[Question #2245] STDs exposure risk

46 months ago
Hello Dr. Hunter,
I really admire the work you, Dr hook and Terri are doing. I know you have answered this question more than a million times by now but I really like to explain you my scenario and take your opinion.
I had unprotected oral sex and protected vaginal sex with an escort on may 8th. What are the chances of STDs with this exposure?
I had pain when starting to urinate after 4 days of exposure and went to urgent care and got tested for Chlam/Gonn/Trich which came back as negative. I was prescribed Doxy for a week and pain was completely cured now I feel normal. What are the chances of following 
1. HIV through this exposure( condom was intact all the time for vaginal sex)
2. Gonn, Trich, Chlam
3. Hepatits A,B,C
4. Syphillis
5.Hsv 1&2. There were no visible sores on her mouth or lips or face and it's been almost 4 weeks and I don't have any symptoms. Prior to this I was negative for both Hsv1&2. She said she gets tested regularly as she is pregnant and never had sores ( hard to believe as  about 56% Americans have hsv and in her line of work she most probably had hsv1?) also while reading some other questions in this forum dr hook mentioned to someone that after 15 days of no blisters or break out or symptoms then can consider to be not infected with hsv? What's your stand on it? What are the chances of hsv1 with one time exposure?
I really need some input from you. Sorry for the long post. Please help me
46 months ago
And any other STDs I missed? I have been avoiding sex with my GF for the past 1 month. Do you think it's safe to resume sex with my gf unprotected 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum. Thank you for your question and for your kind comments about our services.

As you may have seen in previous forum discussions, most escorts (by which I mean expensive female sex workers by appointment, as opposed to street walkers, brothel workers, etc) are generally believed to be at pretty low risk and to not usually have transmissible STDs. Their clients tend to be low risk (men like you!), condom use usually is routine, and they get tested frequently. So the odds are good you were at little of any risk. Further, oral sex is low risk for all STDs and zero risk for some; and condoms work well when properly used (no penetration before or after the condom is inplace) and do not break wide open.

That said, it seems possible you acquired some sort of urethral infection, perhaps from the oral exposure. This isn't certain -- you don't describe discharge, which is a more typical symptom than having only painful urination. It's hard to tell whether the discomfort cleared because of the doxycycline or would have cleared anyway. In any case, without with negative tests for gonorrhea, chlamydia, and trichomonas you can be quite confident you didn't have those. If there was anything at all, it likely was the result of exposure to entirely normal oral bacteria, which probably wouldn't have been harmful in the long run for either you or your current or future sex partner(s).

1) HIV:  No risk at all.
2) There was slight risk of gonorrhea via oral sex, and perhaps very low chance of chlamydia. Zero risk for trich, which is not carried in the mouth or throat. And the tests showed for sure you weren't infected anyway.
3) Essentially zero risk for viral hepatitis as well. Hep B is the only one possible; hep A and hep C are essentially impossible. (Hep C has been oversold as an STD. In fact, it is rarely if ever sexually transmitted except in gay men though traumatic (bloody) anal sexual practices. The frequency of hep C is no higher in the sex partners of infected people than in the general population.)
4) The large majority of syphilis in the US is in gay men, not female sex workers and certainly not in escorts like your partner. If she were infected, there could have been slight risk from oral sex, but if you had been exposed, the doxycycline would have aborted any chance of infection. So no risk and no point in being tested for it.

Your comment that the escort has HSV1 and her "line of work" is mistaken. There is no higher risk of HSV1 in people with few versus hundreds of sex partner. The chance of it from any particular oral sex exposure is probably no higher than one in several thousand. You really needn't worry about it. Absence of penile blisters etc within a couple of weeks indeed will be further reassuring. Not all people with genital HSV (of either type) develop symptoms, but among people who are worried and paying attention (as many men do not), usually would be aware if they were infected. Anyway, with such a low risk, I really think you can move on without worry about it.

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

HHH, MD

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46 months ago
It's been 4 weeks and no symptoms, can I have sex with my girlfriend unprotected? I have been avoiding it for the past 1 month. And do you think I should get tested for hsv? If so how reliable is 6 weeks IGG test? I read online that most people (approx 80%) will have detectable antibodies by 6 weeks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Yes, I see no measurable risk to your partner. You cannot infect her with an STD you doh't have! And I definitely recommend against testing for HSV. The chance of a false or misleading result is a lot higher than the possibility you were infected. That said, your statistic about HSV test performance at 6 weeks is about right.

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46 months ago
Sorry forgot to ask one more question. I had vaccines for hep A&B when I was a kid. Will I get these if I was vaccinated?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
No worries. The vaccines protect life long. You'll never catch either infection even if exposed.

That completes the two follow-up comments and replies included with each question, and so concludes this thread. I hope the discussion has been helpful.
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