[Question #10462] Cunnilingus STI Risk - stripper

22 months ago

Hello, In the beginning of the month I performed oral sex on a stripper on a drunken night for about 2 min, I regret it to this day and have changed some life choices. It has been 4 weeks and I have tested negative so far see list below.

Day 4: Oral throat swab for Gon/Chlymadia NEGATIVE

Day 10: Full STD panel NEGATIVE

Day 15: Oral throat swab for Gon/Chlamadia, Rapid HIV test NEGATIVE

Day 18: RPR test with reflex, Treponemal Test (antibody test), 4th Gen HIV test NEGATIVE

I have browsed through this forum and noticed that my chances of getting an STI is very low and for HIV I have no risk (extremely low risk). However, I have the following questions that for sure will calm my anxiety.

1. Do I need to test for Gon/Chlamadia after getting two negative test results at the time period mentioned above. Can I consider these test conclusive?

2. I did a Herpes blood test at day 10, it has been 4 weeks now and do not see any outbreak can I consider myself ok now?

3. For syphilis, would the test above be okay, if not do you recommend still testing as these are out of pocket exams and I have to pay for them. I did find a canker sore in the back of my tongue on its side 8 days after exposure and i still have it there at the moment (it is painless, however I do remember a sting like a typical canker sore when it appeared). When I did the RPR test and Treponemal Test the sore was present (10 days after the sore appearing). Can I for certain say this sore is not a chancre? I also find the location of this sore curious as it would be a location that ideally would not touch a chancre if one was present.

4. If my exposure was through oral sex only, can any of the STI's transmit to my genitals? If I were to have syphilis hypothetically would i be able to transmit this through my penis?

H. Hunter Handsfield, MD

22 months ago

Welcome and thanks for your confidence in our services.

Also thank you for reading previous discussions about situations similar to your own; you seem to have correctly predicted my responses. Cunnilingus (oral-vaginal contact) indeed is just about the lowest STI/HIV risk of all sexual exposures other than hand-genital contact or fingering -- very safe for both giver and receiver. In addition, the large majority of female strippers, sex workers, etc do not have transmissible STIs at any point in time, and syphilis and HIV are particularly rare, at least in the US.

One gonorrhea/chlamydia throat swab test was enough; the negative result either time was conclusive proof you have neither of those infections. The blood tests for HIV and syphilis were much too soon, but the chance of either is so low that it really doesn't matter much. However, if you feel a need for reassuring lab test results, you can be retested for both at 6 weeks.

To your specific questions:

1. No further testing, please; conclusive already.

2. It was a mistake to have an HSV blood test. The chance of infection was very low, and the tests just aren't very reliable. We never recommend HSV blood tests unless there is serious suspicion of herpes based on symptoms, or after repeated exposure to a known infected partner. In any case, 10 days is way too soon. But presumably it was negative for both HSV1 and HSV2? I suggest no further testing.

3. The syphilis blood tests usually are positive in newly infected people by 4 weeks, but sometimes 6 weeks. Your canker sore probably was just that, and I agree it's even less likely syphilis if not in a spot with direct contact during the sexual event. Still, the only way to be 100% certain is to have a follow-up blood test at 6 weeks.

4. Good question and the answer is no: most STIs don't travel through the body and are transmissible only from exposed and infected anatomic sites. In a way HIV and syphilis are exceptions: they spread throughout the body and soon can be transmitted by genital contact. However, that doesn't happen until at least 2-3 months after infection, and you'll know for sure at 6 weeks that you did not acquire either of them.

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

HHH, MD

---

22 months ago

Hi Dr. Handsfield,

Thank you for your response it is much appreciated.

Just want some clarification, if I hypothetically had a chancre in my mouth (I know based on previous forum responses this is very rare) how soon would this be reflected in a positive blood test?

Also, just based on how my sex act has very low risk for syphilis and I have to pay for these exams out of pocket what would your professional opinion be in testing for syphilis again. I am already at 31 days today and besides the canker sore mentioned I do not see any other development. Also is there any way I can self diagnose myself and distinguish between a chancre and a canker sore. I have been monitoring my mouth closely due to stress/anxiety.

Is syphilis transmitted as easy as just contact with a chancre/rash or is there any other action required such as friction or repetitive touching?

I think I am pretty sure I do not have HIV due to having no symptoms and the act itself being very low risk (or even zero risk) as mentioned over and over again in this forum. I will believe what has been said in this forum and conclude that further testing is not required for HIV.

H. Hunter Handsfield, MD

22 months ago

The syphilis blood tests always are positive within a few days after onset of chancre. If no chancre, by 6 weeks.

I would put the chance you acquired syphilis as probably no higher than one chance in a hundred thousand or lower. If those odds are acceptable to you, you need not test again. It's up to you.

Syphilis generally requires prolonged contact or massage of the organism into the tissues.

Your risk for HIV is no higher than for syphilis. But it is inconsistent and somewhat irrational to decide to be tested only for HIV or only for syphilis. Absence of symptoms is absolutely meaningless in judging the possibility you acquired HIV. If you're going be tested for either one at 6 weeks, I suggest you do both.

---

22 months ago

Thank you Dr. Handsfield, you have given my reassurance that testing again will not be necessary given the low risk. But again if I do test, I will do both. I appreciate your time and effort.

H. Hunter Handsfield, MD

22 months ago

You're welcome. I'm glad to have been of help. Best wishes and stay safe.---