[Question #11236] CSW Encounter - Unprotected Oral Risk?

16 months ago

Hello Doctors,

I thought I’ve learned my lesson from my previous stressful encounter, but temptation got the best of me again.

I visited a CSW in Southern California (rate of $300/hr). I am a male and she is a female. We both showered and used mouthwash before getting started.

Could you kindly provide answers/comments to the below?

1. She performed unprotected oral sex on me. This was done for about 30-40 minutes due to #3 below. Based on searching around this forum, I believe this is very low risk for HPV, HSV2, and other STIs?

2. I rubbed her clitoris and played with her vagina. Is this zero risk for HPV and other STIs?

3. We attempted protected sex. I panicked and couldn’t go through with it because I had major anxiety about previous condom breakage in a prior encounter. My penis touched her vagina with the condom intact. No insertion. I believe this is zero risk for HPV and other STIs?

After we finished, we both showered again.

I did look around this forum before asking and went in knowing this is a low risk (safe sex) event, but would just like to confirm. I am mainly having anxiety because my main sexual partner (female) had a recent clean pap smear (no HPV). Additionally, I’ve noticed a red mark/spot about 1/4 inch below the head of my penis (visible when pulling foreskin back, I am uncircumcised). Could I continue unprotected sex with her? Would you also suggest taking 200mg of doxycycline?

H. Hunter Handsfield, MD

16 months ago

Welcome back. Looking at your two previous threads, I'm happy to see this encounter went with the same safety intended last time-- even more safe, since there was no vaginal penetration, let along condom rupture. You describe a 100% safe exposure with no risk of any STI at all. And you're correct, I would say it's also close to 100% safe for HPV (which usually is a potential risk even with condom protection for vaginal sex, which still allows skin contact above the condom). And as discussed last time, expensive female escorts tend to have low frequencies of HIV and other transmissible STDs.

Those comments pretty well answer your specific questions, but to be explicit:

1. Correct: oral to penile contact is very low risk for all STDs. The highest risks are for gonorrhea, nongonococcal urethritis (NGU) due to oral bacteria, and herpes due to HSV1. Absence of symptoms within 10 days will confirm you acquired none of them. Testing for gonorrhea is optional.

2. Fingering and hand-dental contact are considered zero risk for everything.

3. Attempted but unsuccessful penile penetration, with a condom, is zero risk for everything.

The red mark on your penis doesn't sound abnormal. Probably a small hemangioma you previously didn't may attention to.

I definmitely do not recommend doxycycline or that you be tested for anything. You can safely continue your usual sexual practices with your regular partner.

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

HHH, MD

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16 months ago

Hi Doctor,

Thank you for the swift reply. Further question on one of your responses:

“1. Correct: oral to penile contact is very low risk for all STDs. The highest risks are for gonorrhea, nongonococcal urethritis (NGU) due to oral bacteria, and herpes due to HSV1. Absence of symptoms within 10 days will confirm you acquired none of them. Testing for gonorrhea is optional.”

I know there aren’t any statistics out there, but just how very low risk (for gonorrhea and NGU) is receiving unprotected oral sex from a CSW? Is the risk lower than the condom breakage I experienced in one of my previous posts (#10169).

I did ask her if she had any STDs or is clean, but the reply I got was “that’s why we use condoms” — I feel like I should have stopped things here, but let the moment get the best of me. Especially since she referred to condom use strictly for insertive vaginal sex.

The encounter happened about 12 hours ago. I have been urinating a lot and feel a bit warm (had a 99.4F temp one hour ago).

I’m aware a lot of this could just be from major anxiety. I do greatly appreciate your time and patience!

H. Hunter Handsfield, MD

16 months ago

Yes, the risk is very much lower than from your broken condom exposure.

From her responses and probable lifestyle, I think you can be confident your partner had no transmissible STDs, especially orally.

Urinary frequency and your temperature are entirely normal. (98.6F is not the maximum normal body temperature, but the average over a day. Everyone's temperature varies, with highest usually late afternoon or evening, when it can be nearly 100F.)

You shouldn't be anxious at all. Don't confuse anxieties over a sexual decision you may regret with STD risk from it. They aren't the same. For all practical purposes, you had a zero risk exposure. Believe it!

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16 months ago

Thank you for your support Doctor!

I forgot to mention I was able to get in touch with a local physician who suggested to take 800mg cefiximie and 1g azithromycin — “just to be safe” and for preventive measures.

I know you have repeatedly stated that receiving unprotected oral from the CSW is a very low risk event for gonorrhea and NGU — will taking the above medicine lower the risk even further?

H. Hunter Handsfield, MD

16 months ago

Hmm... On one hand, your local physician seems to understand STDs -- if preventive treatment were advised, it's a good regimen. On the other hand. I can't imagine a genuine STD expert recommending any treatment at all. I do not. The main effect will be its small contribution to non-STD microbial antibiotic resistance, a very big problem worldwide, caused almost entirely by antibiotic over use.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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