[Question #13247] STD/STI Risk Assessment

1 months ago

Hello Doctors,

I am back again. This time I gave oral sex to a worker at a massage parlor. I have pretty much only gone to her and one other but only gone this far with her. The other gave me a short excerpt of oral about 4 weeks ago and I have been monitoring to see if any symptoms arise. Both have told me they are healthy but I have not been able to determine the regularity of their testing.

I am pretty well aware based on your recent answers and old answers to me that receiving/giving oral is relatively low risk. I know gonorrhea and chlamydia are low risk and if present show symptoms in about a 5 day period. For some reason my biggest concern is syphilis. I think mainly due to the fact that it has a 6 week incubation period I am worried I may transmit it to my significant other before any signs start showing. The 5 day period for the other two STDs I mentioned can usually go by between the days I see my SO so I can determine Im relatively safe after the 5 days. (We do not live together and see each other on weekends).

I guess my main questions are

1. Incident specific what are the chances of any STDs from receiving oral sex for about 3 minutes 4 weeks ago and giving oral sex for around 3 minutes today.

2. Regarding bettering my understanding of syphilis, is it possible to transmit without a chancre present? Lets say I did have syphilis of either oral/genital type, if the 6 weeks hadnt gone by but no chancres were present would it be possible to give it to my significant other? Or does a chancre have to explicitly be present in order to transmit.

3. Also I am a heavy smoke, does sharing cigarettes/vapes carry any risk of infection for any one of my friends/colleagues I share with?

Thanks!

Edward W. Hook M.D.

1 months ago

Welcome back to the Forum. I'll do my best to try to help. I think you may be more worried about syphilis than you need to be. Infectious syphilis is about 10 times less common than gonorrhea and is most common among men with other men as sex partners. Rates among transexual women are somewhat higher than among men with only women as sex partners. Further, syphilis is acquired only through direct contact with an infectious lesion. Even then, on average only 1/3 of direct contacts lead to infection. Finally, while it takes 6 weeks for syphilis blood tests to provide conclusive evidence of infection, syphilis lesions become apparent about 3 weeks after exposure and the 6 week guideline pertains to persons who may not be aware that a lesion develops (after all, they are painless) such as persons engaging in receptive anal intercourse. If your CSW partners are getting checked regularly and there are no visible lesions at sites of contact (such as the mouth when receiving oral sex) risk is relatively low. With that, let's address your specific questions:

1. Incident specific what are the chances of any STDs from receiving oral sex for about 3 minutes 4 weeks ago and giving oral sex for around 3 minutes today.

There are no data on how the duration of contact influences risk. Certainly it is logical to assume that the longer the contact the higher the risk but how that impacts risk is unknown.

Syphilis is transmitted almost exclusively through direct lesion contact. No lesion, virtually no risk

3. Also I am a heavy smoke, does sharing cigarettes/vapes carry any risk of infection for any one of my friends/colleagues I share with?

There are no data to suggest that sharing cigarettes, hookahs, or vaping devices transmits syphilis or any other STI.

I hope that this information is helpful. EWH

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1 months ago

Thank you for the insight into my questions.

Just to clarify my question 1. was more about what the chances of getting any STIs from either the oral 4 weeks ago or cunninglingus I gave today.

Secondly when you mentioned the syphilis stats. I figure the rates among non transgender women are lower than both of the cases you mentioned?

Thanks!

Edward W. Hook M.D.

1 months ago

My response to question number 1 holds for all STIs. Longer exposure to an infection women, logically higher risk.

Correct, women who only have male sexual partners have lower rates than MSM or transgender women.

One follow-up remaining. EWH

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1 months ago

I hope my last question doesn't sound repetitive.

Disregard the duration of my incidents and whether or not we know the two women were infected.

1. In the plainest of circumstances, would you say I need to get tested for either exposure/in your opinion what are the % chances I would’ve caught anything. Would you worry about continue sexual acts with a partner.

2. Secondly, in the 3 week timeframe between when these exposures happened and when a syphilis chancre might appear am I safe to continue engaging in sex with my significant other. Due to your statement that no chancre is virtually no risk

Edward W. Hook M.D.

1 months ago

This is sort of silly. Suggesting that whether or not the women were infected is not important makes no sense. The fact is that it is unlikely that they were- quite unlikely. Further, your obvious anxiety is a consideration in whether or not you pursue testing. Negative tests would be reassuring and SHOULD reduce your anxiety. Thus

Testing is a personal decision. I estimate that there is a less than 1% chance that you were infected with anything and a far lower chance of syphilis which seems to be what you are most focused on (even though the risk of syphilis very, very low)

You are correct. If you do not have a lesion, you would not be at risk for transmitting an infection.

This completes this thread. There should be no need for further questions. The thread will be closed shortly. EWH

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