1. How safe was this activity?

2. I had a burning ache in penile region multi days after this, zero discharge. Are these tension focused pains?

3. Would the doxy dose at least eradicate syphilis or anything else that far out from experience ?

4. Had sex with wife about 34hrs after taking doxypep. Any concerns there?

5. If I partake in this type of experience again, should I worry at all about an exposure?

Men who offer sex with complete anonymity and having no idea who their partners are undoubtedly are the very highest risk of all potential sex partners for both HIV and other STIs. I would strongly advise anyone tempted by such offers to reject them -- as I hope you will do next time. (Or at least use a condom!)

That said, unprotected oral sex is quite safe, which much lower STI/HIV risks than vaginal or anal exposures; and there has never been a proved case of HIV transmitted oral to penis. So HIV isn't a significant worry. Neither is chlamydia, which rarely infects the oral cavity and even when present is rarely transmitted by oral sex. Syphilis is possible but rare by oral sex. The main STI risk of importance in this situation is gonorrhea.

DoxyPEP was not warranted and is not recommended after oral exposures, only anal. It doesn't work reliably against gonorrhea, your main risk. It's very effective in preventing syphilis and chlamydia,but as just discussed you were at little risk for either. The main thing now is to be alert to symptoms of gonorhrea (pus from your penis, panful urination) in the next 5 days; and penile sore that could be due to herpes (HSV type 1 but not HSV2), which also usually starts within a few days. Nongonococcal urethritis due to oral bacteria is possible as well. But all things considered, the doxyPEP likely did more harm than good -- little protection but possibly significant interference with testing for STIs.

To your specific questions:

1. Pretty safe for HIV and chlamydia, very risky for gonorrhea; unsafe for syphilis, but for that purpose your doxyPEP reduces your risk to near zero.

2. Burning without discharge usually doesn't indicate an STI. If "tension" means anxiety, the answer is yes:  that's a common reason in people who are nervous about an exposure.

3. See above about doxyPEP.

4. Having sex with your wife that soon put her at risk for gonorrhea and in theory for herpes, whose symptoms might not have started. Little risk for syphilis or chlamydia for the reasons discussed above.

5. Yes, you should be highly worried if you ever do this again. At least use a condom!

At this point, I advise a urine test for gonorrhea (which always includes chlamydia, even tho you are at little or no risk in this case. And although doxyPEP is highly effective against syphilis, I still would advise a syphilis blood test in about 6 weeks.

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

HHH, MD

 Thank you for your detailed answers. I will be staying away from this behavior going forward or at least wearing protection all the time.

I've never heard of a case of urethral gonorrhea that caused no symptoms initially and later began to cause symptoms. But I can't say it never happens.