[Question #2602] Unprotected Oral Sex with Trans Sex Worker

42 months ago
Hello Doctors,

I am writing to you because I am becoming very concerned due to an encounter I had last night. I was drinking heavily and was using cocaine and I decided to do something I had never done before, and visit a transsexual prostitute. The visit was oral sex only, and she gave me vigorous deepthroat fellatio with a a lot of saliva and there might have been some vomit as well. I know oral sex is not a good vehicle of STD Transmission but I have two small cuts on the head of my penis that I just noticed. They look like paper cuts and they are rather small. This most likely happened during the fellatio encounter. 

I'm in a serious relationship with a woman that I love very much and do not want to expose her to any harm. Please assess my STD risk and tell me where I should go from here..

Thanks for your time and input.
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Welcome to the Forum.  Despite the fact that your partner was relatively high risk for STIs, this was a low risk event.  There are no proven cases of HIV that have been acquired through receipt of oral sex and the risk for STIs is quite low.  When STIs do occur, the most common problems are either gonorrhea of non-gonococcal urethritis (NGU) caused by mouth organisms introduced in to the urethra during sex.  This sort of non-chlamydial NGU is not clearly and STI in the traditional sense, is not readily transmitted to sex partners like other STIs, and in not associated with complications.  In the United Kingdom, many specialists do not treat NGU associated with oral sex.  When treated, oral sex-related NGU typically resolves quickly.  If you have acquired gonorrhea or NGU you will most likely develop symptoms within a week of your exposure.  Testing with a urine test for gonorrhea and (chlamydia which is VERY rare) would be accurate any time more than 2-3 days after your exposure.  Diagnosis of non-chlamydial NGU would be made with a swab specimen taken from your penis. 

I hope these comments are helpful.  If you do not develop symptoms you really have very little to worry about and testing is not something I feel strongly about.  It is up to you depending on your level of worry.  I hope this information is helpful.  EWH

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42 months ago
Good Evening Dr. Hook,

Thank you for your prompt and thorough response. As of today, I have not experienced any obvious symptoms of infection so I am becoming a bit more hopeful that I am in the clear. How many more days do you think I should be on the lookout for symptoms? The encounter happened on Sunday Morning.

I have had other regretful exposures of unprotected oral sex in the past, but this one in particular concerned me because of the high infection rates of transexual sex workers, and the fact that it seems I received two small cuts during the exposure (which are almost fully healed now), and the addition of the various bodily fluids (vomit and saliva) during fellatio. I was concerned that these factors presented a higher risk of  STD Transmission (namely HIV) than your normal fellatio experience. I was also paranoid that the cuts were intentional, which probably sounds bizarre and is most likely an idea of my anxiety.

What are my transmission risks for other STD's due to this exposure? (Herpes, Syphilis, etc) and should I even be worried about these things?

And lastly, would you recommend me to continue normal sexual relations with my partner at this time, or should I go for testing?

Again, thanks for your input. It is very much appreciated.


Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
The longer you go without symptoms, the less likely it is that you acquired any STI.  Neither the cuts or the secretions change your risk and we have already acknowledged that your partner was rather high risk.  If you do not develop lesions at a site of exposure in the 12-15 days after your exposure, I would not worry about herpes.  Your risk of syphilis is tiny.  As for the other STIs, the risk is low but they can be asymptomatic (rarely).  Personally, I would not be worried but that is a personal decision, as is you decision about testing.  EWH---