Unprotected oral and mouth ulcers... risk?

[Andy89]

Hi all...

Basically I want to get some reassurance. About two and a half weeks ago I had an anonymous encounter with a guy. One time thing, just wanted to try it out. We kissed a lot, and blew each other, but didn't come in each other. I know from what I've read on here that oral in and of itself is a low risk, but here's my issue. After the fact, I realized that I had some ulcers on my tonsils. Didn't think anything of it at the time. This was a Thursday.

On Sunday, I started feeling really awful, ended up with a high fever (103 to 104), dizziness, nausea, etc, and I ended up at the ER. Long story short, they admitted me and I was in hospital for two days. They ran all sorts of tests but didn't find anything and decided it was some random virus. They did give me two doses of IV Rocephin though.

I had a low fever for a few days after they let me out on Tuesday, but felt better after that. The following Monday I had an appointment with the primary care doctor just to follow up on my other health conditions (diabetes, cholesterol, and the like), and I asked them to run an STD panel since they were drawing blood anyway.

So that panel came back negative for HIV, HBV, HCV, and all, but positive for syphilis. The encounter I described was the only one I've had in the past 2-3 months.

Fast forward to this past Saturday, I've got a fever that comes and goes (temp is actually low in the morning but climbs to 99-99.5 in the afternoon), muscle aches, joint pain, drowsiness, fatigue, and all that. I know I'm probably getting worked up over nothing, and I'm planning on getting tested again at the appropriate time, but I'm wondering if anyone can offer any reassurance (or any terrifying information, if appropriate)  .

I guess what my question boils down to is this: I know that HIV and syphilis exist together more and more often these days, and I know that oral is low risk (even giving it), but that having open wounds can increase risk. First of all, is it even possible that the positive syphilis result could come from this incident (and yes, I know it's not a syphilis forum, but it's relevant), and the second part of that question is: given the circumstances as I've laid them out, if he was positive, what are the chances of transmission?

PS. They didn't think it was necessary to treat the syphilis again since the Rocephin in the hospital should have wiped it out. Said they'd do penicillin if the results indicated it on the next test. 

PPS. Really hoping I don't end up as that one-in-a-million statistic.

[Ann]

Andy,

If the ulcers on your tonsils were actually syphilis chancres, then yes, if the guy you blew was hiv positive and had a high viral load, then you were at risk. Syphilis chancres are painless, so unless you see it, you won't know it's there.

If the sores on your tonsils were just ordinary pockets of debris and not syphilis chancres, then you weren't really at risk. If they were syphilis chancres, then it could be a problem. Even then, the guy would have to have a high viral load.

Thing is, saliva contains over a dozen different proteins and enzymes that damage hiv and render it unable to infect. This is why unless there are extenuating circumstances such as poor oral health, or the presence of syphilis chancres in the oral cavity, coupled with a high viral load on the part of the insertive partner, blowjobs just do not normally result in hiv infection.

Given you had possible syphilis chancres in your mouth, you would be prudent to test. He didn't cum in your mouth, so I think you'll come out of this ok, but the only way to know for sure is to test.

You should test at six weeks following this encounter. The vast majority of people who have actually been infected will seroconvert and test positive by six weeks, with the average time to seroconversion being only 22 days.

A six week negative must be confirmed at the three month point, but is highly unlikely to change.

And make sure you get retested for syphilis to ensure the antibiotics did indeed clear it.

Good luck.

Ann

[Andy89]

Thanks, Ann. That sets me a little more at ease. This fever (while low) is still troubling me, but I know it's probably psychological. Suppose the ulcers were just tonsillitis and not syphilis chancres, I assume the risk would be lower? Can't wait to test at 6 weeks and hope this whole thing is over. If nothing else, I'm going to be a lot more careful in future.

I guess a follow:up question I have is, given that this was the only sexual encounter I've had since well before my last tests, how likely is it that I could have picked up syphilis or anything else and had it appear on a test 9 days later? Would whatever illness I had the weekend immediately after affect anything as far as testing?

[Ann]

Andy,

I want to be absolutely clear in that I'm only suggesting you test for hiv over receptive oral due to the possibility of the sore on your tonsils being a syphilis chancre. I'm very much erring on the side of caution here.

If it's another, different infection, your tonsils would likely be sore (tonsillitis hurts like hell) and you haven't mentioned them being sore once. Syphilis chancres are painless.

Also, tonsils can accumulate debris from eating and that debris can be mistaken for a sore - and this debris collection will also (usually) be painless.

It is also possible that what you saw on your tonsils was a lesion caused by the second stage of syphilis (secondary syphilis). They're also painless.

It takes an average of 21 days for a primary chancre to appear, but it can happen anywhere from ten to 90 days. Lesions or rashes associated with secondary syphilis can appear anywhere from two weeks to two months (sometimes longer) after the primary chancre has disappeared.

Because syphilis shares a three month testing window period for a conclusive negative result with hiv, it is possible that your earlier tests missed it. Please keep in mind that syphilis is MUCH more easily transmitted than hiv and is easily transmitted during oral sex, UNLIKE hiv.

Check this out: http://www.nlm.nih.gov/medlineplus/ency/article/000861.htm

Again, I do think you'll come out of this hiv negative, but the prudent thing to do (given the presence of syphilis and the sores on your tonsils) is to test for hiv at the appropriate time.

By the way, you only have one free post left before you'll have to take out a subscription*, so please use it wisely. *(See details in the Pay-For-Participation Subscription Instructions thread at the top of the Am I Infected? index page.)

Good luck.

Ann