The CSW claims she is tested approx every 28days, she sent a screenshot of her latest results which were exactly 4 weeks prior to the event, these were all clear.  She also claims not to partake in any unprotected vaginal. My concern would be whether she contracted anything in this window leading up to my exposure. Questions;

1. Day 5 I had Gon and Chlam oral swab and urine. These were negative but all UK clinics appear to have changed their window periods to 14days ? Is day 5 reliable - lab based RT-PCR. 

2. Days 6 - Took 2g Azythromycin and 800g Cefixime but about 24-36hrs apart. Anxiety led decision, - would this have aborted any potential syphilis infection risk? 

3. HIV risk level - especially given the cunninglus with tongue bite. (And receipt of oral) 

Not a regular occurrence for me at all.  Day 10 currently and no other penile symptoms except the very dry mouth/tongue. 

This was a zero risk exposure, or very close to zero, for all STD. Congratulations both for selecting a low risk partner and having an entirely safe exposure as well. Escorts (expensive female sex workers by appointment) generally have low frequencies of STI. Most care about their health and, like your partner, are tested frequently and use condoms for vaginal or anal sex; and their clients generally are at low risk (men like you). Oral sex also is low risk, with rare STDs transmitted mouth to penis and even more rarely by cunnilingus (oral vaginal contact). Sores in the mouth make no difference. If you think about it, you'll understand that at any point in time, probably at least 1% or maybe up to 5-10% of people have such problems, including inflamed gums etc -- and yet few STI and no proved HIV infections, not even once, despite billions of such exposure of which many must have been with HIV infected persons and in the presence of such oral lesions. Had you asked ahead of time, I would have advised no antibiotic treatment and not even a need for testing for any STI.

To your numbered questions:

1. Your negative test results for gonorrhea and chlamydia were conclusive. I don't understand advice to wait 2 weeks for valid testing.

2. Although I would have advised against the antibiotics -- your risk wasn't nearly high enough -- but they have done no significant harm. They would have aborted syphilis, gonorrhea and chlamydia. There is no point in re-testing for them in the future; any minuscule chance of infection is now gone.

3. As noted above, there has never been a scientifically proved case of HIV transmitted by cunnilingus; and although there have been claims of a few infected persons that they were infected by fellatio (mouth to penis), in fact there also have been few if any documented occurrences. One estimate from the US CDC, based on how some men believe they acquired HIV (which often is wrong), was a risk of 1 in 20,000 if the oral partner had untreated HIV. That's equivalent to receiving BJs by infected partners once daily for 55 years before being infected might be likely. And in your case you know with nearly 100% certainty your partner didn't have HIV anyway.

Dry mouth is not an STD or HIV symptom.

So all is well. Nothing more need be done. I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD