!).

3) If I have HSV 1 on my mouth from childhood, what responsibility do i have to inform
partners? I don't know if i'm being crazy on this one?!

4) How long has genital herpes been around for? is this a new STD?

5) DO you recommend I get HSV testing? HPV testing (if available)?

I'm very concerned because i'm in a committed relationship and i made a big mistake here!

thanks.

[Edward W Hook, MD]

1.  Most exposures to perrsons with prior HSV-1, even long ago do not lead to transmission of infection but there is no doubt that oral contact by someone who has oral HSV-1 can result in transmission and genital HSV due to HSV-1.

2.  HPV and HSV are not tranmitted in secretions, they are transmitted by direct contact.  EWH

[lackofunderstanding61]

doctor, i know i asked a million questions and thank you for your service here. i'm not sure if you answered this one---
--- what is the recommendation of informing potential partners about having cold sores (HSV1) as a child?
--- does hpv or hsv transmit through fluids on the skin? i really dont understand this one at all
--- i feel like an idiot for cheating and i know that my current girlfriend will take this very badly. this episode has really made me realize that i dont want to have a one-night stand and want to continue my stable relationship. i am not ready to tell her about this! is this low-risk enough to not tell her? I certainly hope so!

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help.  Before I address your specific questions, let me provide some perspective.  My sense is that your concern is far out of proportion to your risk.  Most people do not have STDs and there are no data to suggest that bisexual women are higher risk than  heterosexual women.  Further, the sorts of exposures you mention, oral sex, condom protected vaginal sex, are low risk for STD acquisition.  Finally, your partner has mentioned that she is taking part in regular health care and states she does not have STDs- she's probably right about that too...thus for all of these reasons, your overall risk for STDs is low.. With this as background, let's work through your questions:

1.  Among sexual exposures cunnilingus is the lowest risk for acquiring STD.  While duration is almost certainly a factor, there are no data on how duration of exposure impacts risk of infection. there is no way to estimate the risk of infection from performing oral sex on an infected partner- the event is too rare and the rate too low to be accurately measures.

2.  Condom use reduces the risk of getting herpes more than 50% and your risk of getting HSV from this exposure was low to begin with.  As for HPV, again the risk is quite low.

3.  Your oral HSV could be spread to partners when you perform oral sex on them.  The likelihood of that occurring, IF your partner hasn't already got HSV-1 is less than 1 in 10,000 and most people (about 60% of adults) already have HSV-1, even though most who are infected do not know it.

4.  Hard to say. Probably hundreds if not thousands of years.

5.  There are no recommended tests for HPV in men and I certainly do not recommend a blood test for HSV.  Your risk of either already having HSV-2 that you don't know about or having a false positive is higher (much, much higher) than the likelihood that you got oral HSV-2 form this encounter.  Since you already have HSV-1, you cannot get it again, even at a new location.  If you do not develop lesions in the two weeks following exposure, you did not get HSV-2.

Hope these comments help. Try to calm down.  EWH