[Question #11666] Oral sex following waxing risks.

13 months ago

Immediately following intimate waxing (penis, anus etc) I received oral sex from male. Penis was naturally sore after the waxing process and as always with waxing some small spots of blood from follicles during procedure. My questions

1.) I know receptive oral sex is a very very low risk of HIV transmission - would the fact the penis skin was sore with open hair follicles increase said risk?

2.) I am very worried about syphilis. 4hrs after the contact I took 200mg doxycycline (that I had for a previous condition) and the following day started 14 days on 100mg BID. Will this protect me from syphilis and prevent me becoming infectious?

3.) What is the best testing regime going to be here? 3 and 6 weeks? Longer? Is 6 weeks after a contact conclusive for HIV and syphilis? Or do I need to wait for 8/12 weeks? (UK guidance seems to tend towards 13 weeks for conclusive...)

4.) Hep B/C risks?

Thanks for assistance

Edward W. Hook M.D.

13 months ago

Welcome to the Forum. thanks for your questions. I'll be glad to comment. First, you don't say anything about your partner- few people have untreated HIV. Further. as you might imagine, there are no scientific studies to help in answering your questions however what we know from other circumstances strongly indicate that, despite small blood spots from the hair removal, there is no risk for HIV or hepatitis from your receipt of oral sex soon after the waxing. We certainly know that no other sorts of abrasions, scratches or small penile wounds change the fact that there are no proven cases of HIV acquired from receipt of oral sex. I see no reason for concern and no reason for testing.

In reply to your specific questions:

1.) I know receptive oral sex is a very very low risk of HIV transmission - would the fact the penis skin was sore with open hair follicles increase said risk?

Not "very, very low" risk but effectively NO risk. see my comments above

14 days of doxycycline would have prevented syphilis in the unlikely circumstance that you were exposed and would have cured syphilis if it were already present for some other reason.

I see no need for testing. If you feel you must test, testing with a 4th generation HIV test and standard tests for syphilis will be conclusive and, I'm confident, show that you were not infected

4.) Hep B/C risks?

No risk.

I hope these perspectives are helpful. Please don't worry. EWH

---

13 months ago

Dear Dr Hook,

Thanks for your rapid response, answers and reassurance.

Just a couple of follow ups (accepting the ultra low risk from my contact) for future reference

1.) Would 200mg Doxycycline as one dose within 24hr of a contact, followed by 14 days of doxycycline (assuming one was negative for syphilis prior) prevent a person getting syphilis and becoming infective in anyway - would this be the case, after say 4 days of 200mg doxy bid? And hence not developing syphilis antibodies that would be picked up in a blood screen?

2.) Is there a consensus on time periods for conclusive testing for blood borne STIs following any contact (with zero further exposure)? 4 weeks VS 6 weeks? The UK/NHS guidance seems to be wedded to 45 days with a 4th Gen test for HIV and 13 weeks for syphilis! In your opinion are negative results for HIV and syphilis conclusive at 6 weeks?

3.) Windows periods for Hepatitis B and C? NHS suggest 6-12 weeks for B and upto 6 months for C! Do you agree?

Thanks.

Edward W. Hook M.D.

12 months ago

1. This question is hard to follow. If you took the doxycycline as described, there is simply no way that you could have Syphilis.

2. There is consensus that fourth generation, combination, HIV antigen/antibody test are absolutely conclusive at 42 to 45 days following an exposure. In my opinion, the NHS recommendations regarding conclusive syphilis testing are overly conservative. If your syphilis test remains negative at six weeks, you did not acquire syphilis. Once again, however, I refer you to the reply above. If you took the doxycycline as described, there is simply no way you could have Syphilis.

3. In my opinion, a. Six month window period is too long for conclusive results for hepatitis C. I would anticipate that results would be conclusive after six weeks.

EWH

---