[Question #3097] Follow Up to Question #2867

41 months ago

This is a follow-up to my earlier question. To summarize, I am a 54 year old male who has been living in a different country than my wife for over 1 year. About 15 months ago (after she moved), I received oral deep throat sex for several minutes from another man. We also French kissed. EWH felt any symptoms I thought I had were not related to STIs and did not recommend testing.

Since the stakes are very high (my marriage will end if I transmit an STI to my wife), I am considering testing. There is a 10-panel test I can take confidentially. But, I don't know if I need all the tests. I have been vaccinated against Hep A&B. Also, it sounds like none of HIV, chlamydia or Hep C is transmitted via oral sex. So, I assume I don't need tests for those. Correct?

What about HSV 1&2? I have read many people don't show symptoms. Should I consider testing for HSV 1&2? I also read 20% of Gonorrhea cases don't show symptoms. I started 14 day course of doxycycline in the first week after receiving oral sex. Although I was told that would have cured most chlamydia, syphilis and NGU, I understand it would not cure all cases of gonorrhea.

So, would tests for HSV 1&2 and gonorrhea be reasonable? I ask because I have heard HSV test may give false +'s.

Is there an HPV test I can take (even though none are approved for men)? It's been ~15 months, how long would my body take to get rid of HPV?

Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
Welcome back to the Forum.  I must admit however, I am disappointed that you continue to worry about this.  As you already know, I saw no reason for testing at all.  That continues to be my recommendation as testing is more likely to create further confusion than to help.  Working through your questions:

Agree that there is no reason for testing for hepatitis of any sort (A,B, or C) or for HIV which has never been shown to be acquired through kissing or receipt of oral sex.  There are reports of chlamydia in the throat but they are quite rare, most infections clear without therapy and your doxycycline would have cured the infection.  I see no reason for testing your throat for chlamydial infections.

HSV-1 and 2.  I recommend against testing.  There is no evidence of infection and the tests have problems.  While a negative test would increase the likelihood that you were not infected, such tests are not perfect and the HSV-1 blood test misses up to 25% of infections as described in a recent paper.  Blood tests for HSV-1 and -2 both have relatively common falsely positive tests.  Finally, if you had a positive blood test for either virus, that would not mean that you acquired the infection from the episode you described.  Most persons your age with HSV-1 acquire it in childhood and then have no further outbreaks- this occurs in over 60% of adults over 50.  Similarly, you could have acquired HSV years ago and have no evidence other than a blood test.  Given these facts, were you have a positive blood test- what would you do with the information.  If you told your wife, wouldn't she wonder why you got tested?

The figure that 20% of gonorrhea in men are asymptomatic is incorrect. The correct figure is between 5 and 10%.  Further, the doxycycline would have cured much gonorrhea and, like chlamydial infections, most gonorrhea would have cured itself by now if present.

Finally, HPV.  Most infections clear in 12-18 months without therapy and your risk for infection is low.  If yo have it, you do not know you got it from the exposure that continues to worry you. 

In my opinion, you have far more to loose by testing than to gain.  Again, in my opinion, you would be far better served by working with a trained counselor to address your guilt and anxiety over your misstep than to spend money on testing which is more likely to create concerns than help.  Should you choose to do this, I would encourage you to share my comments with the counselor.  EWH