[Question #2059] Request for a risk assessment

48 months ago
Hello doctors, hope you are well.

I received unprotected oral sex from a female sex worker 2 days ago. There was no other sexual activity of any kind.

Please assess my risk for the following:

1. HIV
2. Any other STIs - what are the possible infections, what symptoms should I be on the look out for and would you recommend any tests given the activity?

Thank you 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Welcome back to the forum. Thanks for your question. My first reaction is to congratulate you for limiting this event to safe sex, which is how oral sex should be viewed, even without a condom.

The HIV part of your question was convered, practically speaking, by Dr. Hook in your previous question a few months ago. The risk of HIV transmission by oral sex, especially oral to penis, is zero or close to it. There has never been a proved case, despite claims by some persons with HIV who they think that's how they were infected. Most or all were simply wrong about the source, or in some cases perhaps not truthful. Further, as Dr. Hook also discussed last time, most female sex workers do not have HIV. If the exposure occurred in the US, you can safely assume there's under a 1% chance your partner had HIV. So you can disregard HIV as an issue.

For those reasons, oral sex should be considered safe sex in regard to HIV. And it's pretty much the same for other STDs:  all are far less common than from vaginal or anal sex, and some are virtually never transmitted by oral sex. The three main risks are gonorrhea, herpes due to HSV1, and nongonococcal urethritis (NGU), which often may be the result of entirely normal oral bacteria. Chlamydia, herpes due to HSV2, HPV, and viral hepatitis all are extremely rare from oral sex, if they occur at all. Syphilis is possible, but it is currently so rare in heterosexual women in the US that it's really not an issue.

In general, I don't recommend STD testing after exposures like this. If in the next 2 weeks you do not develop discharge, painful urination, or penile blisters/sores, you can safely assume you didn't catch anything. If you want additional reassurance, you could see a doctor or clinic for a urine gonorrhea test and examination for abnormal discharge that could signify NGU. Or maybe even HIV and syphilis blood tests after 6 weeks. But I'm not actually recommending this: if somehow I were in your situation, in the absence of symptoms, I would not feel a need for any of these tests.

I hope this information is helpful, but let me know if anything isn't clear. Best wishes and stay safe--  HHH, MD

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48 months ago
Thank you for responding to my question Dr Handsfield. 

I understand from your response that if the symptoms that you have mentioned do not appear within two weeks I should be in the clear from any type of STD.

 However in the meantime if I did want to test for the 3 potential STDs you have mentioned, when is the earliest I could do so and what are the specific tests I should be looking at?

Look forward to your response. Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
I don't recommend any testing at all. Absence of symptoms is virtually certain evidence against any of these infections. A urine test for gonorrhea could be considered, but that's all. (If you do this, it would be accurate now -- valid results any time more than 2-3 days after catching it.) Herpes testing is too inaccurate to recommend, and there is no lab test for NGU -- just exam to confirm the diagnosis in men with symptoms.  

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47 months ago
Thank you Dr Hunt for your response.

It has been two weeks since the act and so far none of the symptoms you mentioned have come up. At this point can I safely assume that I did not catch an STD from the act? 

Also, for my understanding, is it possible to catch any kind of STD from either having my nipples licked or by licking a females nipples? 

Thank you 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Nobody can say the risk of STDs is zero from receiving oral sex. But absence of symptoms at 2 weeks is highly reliable; the chance you caught anything is well under 1 in a thousdand. As I said above, if somehow I were in your situation, I would get tested and would continue unprotected sex with my wife without worry.

Mouth to skin contact (or genital to skin contact) is zero risk, including contact with nipples.

That completes the two follow-up questions and replies included with each question, and so closes this thread. Do your best to move on without worry. But if you feel you need negative test results to be able to accomplish this, you are free to do so. See my original reply above for information about what tests you might consider for reassurance. (This does not mean I actually think there is significan risk. I do not. Testing would strictly be for reassurance from the negative results.)

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