[Question #3506] Unprotected oral sex massage provider

88 months ago

Hi docs, thanks for this service. I have read through some older posts and can likely predict the answer here, but I need to address my specific concerns. I visited a USA massage parlour 4 days ago with the intention of a nice massage with a nice safe ending. