- kissing

- nipple licking/sucking , both me doing the licking and getting my nipples licked 

- massages 

Now I am worried that I might have exposed myself to an STD (particularly syphilis or herpes 2). I have the following questions.

1. How likely is it for me to get syphilis from getting my nipples licked? I saw an article that says there has been 6 cases of men who got syphilis on their nipples from this act. 

2. I have been having some pain in my nipple area. However, I don’t see any lesions or chancers forming. Is this pain a sign that a syphilis lesion will be showing up? 

3. What about the risk of getting herpes from kissing.

4. I do have a 14 day supply do doxycycline. Would this be enough to cure syphilis? 

5. I took a rapid syphilis health check test yesterday and it came back negative. However, I’m not sure how reliable that test is at 3-4 weeks post exposure. Any insight on this? 

The exposures you describe are all zero risk -- or close to zero -- for all STDs. The only possible exceptions are two:  First, there is controversy about gonorrhea transmission by aggressive, prolonged open-mouth kissing between men. So conceivably oral gonorrhea. Second, syphilis also in theory can be transmitted by kissing and perhaps sometimes by contact with other areas of the body, but this is extremely rare if it occurs at all. There was no significant STD risk otherwise from the events you describe. HSV type 2 is almost never oral, only genital -- and so you cannot get HSV2 from the events you have described. And your known HSV1 infection, discussed in your two threads a few years ago, makes you immune to new HSV1 anywhere in your body. (That's also why Terri informed you that you are not at risk of self-transferring your oral herpes to new places anywhere in your body.)

Those comments pretty well address most of your numbered questions, but to be sure of no misunderstanding:

1,2. As noted above, mouth to skin transmission of syphilis is very rare. I cannot comment on the 6 claimed cases you apparently found, but I've never seen anything like this in my 50 years in the STD business. Nipples are no more susceptible than other body sites. And as you apparently already know, if you acquired syphilis, you would obviously be able to see it, i.e. a chancre, which would typically appear 10-20 days after exposure. Pain alone is not a symptom of syphilis.

3. Since you already have oral herpes, you will never catch it again. Indeed, probably the main STD risk in these events were that your partners could have caught your oral herpes. You don't have to have a visible herpes outbreak in order to transmit the virus.

4. You definitely should not take doxycycline in this situation. Your question suggests you are aware that post exposure prophylaxis with doxycycline (doxy-PEP) is now recommended for men who have sex with other men, but only after unprotected anal sex, and for sure not in essentially zero risk events as you have described. And when doxy-PEP is used, it's just a single dose of 200 mg.

5. Having not had a visible chancre by now, you're already out of the woods on syphilis. Your negative blood test is around 80% reliable at 3-4 weeks. If you want additional reassurance, have another syphilis blood test at 6 weeks. You can definitely expect it to remain negative.

A final bit of advice:  Although these events are risk free, it seems you're very close to becoming truly sexually active with other men -- maybe not intended even, but the result of temptation during planned safe events. Please have condoms handy and use them for anal sex, either giving or receiving. Better safe than sorry!

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

HHH, MD