[Question #10351] STI Risk From Kiss at Strip Club

23 months ago

Hello Doctors,After a day and night of heavy intoxication I regretfully ended up in a strip club on a work trip in NYC. This was a week ago. While getting a private dance, the dancer began to make out with me with deep tongue kissing. I do suffer from bleeding gums periodically from flossing too hard and occasional sores due to biting my inner cheeks (OCD related). Due to my anxiety and OCD I have spent a ton of time reading this forum and have come to understand that this was a zero risk exposure for most infections and exceedingly low risk for others. I will have to deal with my extreme guilt and shame separately as I am married, and I actually told my wife about this when I got home as I didn’t want to keep this from her and felt it was right thing to do. With that background my main concern is safety for my wife and her health as we were thinking of trying for another child soon. I ended up being prescribed doxy (100mg twice daily for 7 days) with first pill taken about 55-60 hours after exposure (I now know this was probably unnecessary). I am allergic to penicillin and the urgent care I think could tell I was extremely anxious and I didn’t want to take chances on something like syphillis taking hold if I could prevent it. Even a 0.000001% risk is something that I don’t want to take a chance with when it comes to exposing my wife. I have tolerated the doxy well.

23 months ago

1. I have seen so many different doses and lengths of time thrown around on questions regarding its effectiveness on syphillis (7 days, 10 days, 14 days, etc). Is 7 days at 100mg twice daily enough to 100% abort incubating syphillis had I been exposed? Please note this course was started 60 hours post exposure. I have seen phrases like “reliably treated” used in other answers and so since I am tolerating the medication well I would rather just take it for 10 days or 14 days if needed to completely be sure. As you can tell I’d rather not take any chances.

2. I had a throat swab for chlamydia/gonorrhea taken at 5 days post exposure which just came back negative.

H. Hunter Handsfield, MD

23 months ago

Welcome. Thank you for your confidence in our forum.

Once in a while, only the title of a question has sufficient information to accurately answer. In this case, before I read beyond the title, I'll say that with possible rare exceptions, kissing is risk free for all STI; most likely you needn't be worried at all.

Now I have read the question. Guess what? I'm glad to see you already understand this, even using words that I might have written myself, that you have "come to understand that this was a zero risk exposure for most infections and exceedingly low risk for others". I'm also glad to see you have discussed your strip club experience with your wife. We often recommend that a spouse is often the best source of support and reassurance in situations like this, and I hope you have found that to be the case now.

You are correct in understanding there was no need for doxycycline.

To your specific questions:

1. The dose of doxycycline recommended to cure established syphilis is 100 mg twice daily for 14 days. For preventing syphilis after exposure, a single dose of 200 mg is nearly 100% effective. The study documenting that (by colleagues and close personal friends of mine) had exposed persons take doxy within 72 hours, so you're well within the effective window. If you have taken more than 3 or 4 doses, I would suggest you stop it now; if somehow you had been exposed to syphilis (which is EXCEEDINGLY unlikely), it has been aborted for sure.

2. You were at zero risk for chlamydia, which rarely infects the throat at all and -- despite misbeliefs commonly stated in online settings -- has never been proved to be transmitted by oral sex or kissing. Gonorrhea transmission by kissing is a bit controversial -- highly respected STI investigators in Melbourne, Australia have done studies that suggest it happens, but only in men having sex with men; and even this is controversial. I'm glad you have apparently been reassured by your negative test result, but it wasn't necessary.

In summary, I recommend you stop the doxycycline when you have had 3-4 doses; have no further testing for anything; and continue your normal sex life with your wife with absolutely no worry. There is no chance of giving her anything.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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23 months ago

Thank you Dr. Handsfield for the great work you and the team do. Your statement of “You have NO chance of giving her anything” is very reassuring. Seems about as absolute as it can get, which is helpful since I don’t want to take even the slightest risk with my wife. What I’m about to ask I know you’ve been asked countless times but want to make sure there hasn’t been any change:

1. Still NO cases of HIV being transmitted by tongue and saliva contact in the mouth via kissing? Would minor gum irritation (over flossing) or occasional sores I get from occasionally chewing the insides of my cheeks (OCD) make an impact? I’m assuming even the theoretical risk would need both people having large open sores that are actively bleeding to even make that a theoretical possibility?

2. If I were to take the lab based 4th gen tests, what is reliability at 2 weeks and 3 weeks. I’ve read where you say 99% at 4 weeks and conclusive at 6 weeks. Completely unnecessary given my exposure?

H. Hunter Handsfield, MD

23 months ago

1. It's impossible to be certain no such transmission has never occurred. Since most sexual interactions include kissing as well as intercourse, it is conceivable that some infections resulted from a kiss and not vaginal or anal sex. However, what IS clear is that there have been few or no scientifically documented reported cases of HIV when kissing was the only exposure. So if it occurs, it is exceedingly rare -- and likely doesn't occur at all. Sores in the mouth, bleeding gums, etc are extremely common -- there must have been billions of open-mouth kisses in the presence of such problems and still no know HIV transmissions.

2. Your 4 and 6 week figures are right. Probably ~80% and 90% at 2 and 4 weeks, respectively. If I were in your situation, I wouldn't be tested at all and would suggest you just sit tight for a single negative result at 6 weeks. But it's up you.

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23 months ago

Thank you again Dr. Handsfield. I believe this is my last opportunity for a reply. I’m assuming that your earlier reply where you suggested no further testing for anything and that there is no chance of passing on anything to my wife also included my concerns around HIV (not just syphillis, G, &, C) and the comment about waiting 6 weeks to test for HIV was more to do with the fact that you know a negative result is important for someone like me who struggles with irrational anxiety? I.e. the chance that a) the dancer had HIV is so small, combined with a b) a 1 in a million exposure risk (maybe even lower than that?) is basically 0 for all practical purposes and shouldn’t be a concern?

H. Hunter Handsfield, MD

23 months ago

Yes, that advice was for any and all STIs including HIV. Also correct about my reasoning for considering an HIV test: strictly for reassurance, not because there is any risk. Your closing statement is accurate.

Two remarks in closing that also might reassure you. First, if somehow I were in your situation, I definitely would not be tested or have taken doxycycline, and would continue unprotected sex with my wife without the slightest concern for her health and safety. Second, in the nearly 20 years of this and our preceding forum, with thousands of questions from people concerned about possible HIV infection, none have reported they eventually tested positive. You won't be the first. If and when it finally happens, surely it will involve a truly high risk exposure (think unprotected anal sex or shared drug injection needle with a known infected partner) and nothing as remotely likely as the events on your mind.

That indeed concludes this thread. I hope the discussion has been helpful. (Please do not be tempted to post a new question with further confirmation or clarifications!)

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