[Question #12079] Should I retest after Oral and Rimming
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10 months ago
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Good morning, Dr’s.
I hate to be returning to the forum due to my negligence, but alas, here I am. I recently had a string of encounters with 2 different CSW’s. I saw them on 8/15, 8/24 and again on 8/31. All encounters were insertive oral while the last two encounters included receptive anal rimming.
I waited approx 23 days from the last encounter (8/31) to get a full-panel STI test, which all came back negative. However, since then I have noticed a few things. 1. I had a breakout of a rash on my upper chest and back this past Friday 10/4. It appeared to be folliculitis but I was concerned because it had never happened before and it seems to be clearly up on its on. I know HIV from receiving oral is unlikely but thats automatically where my mind went because of the rash and some other symptoms. Secondly, and equally concerning, I’ve noticed that the soles of my feet and palms of my hands are tingling more often and I’ve noticed more prominent eye floaters recently. I’m concerned that I possibly tested too early for syphilis and received a false-negative.
My questions are
1. Should I retest for everything, and if so when is the best timeframe for accuracy?
2. Would herpes potentially cause the tingling in the palms/soles of feet? I read that was a symptom and being that I didn’t see a chancre since my exposure that maybe herpes is the culprit.
3. I clearly have a problem seeing sex-workers. Would you advise going on PreP or Doxy-Pep? My encounters do not involve vaginal sex as I’m partnered.
Thank you for all that you do and your advice is greatly appreciated.
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H. Hunter Handsfield, MD
10 months ago
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Welcome back but I'm sorry you found it necessary. Looking at your two previous forum questions, it appears you seriously misunderstand the level of STD risk associated with exposures that are actually risk free or close to it. First, oral STDs are uncommon! Online sources can create the impression they are very frequent, but it simply isn't true. The vast majority of exposures to partners oral cavities, salvia, etc are entirely safe because no infection is present to be transmitted. There almost never is a reason to be tested for STDs after any single such exposure. It's a waste of money, time and energy to be tested as often as you have been doing so. And the chance of HIV is probably truly zero, even after such contact with a known HIV infected partner. (One estimate from and CDC is that if the oral partner has HIV, the chance transmission to the penile partner is 1 in 20,000. That's equivalent to receiving BJs by infected partners once daily for 55 years before infection might be likely.)
A folliculitis like rash is not suggestive of HIV or any other STD. Neither skin tingling anywhere on the body or eye floaters. (Where did those ideas come from???) As a general rule, symptoms almost never are useful indicators either for or against a new HIV infection. Even with the most typical symptoms of ARS (acute HIV infection), the vast majority don't have it; and most new HIV infections don't cause symptoms anyway. In the future, I advise you to entirely ignore any and all symptoms or changes in your body after you have new sexual exposures.
To your numbered questions:
1. You didn't need the tests you've already had and certainly don't need more. (Rather than testing after individual near-zero-risk exposure, it would be smarter to ignore each event and get basic tests once a year or so. And those tests should ONLY be HIV, syphilis, gonorrhea and chlamydia. All other tests in standard "comprehensive" panels are unnecessary or unreliable.
2. Another misunderstanding from over reliance on Dr. Google or Dr. Reddit. Herpes never causes tingling as the only symptom. Never, period.
3. If and when you move to unprotected vaginal or anal sex, PEP or PrEP to prevent HIV, or doxy-PEP to prevent syphilis and chlamydia, might be warranted. But certainly never with the kinds of exposures you have described in all three of your forum questions so far.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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10 months ago
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Thank you for the candid response Dr. H. I’m certainly guilty of going down the google/reddit rabbit hole.
My question around retesting after 23 days was mainly around syphilis. The associated symptoms I mentioned, tingling palms/soles and floaters, were what I had read as symptoms as the secondary stage of syphilis.
Going off your responses, I’m assuming there’s a low probability of an infection, although not impossible?
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H. Hunter Handsfield, MD
10 months ago
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Those symptoms do not suggest syphilis of any stage. It is a mistake to search online for diseases you are anxious about, see a list of symptoms, and conclude you might have that problem because one or two symptoms line up. Dr. Google and Dr. Reddit are not friends of anxious people, who almost always come up with the wrong conclusions. Even typical symptoms usually have other causes -- and in this case, you have settled on an exceedingly rare symptom of secondary syphilis among the many that might happen. After all, syphilis and acute HIV are hundreds of times less common that all the other possible causes. And anyway, how could you have secondary syhphilis and not miss the required chancre (open sore) of primary syphilis on your penis???
Impossible you have an infection from the exposures described? Maybe not, but with the chance below one in millions, you should consider it impossible and act accordingly.
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10 months ago
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Understood, Dr. I know that my anxiety has gotten the best of me. I understand that a chancre would appear during the first stage and I wasn’t sure if I was asymptomatic. That being said, I understand the 24 day mark isn’t conclusive and only an indicator.
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H. Hunter Handsfield, MD
10 months ago
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"Only an indicator" diminishes the significance of the risk. There is no realistic risk of syphilis in this event. If I were in your situation, I definitely would not be tested for syphilis and I would continue unprotected sex with my wife without worry.
That concludes this thread. Please note the forum policy against repeated questions on the same topic, especially when anxiety driven, a reflection of unrealistic fears, and so on. This being your third about near-zero risk sexual practices, it will need to be your last. Repeated questions of this sort, or with obvious answers based on the previous discussions, are subject to being deleted without reply and without refund of the posting fee. We're not keen on collecting fees for questions with obvious answers; repeated replies often prolong anxiety rather than relieving it (there's so often a "yes but" or "could I be the exception" sort of thinking); and such questions have reduced education value for other users, one of the forum's goals. Thank you for your understanding.