[Question #12535] Protected Oral Sex STI Risk

7 months ago

10 days ago, had protected oral sex with asian masseuse. Condom used throughout. skin irritationin groin area from massage with boxers on. Concerned about STI entry. Showered and urinated 30 min after. Tested for gonorrhea and Chlamydia via urine on day 6 and throat swab day 7. Both negative. Conclusive? PCP ordered labs for GC detection NAAT APTIMA. HIV 4Th gen AG/AB reflex. RPR RFX QN RPR confirm TP. Should these tests be taken at 2 week mark? Read chancres are hard to spot, thy would only be on genitals not mouth correct? After reading threads Mt situation seems low risk per recorded dialogues. If transmission did occur what is the "most likely ranking" Gonorrhea, Chlamydia, Syphilis, and finally HIV?

H. Hunter Handsfield, MD

7 months ago

Welcome to the forum. Thank you for your question.

Initial reply, after reading only the first two sentences: This was a zero risk exposure for all STDs. Even without a condom, oral sex is low risk; with a condom it is truly zero for any and all infections. You do not need testing for anything.

Now having read the rest: No change in that advice. As just implied, there was no need for testing. And why throat testing? (From your description of the exposure, your mouth was not exposed. Kissing doesn't count.) If I had been your PCP, I would have advised against repeating the gonorrhea/chlamydia test and would not have ordered the HIV or syphilis tests. In any case, there is no point in doing the blood tests at two weeks; the HIV AgAb test and RPR are not reliably negative until 6 weeks.

"If transmission did occur what is the "most likely ranking" Gonorrhea, Chlamydia, Syphilis, and finally HIV?" Transmission could not have occurred. Had you not used a condom, I would have ranked the odds as highest for gonorrhea, but still under one chance in a thousand; syphilis next at maybe one in tens of thousands; chlamydia next, even lower; and HIV truly zero. There has never been a proved case of HIV transmitted oral to penis. And with a condom, definitely zero for all, as noted above.

I hope this reply resolves your concerns. Let me know if anything isn't clear.

HHH, MD

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7 months ago

Thanks for the reply, Doctor. Reason for throat swab was bc i mentioned to PCP of throat discomfort and was slightly itchy and red.

Syphilis seems to be the one I'm fixating on the most. Probably bc of the larger window period. With 1st stage symptom, would it only be located on genital (not mouth or anus) as only receptive fellatio occurred? For this STI, is it more likely to occur in MSM sex? I'm an analytical person so any data you could present on a high-level is appreciated.

I plan to test just to be safe but i appreciate your time and insight. I'll save my final reply upon completion of my final test. Thank you again.

H. Hunter Handsfield, MD

7 months ago

No STD is a common cause of sore or "itchy red" throat and syphilis certainly would not be; probably you caught a minor non sexually transmitted virus, whether from your massage partner or anyone else in your environment. Syphilis cannot cause any symptoms sooner than 10-14 days after exposure. Initial syphilis can occur only at a site of direct exposure. As noted above, the condom protected you from any infection.

Most STIs are more common in MSM than in heterosexuals, but of course that's irrelevant to your exposure. Sorry, but I can't think of any statistical data that would affect my judgment of zero risk you acquired any STD and did not need testing.

It's fine to test "just to be safe", but if you were to ever test positive in the next few weeks, I would conclude it could not have come from the exposure you have described. It's OK to post your future negative test results, but of course all I will do is agree you aren't infected. But I'll make a deal with you: If you should in fact test positive for anything within the next few weeks, feel free to start a new question and we'll refund your posting fee. So you won't lose out on further advice if you still need any clarification or additional information about my replies so far.

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6 months ago

Hi Dr. I am writing to you on day 31 post potential exposure. I have tested at 4 weeks (day 28) and have tested negative for Gonorrhea/Chlamydia (urine), HIV (4th gen), and spyhilis (RPR) as noted in this thread earlier.

From other people's threads looks like HIV is ~95% conclusive and maybe ~90% conclusive for syphilis. Is this about right for my case?

I was checking for chancres/lesions on penis/genital area ( and none have been present) but I didn't realize I had a circular type blemish an inch under my bellybutton. I didn't think much of it but realized it could've been a chancre due to its timing. I don't recall there been oral contact in that region, so I ask, if there was contact, can chancres present itself on non genital/oral areas like the lower abdomen? I first noticed it around 2 weeks post exposure. Since I tested at week 4, I presume the test would've been positive if the blemish was indeed a chancre, is that correct to say? The blemish is still present but i did pick at it so I did prolong its stay. Had i not, it looks like it was healing and close to being gone potentially.

Should the 2 noted blood tests (4th gen and RPR) be negative at week 6 (day 42) is it safe to say I'm conclusive regardless of the blemish?

Please share your thoughts, and thank you for the service you and your colleagues provide.

If possible, would you please leave this thread open for a couple weeks as I'd like to share my status at 6 weeks (day 42). I'll refrain from posting another question on this thread as I understand that goes against the sites guidelines. Thank you.

H. Hunter Handsfield, MD

6 months ago

The HIV AgAb tests are better than your 95% estimate; they detect at least 98% of infections by 4 weeks. 90% probably is about right for the syphilis blood tests. No chancre appears as a "circular blemish"; and yes, the blood test would have been positive if it were a chancre. (Always positive within a week of chancre onset.) Both tests will again be negative at 6 weeks. As discussed above, you were at no risk for any STI and didn't need testing.

Threads are closed after two follow-up comments and replies (or after 4 weeks, whichever comes first), so we're done now. I see no point in keeping it open simply for your next round of negative test results; I would do no more than agree and advise you to have no more testing. But I'll make a deal with you: if somehow I'm wrong and either test is positive, please return and let us know, and we'll refund your posting fee.

I hope the discussion has been helpful. Best wishes and stay safe.

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