[Question #12307] Oral and Kissing Risks and Testing

8 months ago

I (heterosexual male) am starting a relationship and want to not put my partner at risk. Previously I had two times protected vaginal sex with two different escorts and multiple unprotected oral sex. After these, HSV-2, Chy-Gon, HIV-SIPH tests were all negative. Recently I started having unprotected oral and deep kissing with escorts. I am in Switzerland. I usually asked escorts if they are tested and they said yes. My last exposure was 2 days ago, no oral sex just mutual masturbation, using spit as lubricant (maybe some vaginal fluids) and kissing (deep). 2 weeks ago had another exposure but that only included licking of scrotum and kissing. I will get tested for HIV and Syphilis 6 weeks later just to be sure. I have read on Swiss medical sites that most quick Syphilis tests are not very reliable. Shall I do this test or a quick one is also enough? I will take urine or swap tests after two weeks from the exposure for Gonorrhea and Chlamydia. I plan to also take the oral swab but is there a realistic chance of getting oral STDs by deep kissing? I never had anal sex but do you think I would need the anal swab well? I never got tested for trichonomas. Shall I get tested? I had no symptoms so far.

H. Hunter Handsfield, MD

8 months ago

Welcome back to the four. Thank you for your continuing confidence in our services.

In general, I would say you are over testing. All in all, these exposures all have been pretty low risk. Escorts -- expensive female sex workers by appointment -- tend to have low frequencies of HIV and other STDs. In general they care about their health, usually use condoms and follow other safe sex practices, get tested frequently, and most of their clients are low risk themselves (men like you). And most persons do not lie when asked directly about HIV/STD testing and infection status. Hand-genital contact (mutual masturbation) is no risk at all, and saliva infrequently transmits HIV or STDs. Oral sex is low risk in general -- not entirely free of STD risk, but a lot lower risk than vaginal or anal sex. And no risk at all for HIV, or low enough risk it can be ignored.

There is controversy about gonorrhea transmission by deep kissing; to the extent there is risk, it's almost entirely in men having sex with other men. Otherwise kissing is nearly zero risk for all STDs. Syphilis and HIV are extremely unlikely in the situations you have described. It's fine to have throat swab tests for gonorrhea and chlamydia, and can expect negative results; you are at very low risk for both. You needn't wait two weeks; testing is valid any time more than 3-4 days after exposure.

There is no point in you having an anal swab for any STD since your anus has not been exposed. Males do not need trichomonas testing; it rarely causes symptoms and usually clears up rapidly without treatment. And without penile-vaginal exposure, there is no chance you have it. (Trich doesn't infect the mouth, so oral sex is no risk.)

It is not true that the newer rapid syphilis blood tests are not reliable. In general they are quite good, and I can't imagine they are any less reliable in Switzerland than anywhere else.

I'm not certain you really need any testing at all at this point. If your sexual lifestyle continues more or less as described here, and you develop no typical symptoms (penile discharge, painful urination, sores at exposed sites) it should be fine to pretty much ignore individual exposures and just plan on regular testing every few months or maybe once a year.

I think those comments pretty well cover the issues on your mind, but let me know if I missed anything.

HHH, MD

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8 months ago

Thank you very much for the answers and clarifications. I just wanted to make sure that I am not missing anything. Your service clears a lot of things for me, especially considering that I am an anxious person and there is a lot of anxiety inducing content online. You can close the thread.

H. Hunter Handsfield, MD

8 months ago

Thanks for the thanks. I'm glad to have helped. Best wishes and stay safe.---