[Question #13330] Unprotected oral & protected intercourse
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7 days ago
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Dear Doctors
Male 44 years old from the UK
Recently visited an escort and had the following: unprotected oral (fellatio) and gave cunninglus. We also had condom protected vaginal sex.
Post event 3 days ago I am feeling incredibly guilty and massive amounts of anxiety. Symptoms wise feeling very hot all the same and sweating with dry/mouth tongue.
Unfortunately cannot test as away on. 2 week break so will need to wait until day 20. What test(s) do you consider to be required in my scenario above? Main fear is HIV but realise my true risks are very low. Also tried to contact escort post event but unfortunately did not respond back to confirm when her last tests were.
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Edward W. Hook M.D.
7 days ago
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Welcome to the Forum and thanks for your questions. I’ll be glad to comment. The encounter you describe was low risk and virtually no risk to HIV. Most commercial sex workers do not have STI including HIV, most single exposures to infected partners do not lead to infection, condom use virtually eliminates risk for most STI transmitted through vaginal sex, and oral sex is low risk for most STI including HIV. There are no proven cases of HIV acquired from receipt of oral sex, the estimated risk of HIV acquisition of HIV in the unlikely circumstance that your partner has untreated HIV is less than 1 in 10,000, and the major STI acquired from receiving oral sex is gonorrhea ( the risk from cunnilingus is lower still). Were you to acquire penile gonorrhea from receipt of oral sex, there is a more than 90% chance you will develop obvious penile discharge within 3-5 days of your exposure,
The overall risk is so low that I don’t feel strongly that testing is needed, except perhaps as reassurance, particularly if you remain asymptomatic for 20 days. If you choose to test, testing for Gonorrhea and chlamydia ( urine and a throat swab) will be conclusive any time more than 3-5 days after your encounter. Most blood tests for HIV and syphilis will be positive by 30 day and conclusive after 6 weeks.
Finally, I caution you against compulsive and/or vigorous self examination. If you become symptomatic, it will be obvious and over examination tends to simply noticing otherwise normal sensations and findings. Also, stay of the internet which will only mislead you and amplify your concerns.
Please don’t worry. If any part of this is unclear, use your up to two follow ups for clarification. EWH
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6 days ago
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Dear Dr Hook
Many thanks for the prompt response it is much appreciated. It’s day 4 and no main symptoms to report and will follow your advise and avoid scanning the internet further. Would you put the dry mouth/tongue simply down to anxiety at this stage? Based on this exposure would you say that chlamydia/gonnorhea are the main risks here (even if very low probability)?
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Edward W. Hook M.D.
6 days ago
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I also would attribute your dry mouth to anxiety. This is not a sign of any STI. Likewise I agree that your main risk, and that risk is quite small, is for oral Gonorrhea. EWH---