[Question #2355] Receptive Oral Risk

46 months ago

Male received receptive oral for less than 2 mins at strip club on 3/27/17. She stopped and then licked her thumb and moved it around the head of my penis for less than a minute. I am terrified. Since then I have done following: 54 days post, saw urologist, no symptoms, and he said all was good. 8 days 10 panel test and all negative. 14 days dermatologist looked at a shiny spot (no bump) and said nothing there. 19 days protected sex with condom with wife. Developed red patch on rim of penis. 24 days same derm looked at it and said contact dermatitis. 35 days 2nd derm looked and confirmed it was nothing. Red part still there today so I don't think its GHSV1. 6.5 weeks 10 panel done and all negative. Noticed two spots on underside of head and went to derm, said Fordyce spots. Followed up with a PA and GP and all agreed. 11.5 weeks test for HIV 4th gen, HSV1,2 Igg. All negative. I never developed blisters, but felt occasional burning and itching likely due to anxiety. This weekend I noticed a small red abrasion on shaft and had a minor jock itchthat seems to be resolving. After last test, I was ready to move on, but then I read about inaccuracy of results. Questions:

1. After all tests and symptom history, what are chances I am silent carrier of GHSV1? I know for certain I never had HSV1 before this.

2. Is it true you guys have never seen a case of GW on penis from receiving a bj?

3. My wife had a pap done last week and results pending. What are chances she will have an abnormal result due to this episode? (I know it cant be traced back etc, but I would rather not have the conversation at all.)

4. What are chances I got hpv from this exposure. I know HPV is a fact of life, but I just want to the chances are I got it from this.

Am I trying too hard to convince myself I got something? I am seeing a psych tomorrow.

46 months ago

I meant 4 days post I saw a urologist, not 54. Sorry for the typo. Thank you in advance for (hopefully) putting my mind at ease.

Edward W. Hook M.D.

46 months ago

Welcome to our Forum. I'll try to help. Before I get to specifics, let me tell you that my goal in this post is to assure you that you did not get an STI from the events you describe and to urge you to put your fears aside and move forward. Now for specifics:

Your partner was, for all practical purposes, a commercial sex worker. Most commercial sex workers do not have STIs or any sort and oral sex only relatively rarely leads to infection. When it does, the most common problems are either gonorrhea of non-gonococcal urethritis NGU) caused by mouth organisms introduced in to the urethra during sex. It is not nearly three months since your encounter and all of your tests are completely negative, providing further proof that you were not infected. Your concerns about having something missed by attesting are misplaced- the tests are highly reliable and in your case, having gotten negative results on two or more occasions you should be entirely confident of the results. One lab mistake might occur very rarely- two, essentially never!! Now on to you specific questions:

1. After all tests and symptom history, what are chances I am silent carrier of GHSV1? I know for certain I never had HSV1 before this.

Essentially zero- stated on the basis of your low risk exposure, your absence of typical outbreaks and lesions (which is confirmed through examination by trained clinicians) and your negative tests. Taken together, you should be entirely confident you did not get HIS from this exposure.

2. Is it true you guys have never seen a case of GW on penis from receiving a bj?

The statement is correct. Never!

Again, close to zero.

4. What are chances I got hpv from this exposure. I know HPV is a fact of life, but I just want to the chances are I got it from this.

there are no high quality scientific studies to call upon to answer this question but overall the risk is very, very low. Oral HPV is far less common than genital HPN and most exposures do not lead to infection.

Am I trying too hard to convince myself I got something? I am seeing a psych tomorrow.

Good, that is the right thing to do. Your tests and doctors have told you are not infected. The challenge is now how to get you to believe it. EWH

---

46 months ago

Dr., thank you so much for putting my mind at ease. I just have two follow ups: 1. regarding a small abrasion on my shaft that appeared a week or so ago, and the jock itch episode this weekend, the timing of those two things is not consistent with any STD given the exposure was 3 months ago, and isn't a recurrence of an initial outbreak I missed (even though I inspected myself multiple times a day)? And finally, regarding the reports that Igg misses up to 30% of HSV1 cases, the chances of two tests missing is near impossible? Do I understand that correctly? So no need for me to test at 16 weeks or do a western blot? (oh yeah and the HIV test at 11.5 weeks is conclusive, right?) Thank you so much! This is the first chance I've had to breathe.

Edward W. Hook M.D.

46 months ago

I'm perplexed, you seem to be perseverating on the idea that you got something/anything from the virtually no risk encounter that you described. Why do you choose to argue against the evaluation of multiple trained professionals and negative test results following a virtually no risk encounter? In answer to your questions:

1. These are not consistent with an STI acquired from your encounter about three months ago. They are consistent with hypervigilance, perhaps fueled by guilt and anxiety,.

2. The figures of missing 30% of persons with HSV-1 is based on studies of persons with typical outbreaks which were culture/PCR proven and are not relevant to you. Sure, I suppose there is a chance that you managed to acquire HSV-1 at your encounter of concerns, miss the outbreak, and haven't developed antibodies to the infection. In my opinion there is abot an equal chance that this is an alien life form from outerspace! Again, I think you are being inappropriately paranoid.

I see no need for additional testing. I urge you to move forward, not perseverate on what no appears to be a past error in judgement on your part which did not lead to infection. I say this out of concern, nothing more. EWH

---

46 months ago

Thank you so much! I feel much better now and will start moving on. I can't tell you how helpful you have been to me, I am very grateful. I won't reference a recent article I read concerning NASA's anticipation of discovering alien life forms in the near future!