[Question #2787] Oral sex exposures

42 months ago

Hi,
I am male, 39y and live in the Pacific Northwest of Canada.
This was a hard year for me and I end up seeking companionship with female CSWs. I had 6 encounters since April and my exposures were like that:
April 25 - Unprotected oral (fellatio and cunnilingus);
June 29 - Protected vaginal sex and unprotected Oral (cunnilingus);
July 5 - Protected vaginal sex and unprotected Oral (fellatio and cunnilingus);
July 18 - Protected vaginal sex and unprotected oral sex (cunnilingus);
August 1 - Protected vaginal sex and unprotected oral (cunnilingus);
Sept 6 - Protected vaginal sex and protected oral;
All CWs are Caucasian girls, "high end" and "well reviewed". Three of them I asked about their test routine and they said they are consistent and they always think on their safety first, the other 2 I didn´t ask but they are friends with the others, so I assumed that they have the same mentality.

Since then I am in a better place in my life, got back together with my wife and son and life is getting better. The problem is that now I am afraid that I might got something from these encounters and could pass on to my wife. My son is still nursing, so to him too. I had sex with my wife twice, protected vaginal, but last time she performed fellatio on me for about 1min. Since this episode I am very worried that I might have passed something to her.

I know oral sex is safer, but how much all these exposures increase my chances of getting something? I am very worried about HIV and Hep B. I have HSV1 so I know the chances of getting in a different place are low, but how about HSV2? I don´t remember having an outbreak, but I know it can be asymptomatic sometimes. In Canada I can get a POV HIV test (pick your finger for blood), how conclusive will be this test if I do it this week?  Thank you, I am trying to put my mind at ease.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum and thanks for your question. It's always a pleasure to hear from a fellow Pacific Northwester.

First, the frequency of HIV is very low in female CSWs in our part of the continent -- e.g. Seattle, Vancouver, and elsewhere in BC, Washington and oregon. Well under 1% have HIV, probably close to 1 in 1,000, and even that is probably too high for expensive escorts (which I impute from your comments about "high end" and "well reviewed"). So even if you had had completely unprotected and fully unsafe sex, you would be at little risk. Not zero, but very low.

Second, condoms work, so the vaginal exposures were well protected. And oral sex is not only "safer":  There has never been a proved case of HIV transmission mouth to penis.

So HIV really isn't an issue. As for other STDs, the ones for which you were potentially at signfiicatn risk would usually cause obvious symptoms. Absence of abnormal discharge from the penis, penile sores, and painful urination all are good signs you were not infected. Oral sex carries risk for HSV1, not HSV2, by the way -- and you are right that your prior HSV1 protects you from new infections with the same HSV type. You probably were at risk for HPV, but we all get that anyway (repeatedly), and assuming you and your wfie have had other past sex partners, you can assume you have been infected and so has she. Neither your risk nor hers is any higher because of your exposures while the two of you were apart; and if HPV were ever to show up in either of you (warts, abnormal pap, etc), there would be no way and no valid reason to attribute it to the exposure you've had since last April. Hepatitis B is not a significant risk in this situation, and you are correct tha

So I doubt you have put your wife at risk. What now? Since your risk wasn't zero and you're concerned, I would suggest you have a urine test for gonorrhea and chlamydia, and blood tests for HIV and syphilis. Based on all you have said, almost certainly they all will be negative. But that's all. I recommend against testing for hep B, HSV, or anything else.

I hope this information is helpful. Congratulations for getting things back together with your wife and best wishes for romance and happiness in your relationship. Let me know if anything isn't clear.

HHH, MD



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42 months ago
Hi Dr. Hunter,

Thank you for your detailed answer, it helped me a lot to reduce my anxiety. Your work together with Dr. Hook and Dr. Warren is great!

I went to the Sexual Health Clinic yesterday and based on what I told the Doctor, she said I would qualify for a rapid HIV test (POV) and urine test for gonorrhea and chlamydia. The HIV test was negative and based on my exposures (the last real exposure was unprotected oral sex 8 weeks ago) I think I can consider it definitive and move on. For chlamydia and gonorrhea, I am still waiting the results and might get it by the end of the week, I´ll update here as soon as I know the answer. I´m hopeful it will be negative since I never had any discharge from the penis, pain during urination or sores. I´m doing my best to control my anxiety.

The Dr. said that I was not at risk of Hep B and offered to give me the vaccine, since I don´t recall taking it and if I did it was a long time ago. I took the first shot and now will have to get back for the other two doses. I hope I don´t need it, but I guess is one less thing to worry about if I end up having new sexual partners.

About syphilis, the Dr said I am not in the risk group so I don´t need to test for it. I didn´t mentioned on my first post, but I had a strep throat (group A) about a month ago and took 15 days of penicillin. So even if I was at risk or had an infection, the Dr. said that the penicillin would have cleared my infection.

If by any chance my urine test result comes positive, I assume that to be on the safe side, my wife should get tested because of the one exposure where she performed fellatio on me for 1 min or less,  or the risk is too low to be worried about testing for oral gonorrhea or chlamydia? For syphilis a similar question, I never had or saw any ulcer on my penis, since the transmission only takes place with direct contact, I assume the risk is very low that I might have infected my wife IF I had syphilis before the antibiotics, should I move on and stop worrying?

Thank you again! Hope you are enjoying the fall on the PNW.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Apologies for the delay in responding to these follow-up comments.

I agree mostly with your doctor. However, generally I recommend against testing for syphilis whenever there is even remote risk. The tests are easy and quite inexpensive, and syphiilis should be viewed as a low risk but high danger condition -- sort of like HIV. And unlike some STD tests, the syphilis and HIV blood tests are highly reliable, with no realistic chance of false results (assuming they are done at least a few weeks after the last possible exposure).

I agree your wife would best be tested if anything returns positive on yourself. Presumably those additional tests have already been done? Let me know, or if any other continuing questions. Sorry again for the delay.

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41 months ago
Hi Dr Hunter,

Thank you for your follow up answers. 

Yes, I received the results for the Gonorrhea and Chlamydia and they were both negative. 

I am, however, still concerned about syphilis and might go back to the Doctor and see if I can have the blood test done. Usually after how many weeks syphilis test is reliable? You mentioned that the test is highly reliable with no chances of false positive results, but I read before that the antibodies produced for the syphilis aren't specific for the syphilis bacteria, so it might produce a false positive. How often does this happen?

Thanks again, I am feeling less anxious and much better now.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Glad to hear you're feeling less anxious.

My last reply has a typo:  I generally recommed testing for syphilis whenver ther eis even remote risk (delete "against"). Sorry for any confusion. The syphilis blood tests are conclusive any time 6 weeks or more after exposure. You definitely can expect a negative result, and so that concludes this thread. Best wishes and stay safe.
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