[Question #174] Oral sex risk

95 months ago

Dear Doctors,

I appreciate your work very much and during this bad time I felt you were like good reassuring "fathers" for me.

About 6 weeks ago I have received what I believe to be condom protected oral sex (I was the insertive partner). I am not sure the condom was intact at the end as I was a bit drunk; hence my worries. This is causing me extreme anxiety as I have a wonderful family. I have tested for chlamydia / gonorrhea after 1 week (both negative); I have tested after 33 days for HIV  Ag/Ab 4th generation (negative). I will test tomorrow for Hepatitis B and syphilis after 44 days.

My questions:

CHLAMYDIA / GONORRHEA: 1) the healthcare in the country I live states that chlamydia test shall be performed after 3 weeks from exposure. Did I test too early for chlamydia? Shall I repeat?

SYPHILIS: 2) I am experiencing some irritation on the roof of my mouth and some aphta; can syphilis manifest in the mouth although I received oral sex on my penis? 3) Is a test at 6 weeks conclusive? 4) in case I am infected, can I transmit it syphilis to my wife without visible chancres or sores on my genitals or mouth while having sex with her?

HEPATITS B: 5) am I at risk?; 6) is a test at 44 days conclusive?

HIV: 7)  What is the new CDC recommendation about window period for 4th generation tests: i.e. should I test again? 8) Should I take the HIV test again in case either the syphilis or Hepatitis B test will come back positive? 9) I have experienced some rash on the back that comes and goes and feels like burning skin: anxiety or something else?

I hope you can give as details answers as possible to my queries, hoping that they will help relieve my terrible anxiety.

thank you very much in advance!!

Edward W. Hook M.D.
95 months ago
Welcome to the Forum.  I will try to help.  Before I get to specifics, a few generalizations.  Condoms,are the single best means for reducing risk for STI acquisition.  Further, condom failure is easy to detect.  When condoms fail, they break wide open, they do not break "just a little".  Further, as long as the tip of the penis is covered, the condom is doing it's job in terms of gonorrhea, chlamydia and HIV prevention.  Now for your specific questions:

1.   Your 7 day gonorrhea and chlamydia results are reliable.  Believe them.

2.  No, your oral irritation is not syphilis.  Syphilis lesions would result from DIRECT contact.

3.  Yes, your four week (33 day)'result with the combined HIV antibody/antigen results are conclusive and you should believe them.

4.  See above, syphilis is not a concern.

5.  There are no reports of hepatitis acquisition through receipt of oral sex.  You were not at risk both for this reason and because condoms prevent sexual acquisition of hepatitis.

6.  See above.  Testing is not needed.  If you feel you must test, while 44 day results are strong but not completely definitive.  Hepatitis can take up to 3 months to make blood tests positive.

7 and 8.  CDC results,are overly conservative.  In my opinion , no need for further testing.

9.  Nothing you had said suggests this irritation/rash is related to your receipt of oral sex about six weeks go.  

I hope these comments are helpful.  EWH
95 months ago
thanks Doctor for the prompt reply! few follow up:

- Can a person be infected with syphilis without any visible chancre on the area of direct contact (primary syphilis being asymptomatic)?
- I will use a condom with my wife (this is our contraception). Assuming (and i hear you that it is not a concern) that I have syphilis, can I infect her without an open sore in my genitals?
- About HIV: i am experiencing some sore throat and mild fever now (day 44 after encounter). I tested at day 33 with HIV Ag/Ab. Is the test after one month capable of detecting HIV also in case of a late seroconversion? Or is there a risk of false negative.

Thank you very much Dr Hook.

Edward W. Hook M.D.
95 months ago

Sometimes chancres can go unnoticed.  For men this is most typical if they have engaged in receptive rectal sex and have a rectal chancre or are uncircumcised and have a chancre under the foreskin.  If you have examined yourself, it is unlikely that you missed a chancre. Syphilis is a rare disease, even rarer to be acquired through oral sex, particularly because you used a condom.  I see no reason fro you to be worried about syphilis, as I said before.

Your questions are a bit repetitive,  As I said above, your 33 day test is definitive.  Late seroconversion in persons who have not be taking medications to prevent HIV (PrEP) is an internet fueled myth.  My advice is to believe the results and move on.  EWH

95 months ago
Thank you Doctor!

My question about HIV might seems repetitive but it is driven by what I found on the webpage of the national health board of the country where I live, which states the following (translation) "A negative test result with HIV Ag/Ab test can be consider conclusive when taken at least 4 weeks from the possible exposure. The Health Board does not recommend further testing unless a person presents symptoms of acute infection or has exposed himself / herself to a new risk scenario". The text in bold is what is confusing me and I was wondering for how long I need to monitor my symptoms. 
My very last question is related to possible false negative with 4th generation combo tests at one month mark: have you read of any case from medical reports or academic studies? Have you seen any such case?

I take the chance to thank you Doctors very much. What you are doing is truly amazing: you are putting your exceptional experience to advice many of us allover the globe who are very afraid and often have anxiety driven by regret. You should really be proud of your meaningful and impactful work!

Edward W. Hook M.D.
95 months ago
I would not connect the two sentences you quote so closely.  The second sentence refers to situations following RE-EXPOSURE and symptoms which are marked after four weeks.  The sentence you quote could have been written more clearly.  I have not seen persons with negative 4th generation tests of the sort you were tested with develop positive tests more than 4 weeks after exposure.  Believe your tests.  You did not get HIV from the exposure you described, you do not need further testing, and you can (and need to) move forward without concern.  EWH---