[Question #13636] Unprotected oral STI concerns

2 months ago

Hi doctors. About 4 weeks ago, I went for a massage in an Asian Massage Parlor but ended having unprotected oral sex (received fellatio and anilingus) and protected vaginal sex with the CSW. She offered unprotected vaginal sex which I declined and had protected vaginal sex.

A week later I had penile discharge and sore throat. I went to see a GP who administered a shot of Ceftriaxone and Azithromycin 500mg x 2 tablets. The GP ordered urine sample and throat swab for Gonorrhea and Chlamydia, and the test was positive for Gonorrhea in both urine and throat.

14 days after the exposure, I asked the GP for other STI testing - HIV, Syphilis, Hep B & C which all came negative.

2 days after my exposure, I had unprotected intercourse with my partner. After I got diagnosed with Gonorrhea, I informed her. She tested 2 weeks after the intercourse, and 5 days later she results showed that she was positive for Gonorrhea too. So, on day 19 after intercourse, she got the same treatment as me.

So, given that the CSW offered unprotected sex (both oral and vaginal) to all her clients, please help me with the questions below:

(1) What are the chances of me getting other STIs - specifically Syphilis and HIV? If I have got other STIs, how contagious I would have been during my unprotected intercourse with my partner (which was 2 days after the exposure), and what are the chances I could have infected her? I feel so guilty about me transmitting Gonorrhea to her already.

(2) How conclusive are the results from the 14 days? Do I need to get re-tested again? Do I need to get any other STI tests?

(3) What are the chances that Gonorrhea have affected mine and my partner's fertility? Will there be any issues in future after treatment?

Edward W. Hook M.D.

2 months ago

Welcome to our Forum and thanks for your questions. I’ll be glad to comment. Your infection, as well as the infection your partner had was treated correctly. Further, your treatment eliminates virtually any risk for syphilis- that is not a concern. Hepatitis C is rarely sexually transmitted and your risk for hepatitis B is quite low as well but your testing was not conclusive. Repeat testing at 4-6 weeks would be conclusive. Personally I would not be concerned about hepatitis.

The chance that your infections had any effect on you or your partner’s future fertility is very, very low and not something to worry about.

My advice is to move forward without concern. EWH

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1 months ago

Hi doctor,

Thank you very much for your comments. That has helped to put my mind at much ease.

I have a few follow-up questions:

1. Since I received unprotected anilingus from the CSW, do I need to get a Gonorrhea test done with my anal swab too? The initial tests only included a throat swab and urine sample.

2. When you say 'your treatment eliminates virtually any risk for syphilis - that is not a concern.', does that mean that the treatment of Ceftriaxone and Azithromycin for Gonorrhea eliminate any risk for Syphilis? Does the same apply for my partner too given that she received the treatment much later (on day 19 after exposure) compared to me (on day 9 after exposure)?

2. On the blood test, the GP also checked if I was vaccinated for Hep B which I was not. I got my first Hep B vaccine too as recommended by the GP. I will get the remaining doses on the schedules advised by the GP. Given that I have now received the first dose of the Hep B vaccine, will it be a good idea to get the repeat testing done for Hep B?

3. Also, what are my risks for HIV? Do you recommend getting re-tested for HIV and Syphilis after 6 weeks of exposure and would that be conclusive, or do you see no need for re-testing for HIV and Syphilis? The GP advised to get re-tested after 12 weeks.

5. Do you recommend getting tests for other STIs too - thinking about HSV-2, Hep A, Hep B, Hep C, Trichomoniasis, and Mycoplasma genitalium (Mgen)?

Thank you.

Edward W. Hook M.D.

1 months ago

I'm sorry you continue to worry. I'll go straight to your questions:

1. Since I received unprotected anilingus from the CSW, do I need to get a Gonorrhea test done with my anal swab too? The initial tests only included a throat swab and urine sample.

The risk for any STI from receipt of analingus is lower, even lower than for receipt of oral sex but, if you are going to test, all exposed sites should be tested. The ceftriaxone you received would have sured anal gonorrhea.

Correct. It is easier to treat/prevent infections before they are established. Had you been exposed to syphilis, the antibiotics you received would reliably prevent development of syphilis.

There is no evidence that hepatitis B is transmitted through receipt of oral sex.

There are no proven cases of HIV acquired from receipt of oral sex. Testing is always a personal decision but were I in your situation, I would not bother to test again for HIV or syphilis. RE-testing would be to determine if you had re-aquired gonorrhea - treatment failures are exceedingly rare.

5. Do you recommend getting tests for other STIs too - thinking about HSV-2, Hep A, Hep B, Hep C, Trichomoniasis, and Mycoplasma genitalium (Mgen)?

I would not. Hepatitis C is not an STI and HSV-2 is almost never transmitted through oral sex (although HCV-1 can be. If you were going to develop herpes, you would have gotten lesions within 10 days of exposure. Similarly there is little evidence that M. genitalium is transmitted through receipt of oral sex.

I hope this additional information is helpful. You have one follow-up remaining. EWH

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