Hello Doctors (HHH/EH),

I had the following encounter with CSW in UK:

1. Insertive Oral Sex (receiving) with Ejaculation in her mouth (10 minutes)

2. I fingered her vagina for (3 minutes)

3. French/deep kissing

some context:

1. Shaved my penis/testicles 1 hour before. worried of shaving cuts, but didn't notice blood

2. my fingers might have peeled (small cuts) in tip of fingernails.

3. She claims never do penetrative sex without condom. tested hiv-negative 8 months before.

4. I was having sore throat before/during the encounter

Q1: how do you rate the possibility of transmitting (in percentage) for this single encounter? assuming she's infected with most of these STI given her exposure.

Q1.A. HPV?  (mouth to penis) what is the percentage? I'm really worried about getting high risk HPV strain and transmitting it to my wife (along with bad effects)

Q1.B. HIV? given that I shaved soon before it

Q1.C. Chlamidiya/Gonorrhoea?

Q2: Should I stop having sex with my wife? not sure how long can I run away without having sex

Q3. Should I get tested for HIV? I'm worried of false positives (urged to have the early PCR 2 weeks test) since I want to get back to my sexual activities with my wife soon to stop speculation

Q4. How soon can I test for Chlamidiya and Gonorrhoea? ( is 7 days ok? I see many places saying 14 days )

Q5: how easy to transmit HPV (Mouth-to-penis) from a single encounter (like mine) and is oral HPV different than Genital HPV (in terms of HPV strains?)

This was a low risk exposure. Fingering and kissing are entirely free of any STD risk, and fellatio is very low risk, especially for the insertive (penile) partner. Ejaculation in the mouth makes no difference. Neither does genital area shaving -- at least there have been no scientific reports of incrased risk, and biologically a higher risk would not be expected from the minor skin irritation (or even overt cuts) that might be resulted from shaving. And it also sounds like your CSW partner is careful in regard to sexual safety. Your sore throat at the time of exposure also makes no diffference.

1A) There are no data on HPV transmission by oral sex, but undoubtedly it is very low (under 1 in several thousand?) for any single encounter. In any case, as a sexually active human being, you can safely assume you have (or have had) genital HPV before now. This particular event would not meaurably elevate that possibility.

1B) There has never been a scientifically proved case of oral to penile HIV transmission. As I said above, the shaving makes no known difference. And my understanding is that on average fewer than one in a thousand UK CSWs have HIV. (Well, that's a London statistic. I don't know about other areas of the country.) 

1C) Chlamydia is rarely transmitted by oral sex; it's rarely carried in the oral cavity, and when present probably is not easily transmitted. Several research studies have shown there is no statistical association between urethral chlamydia and insertive fellatio. There is a higher chance of gonorrhea, but probably still under 1 chance in a thousand for any one exposure. Also, almost all urethral gonorrhea causes overt symptoms you would not miss. If within 5 days you did not have pus dripping from your penis and painful urination, you can safely assume you didn't acquire gonorrhea.

2) While I cannot guarantee you aren't infected with an STD from this event, the overall risk was very low. If somehow I were in your situation, I would continue unprotected sex with my wife without worry.

3) From a medical or risk perspective, you don't need HIV testing. But if you want the additional reassurance of a negative test result, feel free. If so, I recommend an antigen-antibody (combo, i.e. 4th generation) test 4-6 weeks after the event. PCR really isn't worth the money. However, your concern about false positives is misplaced. That happens from time to time, but quite rarely.

4) 14 days is nonsense. Any time 5+ days after exposure is fine.

5) Same question as 1A. There are no significant differences in HPV types likely to be found in the mouth as in the genital area.

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

HHH, MD

thanks a lot for your input. it is very informative and mind relieving. Don't know how to thank you for this service.

I've been in a monogamous along with my wife (we never had any sexual encounter before and outside of our marriage). which makes me feel even more burdened because I'll be bringing infection that we never got exposed to. I love her and I don't know what was I thinking when i did this. 

An important note that I forgot to mention: my exposure was 7 days ago.

HPV:

Based on you Assessment/expertise and statistical data,  do you think I should be overly worried about getting infected? and what is the prevalence of HPV in mouth overall and the prevalence of  high risk HPV in oral? 'given fact she is CSW :(' 

in other words Chance of Infection = Chance of Transmission * Chance of Prevalence * HPV High Risk Prevalence.

HIV:

* I'm planning to do both PCR and 4 Weeks 4th Gen. based on you suggestion. what is the accuracy rate of PCR? and when should i take it? does having flu or ending flu affect the test results?

