[Question #10603] Gave Oral Sex

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21 months ago
Hi, I am a male and I recently gave unprotected fellatio to another male. Said episode lasted between 1-2 minutes. Other male did not ejaculate. We discussed STD's and he said he had none. He had no visible sores or symptoms. I confirmed the same. Both of us met on a website. I am not concerned about HIV only concerns are about HPV, syphilis, monkey pox, gonorrhea. Other male was white and professional. We are in the Midwestern United states. Also, wondering how critical testing is and should I sequester myself from other family responsibilities b
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Edward W. Hook M.D.
21 months ago
Welcome to our Forum. Thanks for your questions.  Congratulations on your cautious approach to sex with a new partner.  Your questions are good ones and have more to do with keeping you sexually healthy going forward than anything else.  First a few generalities

Sexual activity with a new casual partner always has some risk but there are things you can do to reduce your risk for any infection.  Several STIs can be reliably prevented through vaccination so this is something I would suggest you consider.  Depending on your age it is relatively likely that you are already vaccinated for Hepatitis B.  If you are not, you should be.  In addition both HPV and Mpox (the new term for Monkey Pox) is readily available, safe, and highly effective,  Consider them.

Second, as you approach new partners and as you did with this one, discussing their sexual history is always a good idea and is to be encouraged.  Appropriate questions are have you ever had an STI and if yes, when (persons who have had STIs before are more likely to get them again and the more recently a partner has had an STI, the higher the risk that they may have been re-infected).  A second good question is when were you last tested and for what (the more recently a person has been tested the less likely it is that they will have acquired an STI in the interval).  Having an STI in the past is not necessarily a bad thing but it helps provide perspective

The risk for other STIs is a function of sites of exposure and numbers.  Most STIs are transmitted by persons who are unaware that they have STIs.  ORal sex (performing or receiving) is a lower risk activity with other men that anal sex.  STIs are less efficiently transmitted (in the biological sense) through oral sex than through ano-rectal intercourse.  Obviously more partners increases risk.

Getting past these generalizations,  the encounter you describe sounds relatively low risk.  Your partner sounds to be relatively lower risk and you had the discussion you mentioned.  Even if a partner was infected, most single exposure do not lead to transmission.  In the absence of lesions, syphilis is unlikely.  Gonorrhea is typically symptomatic at the penis so your examination also suggests he was not infected.  

You may wish to get tested for your own peace of mind or, periodically if you will be having other partners in the future.  With fellatio the important test is a throat swab for gonorrhea (typically chlamydia is automatically done at the same time but is very, very rare at the throat).  A throat swab for gonorrhea can be done any time more than 3-4 days after your encounter.  If you wish to test for syphilis, you will need a blood test at 4-6 weeks after the encounter.  Your risk for syphilis from your report is low.  As for HPV, there is no test.

I hope this information and perspective is helpful.  If any part of this message (which may be more than you asked for) is unclear or there are other brief questions please use your up to two follow-up for clarification. EWH
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21 months ago
Hi! Thanks for the follow up. I would provide that I am otherwise in a long term and monogamous relationship. This was a one off. I just checked my states mpox database. There have been 10 new cases in 2 months. So, a very minute risk of exposure. Plus not everyone gets it. 

However, in regards to monkey pox, syphilis, gono, etc... Am I free to live in a house with other people? I feel like testing, which is a personal choice, is most likely not warranted at this time?  Let me know your thoughts on regarding returning to normal live. Btw, exposure occurred to hours or so ago
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Edward W. Hook M.D.
21 months ago
Thanks for the additional information.  I see no concerns regarding interactions with others.   In the unlikely event that you experience any symptoms, I’d recommend seeking evaluation by an experienced clinician but frankly, I think it’s most unlikely you’ll need to do this.  Otherwise, no reason to avoid interactions with others, including your regular partner.  EWH ---
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21 months ago
Hello, Doctor and thank you for the reply. I do have some follow ups:

In regards to Mpox, I checked the state dashboard again: 4 new cases in 2 months, but my county has only ever had 4 cases since beginning of that outbreak. 

Questions 

1)I feel Mpox is such a slight risk that I need not be concerned with it due to this incident, would you agree?

2)should I consider HIV prep/prophylaxis out of an abundance of caution?

3) should I consider dicilomine to mitigate syph, gono, and Chlamydia? It's been less than 24 hours of exposure

4) what would you estimate the statistical risk factor to be to acquire mpox, hiv, syph, gono, Chlamydia, AND/OR herpes. 

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Edward W. Hook M.D.
21 months ago
Going directly to your follow-ups:


1)I feel Mpox is such a slight risk that I need not be concerned with it due to this incident, would you agree?
I do agree.  I would not be concerned

2)should I consider HIV prep/prophylaxis out of an abundance of caution?
If you approached me in clinic requesting HIV PEP, I would decline to provide it.  The estimated risk of acquistion of HIV from the brief exposure you describe is less than 1 infection per 10,000 exposures to infected partners and that estimate is likely conservative.  Further it is statistically unlikely that your partner had HIV, thus your statistical risk is less  than 1 in millions

3) should I consider dicilomine to mitigate syph, gono, and Chlamydia? It's been less than 24 hours of exposure
Studies show that a single dose of 200 mg of doxycycline would reduce any risk you have of getting chlamydia or syphilis by more than 80% and your risk of getting gonorrhea by more than 40%.  Overall your risk is already so low that if I were you I would probably not bother but the decision to take doxycycline PEP is a personal decision.

4) what would you estimate the statistical risk factor to be to acquire mpox, hiv, syph, gono, Chlamydia, AND/OR herpes. 
I estimate your r for acquistion of any of these infections to be a very small fraction of 1%

As I believe you know, we provide up to three responses to each client's questions.  This is my 3rd response.  Thus this thread will be closed shortly without further responses.  I hope that the information I have provided has been helpful. EWH
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