[Question #11453] STD Scare
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14 months ago
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Hello and thank you in advance for your help.
About 5 weeks ago I had an encounter with a sex worker that included the following:
1. She performed fellatio on me with a condom
2. I performed unprotected cunnilingus and analingus on her for probably less than 1 minute
3. Attempted intercourse with condom, but did not achieve penetration
4. Some kissing
3 weeks after this encounter, I noticed a round, painless red mark on the head of my penis accompanied by a painless mouth sore a few days later. The spot on the penis was somewhat faint and looked like it could have just been caused by friction. I thought it was just balanitis. The mouth spot was dark red and on my inner cheek and was gone in under 48 hours.
This week (5 weeks post-encounter), I have several mostly painless, white marks in my inner cheeks and inner bottom lip. These look like I may have bit my cheek (I have been waking up clenching my teeth at night and that’s when I noticed them). I believe this is all due to anxiety, but now I am nervous to sleep with others.
Is there a chance this could be syphilis? Could I test for it now or would I need to wait another week?
Thank you!
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Edward W. Hook M.D.
14 months ago
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Welcome to our Forum and thanks for your questions. I'll be glad to comment. While I'll address your specific questions below, there is virtually no chance that the lesions you have noted are due to syphilis. I explain why below but if you want to absolutely prove that the lesions you have noted are NOT syphilis- if they were, a test at this time would be positive at this time. Regarding your specific questions:
1. She performed fellatio on me with a condom
No risk for much of anything. Condoms work!!!
2. I performed unprotected cunnilingus and analingus on her for probably less than 1 minute
Very, very low risk. The CDC which tends to be conservative, suggests that the risk for HIV form these sorts of exposures is less than 1 infection in 10,000 exposures, at most. (CDC tends to be conservative)
3. Attempted intercourse with condom, but did not achieve penetration
No penetration, no risk
4. Some kissing
Virtually no risk as well
My advice- relax, don't worry and move forward. If you feel the need to prove you were not infected, test. If any of your symptoms were due to HIV, your tests would be positive. EWH
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14 months ago
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Hi Dr Hook,
Thank you for your quick response! I am slightly confused though, as you state in the opening that these lesions are not a concern for syphilis. However, further in the response it appeared that you were discussing HIV risk.
My concern is much more around syphilis, as the first lesion appeared around 3 weeks post-encounter. And the new lesions are about 5 weeks post-encounter.
Do the penis and oral lesions I described 3 weeks after the encounter resemble primary syphilis (penis: round, painless red mark resembling friction rub / oral: small, painless, blood red lesion in inner cheek)? Do my current lesions described resemble secondary stage syphilis (white lesions in inner cheek, painless)?
Apologies for any confusion from my original post. I am very nervous about syphilis or other STIs. Less concerned about HIV from this exposure.
Thank you so much for you help.
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Edward W. Hook M.D.
14 months ago
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My apologies if I created any confusion. Risk for Syphilis and risk for HIV typically parallel one another. Your lesions are not suggestive of syphilis and your risk for syphilis is vanishingly low. The lesions that you describe are not typical of Syphilis. If my reassurances do not help, I once again suggest that you test. If these lesions were due to syphilis, your test would be positive. EWH---
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14 months ago
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Thank you again.
If I decided to test, would you recommend a blood test or a mouth swab?
Are there other STIs that I should be considered?
My biggest concern comes from the unprotected cunnilingus and analingus that occurred. What would be the biggest risks from these activities?
Since these were oral activities and most of my “symptoms” have been oral, it raised my level of concern.
I also meant to mention that this was a sex worker in Mexico. I don’t know if that changes anything.
Thank you again,
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Edward W. Hook M.D.
14 months ago
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That the sex worker was in Mexico makes no difference in my assessment.
Given that your unprotected exposures were oral, if you choose the test, the most important test is a throat swab for gonorrhea. The likelihood of other STI is minimal.
---As you know, we provide up to three responses to each clients question. This is my third response therefore, this thread will be closed shortly. Take care. Please don’t worry. EWH.