Gonorrhoea/Chlamidya:

* I'm quiet confused with the discharge thing. how much discharge should I expect (a lot? non-stop?). the only thing I noticed during those 7 days (so far) was when I try to open 'widen' my penis opening, I feel like there is some liquid inside, but nothing coming 'dripping' out (as of Day 7). on one occasion only (was preceding urination) I saw a tiny watery fluid 'with some white colored traces' coming out of the head (that was day 3 i think).

I also feel some itchiness and throbbing effect on my penis head and testicles ( Anxiety? or STI ?). I've been very anxious last week and not sure if it could the reason .

Finally, what about HSV-1/2? should i worry? get tested? when?

HIV:  If you wait to be tested at 4 weeks, skip the pCR; the 4th gen test at that time will be equally accurate and a lot less expensive. PCR is not intended for use in this setting, except in much higher risk situations than yours. There are no medical condtions, including influenza, that have any effect on HIV test accuracy.

Urethral discharge:  It's not mysterious. Do not examine yourself closely. If you do not notice pus or mucus dripping, or if you have not obvious stains in your underwear, then there is no discharge. Small amounts of clear moisture from time to time are normal -- often in the morning men will have pre-ejaculate fluid apparent, from normal nocturnal erections. No STDs cause the sort itchingess, throbbing, etc you describe.

HSV2 zero risk from oral sex. HSV1 small risk, but very low for any single exposure and not worth testing etc unless there are symptoms.

If you remain in doubt, see a physician knowledgeable about STDs for examination and testing. Don't try to sort out all testing options yourself, e.g. through an online lab service.

Dear Doctor,

I really cannot thank you enough for the wealth of knowledge you're sharing and the great help you're doing to all of us.

My Apologies if some of what I'm writing below might sound repeated, but I want to know more:

Chlam./Gono:

I've visited a clinic and Tested on 7 days mark. Both Negative. Should I test 1 or more weeks from now? or consider it close?

HIV: While I've read many of your responses 'to other similar cases' in past and realize my risk is virtually zero (even assuming she is positive), It's just that I'm feeling un-immaginable guilt and worry that I might get my wife infected. That's why I'm considering PCR (because I can do it in shorter window period, but I heard/read that there are many false-positive and this would only make me freak out even more.). my wife is starting to question why we didn't have sex for over 9 days now.

HSV-1/2:

It's relieving that I don't have a risk for HSV-2. It's been 7 days and I'm not noticing visible changes around my penis. May I ask what are the symptoms that I should look for? how long do they take to appear (if any)? What is the prevalence of asymptotic males if you know that in general? and for peace-of-mind, When do you suggest I take a blood test for it? "I know It's nonsense from medical point of view" but I want to release the burden off my chest and move on supporting my family"

HPV (My biggest fear so far):

To summarize my status/risk and future action I/my wife need to do if any:

Given my encounter (Deep Kissing/Insertive Oral), the risk of transmission 'oral/genital' is very low (may I ask why? not questioning your judgement, but more of educational)? I'm 28, my wife is 22, what are the chances HPV 'high-risk' (if transmitted to me and then to her) to be 'cured?' by our body and how long? If I'm infected and I infected her, will we be infecting each other back 'loop like scenario if someone cured his HPV and the other is still not cured'. sorry if I'm sounding stupid, but all these are coming to my anxious mind. if high-risk HPV is 'cured?', the risk for cancer is 'somehow' elevated? at what age should she start do pap-smear test? 

To add to my last point about HPV:

Do you suggest we get Vaccine? or is it for me or her?

Do you suggest we get HPV Vaccine?  or it is late for me or her?

The gonorrhea/chlamydia test already done is sufficient. There is no need or point in additonal testing.

Getting beyond your anxiety is your challenge, not mine. I've given you the facts and probabilities and the rest if up to you. I already told you that you have been misled about what you read about false positive test results. They are very rare and this should not influence your testing decision. However, you don't need testing anyway, so I suggest you skip it. There is no reason not to be continuing sex with your wife.

The symptoms of herpes are complex, but initial infection usually includes blisters/sores of the exposed area, onset within a few days of exposure. Beyond that, this is a complex question that would require more than you should expect from a forum like this. Same for your HPV questions -- proper reply would require several paragraphs, and in any case aren't really appropriate to your situation since your risk for HPV was zero (or close to it) from the exposure described.  Information on herpes symptoms and HPV transmission, symptoms, etc is readily available online. I suggest you start your searching with the websites of ASHA, the sponsor of this forum (www.ashasexualhealth.org) and CDC (www.cdc.gov/std).

Threads are closed after 2 follow-up questions and replies, so that concludes this discussion. Best wishes and stay safe.