[Question #13002] Massage, Oral Exposure & STI

3 months ago

Hello Doctors, thank you for spending time to educate folks here, really appreciate the great work !

I was on a work trip to India 4 weeks ago, staying at a luxury hotel. Visited the spa once and somehow the masseuse and I had an emotional connect discussing various life things and she kissed me and gave me a HJ (not for money). I visited her 2-3 times more during my stay there and every time it was the same. However during my last session, she asked if i wanted something special and immediately put my penis in her mouth(unprotected), and sucked it 2 times - I stopped her stating it was not appropriate and we parted ways after. No other sexual activities happened. I got a Urinalysis done 4 days later in India, which stated no bacteria present. It is day 21 today post the last session and I have a bit of a cold, scratchy throat and some body aches. No symptoms on my Penis. Wanted to check what my risk is here for STIs in general, HIV in particular. this is my first encounter with an outside person in 9 yrs. Worried about HIV, HSV, Syphilis and HPV to be honest due to Kissing and Oral exposure for those 3-5 seconds. Let me know what you think and if any testing is recommended, how soon can the tests be conclusive.

Edward W. Hook M.D.

3 months ago

Welcome to the Forum. Thanks for your questions and your confidence in our service. I'll be glad to provide some information. The exposure you describe was no risk for HIV and virtually no risk for other STIs. There are several reasons for this. The reasons include:

1. Most masseuses do not have HIV or other STIs, even those who regularly engage in sexual activity with clients.

2. There are no proven cases of HIV acquired from receipt of oral sex. None!!

3. Acquistion of other STIs from oral sex is uncommon. The major STI acquired on those rare occasions when it occurs is gonorrhea and that is typically symptomatic within 3-5 days of the encounter.

4. Even when a partner has an oral STI, most single encounters do not result in transmission and in your case the brief duration of exposure reduces your risk even more.

5. No, at 21 days, if you were going to develop symptoms of HSV or syphilis, an obvious lesion would have developed at the site of exposure by now

Testing is always a personal decision. In your situation I would not bother to test however some clients chose to test for the additional reassurance that a negative test provides. If you choose to test, the main testto get is a urine test for gonorrhea and chlamydia. We recommend against blood tests for herpes in these situation as they so often yield falsely positive results.

I hope this information is helpful. Take care. Please don't worry. EWH

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3 months ago

Thank you so much for the response. My rational self did wonder if HIV was so easily transmitted with 3-5 seconds of exposure, then everyone would have it ! Thank you for putting the HIV concern to bed. A few follow-ups since I am allowed:

1. You mentioned about Oral STI, although the exposure was brief on my genital, how about oral STI transmission from mouth to mouth kissing, given i exposed myself via kissing in all 3 of my sessions with the masseuse if she had an oral STI.

2. Would your opinion be that my scratchy throat, dry mouth and cold symptoms are due to some other reason and not necessarily an STI and related to this exposure 21 days ago.

3. I read through most of the Q&As on this site, very helpful - haven't seen anyone talk about HPV much, whats the risk of transmission for HPV in such scenarios.

4. I understand your recommendation to not get tested for HSV due to false positives. Regardless of this particular situation, when is usually a good time to test and validate we do not have HSV to be aware and cognizant of not transmitting it to kids inadvertently ?

5. What is a good timeline post exposure that one should stop looking for new symptoms, 3/4/6 weeks. I was thinking 6 weeks but would like to understand if it is more.

Thanks once again for your valuable time.

3 months ago

Sorry, wanted to add another note on your response point #5.

You mentioned about appearance of a lesion by now. I did have one small pimple come up on my testicles. Very small, looked like a pimple so did not bother to think about it much. Has stayed as is since when it appeared. No pain, no irritation, just very miniscule in size. No fluid or anything in it. Area underneath it becomes reddish if I irritate it too much in order to check for pain etc. Hopefully this is not indicative of syphilis or anything.

Edward W. Hook M.D.

3 months ago

Deep kissing has been suggested to be a rare/occasional source of STI acquistion, again, particularly for gonorrhea. It is very, very rare.

2. Would your opinion be that my scratchy throat, dry mouth and cold symptoms are due to some other reason and not necessarily an STI and related to this exposure 21 days ago.

Oral STIs are most typically asymptomatic

3. I read through most of the Q&As on this site, very helpful - haven't seen anyone talk about HPV much, whats the risk of transmission for HPV in such scenarios.

Virtually all ( of 80% of sexually active persons will have HPV. Oral transmission is rarely the source of infection. There are many other posts on the site on oral HPV. The bottom line is that it is not something that the encounters you describe have put you at risk for.

We recommend against virtually all blood testing for HSV. It rarely is helpful and is a common cause of misunderstanding. The way to diagnose HSV is with a swab test (PCR) taken form a lesion if present. Questions about HSV should be directed to Terri Warren on this site as a separate question.

5. What is a good timeline post exposure that one should stop looking for new symptoms, 3/4/6 weeks. I was thinking 6 weeks but would like to understand if it is more

You are long past the time when signs or symptoms of infection would appear. The "pimple" you describe does not sound like an STI and is in a location where STIs rarely occur.

I think you are worrying far to much. It's time to put your concerns aside and move forward. You have one follow-up remianing.

EWH

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3 months ago

Thank you so very much. Not worrying per say, trying to educate, i guess kinda both. Since this is my last follow-up I will try to be brief and specific. As suggested, will post a new question if needed for HSV to Terri Warren.

As advised, I got the gonorrhea and chlamydia, Urine NAAT test done - was negative. At 21 days I am guessing that is conclusive. What is the level of exposure and risk for me for NGU at this point. Today is almost day 28 and I don't have a discharge or anything but have had a very mild sharp lower abdomen pain that occasionally radiates through the pelvis and the groin. Very mild/occasional tingling and burning on the tip of the penis although don't notice much during urination and is infrequent. I got Urinalysis done which was negative for anything. So, maybe its just my mind or dehydration, not very sure. Wanted to ask if I should just let it go or consult my PCP for further analysis if related to any UTI/NGU etc.,. Would NGU always present with a discharge or anything else ?

Thank you for all the responses so far, it was a pleasure being acquainted with your services and the whole forum here.

Edward W. Hook M.D.

3 months ago

As you know, this will be my final response before the thread is closed. After the thread is closed, there should be no need to return with further questions regarding these encounters. If you do, your question may not be answered and your fee may not be returned.

Your tests for gonorrhea and chlamydia are entirely conclusive. If you are without symptoms at this time, you can also be assured that you do not have NGU which, when it occurs following receipt of oral sex, is not a threat to your health or your partner's (NGU following receipt of oral sex is typically due to disruption of the bacteria present in the urethra and is not a classical STI- many clinicians do not even treat it). Your normal urinalysis also is evidence you do not have NGU.

Intermitted abdominal pain is not a sign of STI either. The symptoms of STIs do not come and go. The occasional mild tingling you note on urination suggests that you are looking too hard for symptoms and detecting normal sensations.

I think you are worrying too much. I suggest you try to put your concerns aside and move forward as you would normally. EWH

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