Thank you for this service.  I used MedHelp in the past and your advice was always reliable and accurate.

Yesterday I engaged in mutual unprotected oral sex with a transgender CSW.  I have seen her in the past and usually just received a massage with a handjob or covered oral.  This time my 'urges' got the better of me and we performed unprotected oral on each other which lasted maybe a minute or so until I ejaculated.  She did not ejaculate nor did I notice any pre-cum from her penis..   Her penis looked clean and she said she has never had a problem and gets tested.  As an aside,  she is not inexpensive ($250) and the majority of her clients are older married men.   Lastly, I rinsed my mouth out with hydrogen peroxide and washed my penis with hand disinfectant immediately after the event.  

Of course now I am beside myself since I am in a committed relationship and do not want to pass anything onto my partner.  I am HSV1 positive and have never had any cold sores or apparent symptoms.   I recognize that if I need to get tested, I may have to wait sometime to get accurate test results depending on the STIs.    

I know this is a single exposure and probably a low (very low?) risk and I would greatly appreciate your advise on how to proceed specficially as to whether you believe testing is necessary and when.  

Thanks for your help.    

 

You describe a very low risk sexual exposure, especially for HIV (one chance in 10 to 20 thousand, and that's only if the partner is infected, which seems unlikely from your description of your partner). Chlamydia zero, gonorrhea low chance, syphilis rare. Your mouth rinse probably made no difference in your risk for anything, and certainly hand disinfectant didn't either; no STIs ever are transmitted by hand-genital contact. From a medical/risk perspective, testing is optional; if somehow I were in your situation I would not be tested and would continue unprotected sex with my wife without worry.

That said, reassurance alone is a valid reason for testing even when the risk is minimal. If that applies to you, I would suggest a urine gonorrhea/chlamydia test and perhaps a throat swab for gonorrhea; these are valid within 4-5 days after exposure. You could also have a 100% accurate HIV RNA PCR blood test at 11 days; and a syphilis blood test and confirmatory HIV AgAb test at 6 weeks. But I really would not advise holding off on sex an home that long.

Another option is to ask your trans CSW partner to be tested again, at your expense. If negative, you'll know there was no possibility you were exposed.

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

HHH, MD

Thanks again for providing this service.  

Your reading has been correct:  oral sex is zero risk for hepatitis B probably close to zero for HPV. Really nothing to worry about or to be tested for.

Normally threads are closed after a month (which is why I looked at this question now and discovered your last question -- apologies again). But I'll leave it open a few more days in case you have a reply or question about this final response.