Dear Doctors,

First off I would like to thank you for your service throughout the years. It has given me great comfort in previous moments of anxiety. I am a male in my early 30s from Manila who just made a big mistake. Last night, after a difficult and tiring day, I visited a massage parlor near the neighborhood. 

After my massage and despite an earlier commitment not to succumb, I got convinced by my masseuse to avail of extra services,  which involved just an unprotected blowjob and me touching/kissing her body. The act itself lasted just a few minutes, after which i finished in her hand. There was no other contact, definitely no intercourse. 

Needless to say, I deeply regret what I did and more than a little worried about the consequences.I am writing to ask for your realistic, science-based advice and reassurance with respect to the risk I put myself into and what I have to do next. How worried should I be about major STDs just because of this single encounter? I read from previous work by Dr. HHH that insertive oral can more-or-less be considered safe under most circumstances. Should I be worried about HIV or syphilis? Also, if there is great cause for concern, I would like to ask for a realistic plan about what to do next with respect to testing and when to have them. My partner is in another country and I want to be sure that when we meet at around late December that I am not a risk to her or to anyone else. It would just ruin me. 

As additional info, the masseuse said they were tested every week, and she seemed very strict about her terms (no kissing, condom use, etc.). I have no reason to believe or disbelieve that. While it is far too early for symptoms for most things, I am not experiencing anything at the moment other than stiffness and tingling that, from experience, I know to be anxiety. I'm beating myself up about this and would like nothing more than to just put it behind me. Thanks in advance, and I hope you can give me the right information.

 Low risk however is not no risk and given your concerns over the exposure it is probably reasonable to be tested, at least for the most common STI's, at some point in the not-too-distant future.    The most important STI & AIDS to test for would be gonorrhea and chlamydia both of which can occasionally be acquired through receipt of oral sex ( The risk for chlamydia is much much lower than the risk for gonorrhea. ).  You could have a urine test for gonorrhea and chlamydia performed at any point more than three days after your exposure and if these tests are negative as I expect they will be, you can be completely confident that you were not infected at this exposure.    There is no risk for HIV from any of the activities you describe and the risk for syphilis is vanishingly low. If you acquire syphilis it will be apparent As an open sore or lesion occurring at the site of exposure. (Your penis).

 I hope my comments for reassuring to you. Your risk for infection is low and if I were you I would not be worried. EWH

Thanks for your prompt response. Your advice is well taken and makes me feel less worried than I would have been. 2 days after, and I don't feel anything odd still. 

I have a few followups regarding your advice. I do plan to have myself looked at for C and G after the time span you elaborated. However, being in the 3rd world, I don't think the centers I have access to do the urine culture you suggested. When I had myself tested before, I think they assessed infection via routine blood and urine tests, combined with symptoms/history, and assigned antibiotics if doctors felt the need. Are these enough for my purposes? There's also the gram stain, which I've also tried. I dunno if results from these would satisfy you and hope for your input here about their sufficiency. 

Also happy to hear about my no-risk and 'vanishingly low' risk of HIV and syphilis, respectively. Do these mean that you advise I not test for these anymore? And if you still think I do, when's the best time in your opinion, given my level of risk (I recently tested neg for both a little before this encounter)? Lastly, if by some weird chance I get put on an antibiotic routine like doxycycline, would these knock out any potential syphilis along with the rest?

Sorry for so many questions, but out of respect for your time and mine, I want my last entry to just be about sharing results/final thoughts. I know you deal with a lot of nervous wrecks and I don't want to be that. I look forward to your advice and hope to implement them ASAP. 

 We recommend against unwarranted antibiotics without proof of infection. Particularly in very very low risk situations such as yours. Medicines have side effects  May cause their own sorts of complications.   A medicine like doxycycline taken for two weeks would illuminate the possibility of syphilis, cure chlamydia if present and bite cure about half of cases of gonorrhea. Despite that as noted above we do not recommend it.   EWH

As you advised, I had myself checked out yesterday by my doctor for the infections indicated. No sign of infection was found and my doctor did not find anything remarkable about my physical condition. We also had a long talk about risks and how to process my experiences about what happened and to move on from it. I would like to thank you also for the advice you gave me. Almost a week out and no symptoms still that I can't attribute to just worry.  

I know you brought up both syphilis and HIV, and mentioned how I had very little risk for the former and none for the latter. My GP believes that the risks I had for both were virtually nil, and actually does not advise I go for anymore testing for that specific incident. Is that an assessment you are on board with? I could get myself tested for syphilis and get an antibody test along with it, but only if you think it's something I need to do with respect to my risk. If so, when can I have results I can be confident in?

Thanks again for your help, Doctor. I am trying to take steps to get my head fully back on track and your parting words will do wonders for that.