Thank you for operating this service. I know it is a great help to me and others.

My question is regarding cunnilingus. I am mid 20's single male. I am career focused and have trouble holding down a relationship. in my need for more "intimate" moments I frequent a massage parlour here in Sydney. I never engage in unprotected penetration. I also get tested twice a year for all STI's. 

My most recent test panel was 4 weeks ago and everything came back clear. I always go to the same girl everytime I visit the massage parlour and she tells me she is clean etc, but this time I feel a little different. 

about three weeks ago I went in as usual and we performed mutual oral sex on each other (I wore a condom, she insists) and the cunnilingus wasn't particularly full on, i.e. not a lot of vaginal fluid, mainly just tongue to clitoris stuff. at the time I had a chronic cough that produced phlegm and was since cleared up with antibiotics. normally I wouldn't think anything further of the event, but three weeks later (last week) I began to feel ill. I woke with a sore throat, a little achey, I had intermittent night sweats, but no fever, rash and the sore throat subsided within two days. now I still feel shakey, muscle soreness and fatigue. This sent me into a spiral of "what if's?" I have since ordered some bio-lytical insti tests to do at home (I'm too embarrassed to go back to my normal healthcare provider so soon after testing, and also Sydney is undergoing its worse cold and flu season for many years)

so to my questions:

1. does my chronic cough increase my risk of catching something?

2. given I have ordered the insti test's, at what intervals should I do them and be confident of the result?

3. would you recommend getting screened for other STi's or should I wait for my normal 6 monthly screen?

Apologies for the long winded explanation, anxiety is causing me to over analyze everything at the moment.

You apparently know that cunnilingus is inherently safe, with low risk of STD -- probably that's one reason you have decided to limit your sexual exposures in the way you have, right? That's good reasoning. Some STDs are zero risk from cunnilingus, or at least such low risk that no proved cases have ever happened, including HIV. There are small risks to the oral partner for oral gonorrhea or herpes, but that's pretty much it. Chlamydia rarely infects the throat, so no serious worries there. HPV can be transmitted to the oral cavity, but that happens all the time anyway, and your risk of HPV (oral or otherwise) is no higher on account of these events than it would be otherwise.

All humans get minor respiratory infections from time to time, with cough, sore throat, and often flu-like symptoms. Usually these illnesses show up 2-5 days after exposure, not 3 weeks. In other words, this probably has nothing to do with the sexual exposure 3 weeks earlier., but is much more likely from day to day contact with friends, co-workers, etc. And in any case, there is no STD that causes such symptoms. You might be worried about HIV, but new HIV infections don't cause cough; symptoms start within 2 weeks; and the sore throat and muscle aching would last at least 1-2 weeks, not a day or two.

To your specific questions:

1) No, your symptoms at the time of exposure are not likely to increase the already near-zero risks from cunnilingus. (However, in the future I would advise against proceding with such contact. You probably put your partner at risk of your cold.)

2,3) I recommend against any HIV testing on account of this event. But if you proceed, the INSTI test is conclusive 6 weeks after the last possible exposure. Since you're already planning on 6 monthly routine HIV and STD tests, I recommend you just wait until your next scheduled testing.

FYI, Australia's federally funded sexual health centres are the world's best network of STD/HIV clinics and testing centres, with uniformly superb, world-class advice. If you ever have a need, or for your routine testing -- or for personalized advice about testing after particular exposures-- you'll never go wrong with your nearest SHC. If you're in Melbourne or Sydney, those SHCs are the best of the best.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

I currently get my testing done at a sexual health clinic here. You are right they are excellent, I think im just embarassed to go back so soon for what you rightly say is a very low risk thing. Im sure all my "symptoms" are probably the result of stress I have been under lately. If you would like to leave the thread open ill do my insti test at 6 weeks since I have already ordered it and post my results. Hopefully it may help someone else who may be going through something similar.

Thanks again