[Question #12002] Unprotected oral by massage worker
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11 months ago
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Hi Doctors, really appreciate your forum! Been browsing and researching non-stop the past 48 hours. I am a 35 year old male currently in Vietnam vacationing. Went to a massage parlor on 9/20 where the massage worker briefly (at most 1 minute) performed unprotected oral sex on me (from what I remember, nothing further than the lips and a couple of licks), but it was primarily a handjob.
Additional information below:
- CSW washed me in the bathtub
- CSW wiped my genital area with what I assume was an alcohol wipe
- CSW washed me again in the bathtub at the end of the session
- I peed around 45mins after session
My questions:
- Basked on the information that I provided, am I still at risk for any STI?
- I am planning on getting Doxycycline and Cefixime later today. CDC recommends Cefixime 800 mg since I cannot get ceftriaxone. Will the Cefixime 800 mg be sufficient enough?
- I scheduled a STI testing with my Planned Parenthood clinic on 9/24 immediately when I arrive back to the US. Two days after taking the Cefixime, will the testing be accurate to show that I do not have gonorrhea?
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11 months ago
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Forgot to add this question:
- Will the Cefixime 800 mg and Doxycycline 100mg be effective 48 hours after contact with the CSW?
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Edward W. Hook M.D.
11 months ago
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Welcome to the Forum. thanks for your questions. I'm not sure what you mean by "researching" but if that involves looking for answers on the internet, I urge you to stop. Much of the information found there is incorrect and misleading.
The encounter you describe was virtually no risk for acquistion of any STI- IMO, taking antibiotics would be a mistake and only lead to possible confusion downstream including making it difficult to interpret your test results on September 24.
Specifically, the risk of any STI from receipt of oral sex is very low, particularly if the exposure primarily involved licking your penis vs taking your penis into her mouth. Even if she put your penis into her mouth, the likelihood of infection is very low.
If you opt to take antibiotics, taking 800 mg of cefixime and doxycycline is likely to prevent syphilis and chlamydia and will reduce but not eliminate your risk of gonorrhea. EWH
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11 months ago
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Thank you for the response!
Follow-up questions:
- From reading previous answers on this forum, if I do not see any symptoms (painful urination and discharge from penis) within 3-5 days from the massage session then could we assume that I did not gonorrhea? Based on reading, chlamydia is impossible from oral sex.
- Responding to "If you opt to take antibiotics, taking 800 mg of cefixime and
doxycycline is likely to prevent syphilis and chlamydia and will reduce
but not eliminate your risk of gonorrhea.". I'm a bit confused since the CDC states that, " If a chlamydia test result has not been documented, the partner may be
treated with a single dose of oral cefixime 800 mg plus oral doxycycline
100 mg 2 times/day for 7 days" https://www.cdc.gov/gonorrhea/hcp/clinical-care/index.html#cdc_clinical_care_treatment_treat_recomm-use-of-ept-in-the-treatment-of-gonorrhea There seems to be a little bit of conflicting information? Is there another medication that you would suggest?
- Will the cefixime and doxycycline antibodies work immediately?
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11 months ago
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Just wanted to update:
- I did take 800 mg of cefixime and 200mg of doxycycline earlier today, which is within a 48 hours time frame. When could I expect the antibodies to be working and removing gonorrhea?
- I have also read that taking 2g of azithromycin would also help. Would it possible to take 2g of azithromycin as well? If so, what is azithromycin's time of cure?
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Edward W. Hook M.D.
11 months ago
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In response to your follow up questions:
Over 90% of person who acquire gonorrhea develop an obvious penal discharge within 3 to 5 days following an exposure. Thus it is quite unlikely that you have acquired gonorrhea. Getting chlamydia from receipt of oral sex is not impossible, but it is relatively rare.
I do not see the contradiction that you mentioned. The recommendation that you quote is for people being treated for known gonorrhea. You have apparently treated yourself for an impossible, somewhat low risk exposure. If you were taking medication is preventative treatment then cefixime is not part of that regimen.
If you were exposed to gonorrhea, which is unlikely, suffix is a slightly less effective alternative than Seth Triax. Your exposure was in Southeast Asia, where strains and the treatment failures are slightly more common than they are in North America.
Azithromycin would add nothing to the medication‘s. You have already taken, most probably unnecessarily. EWH.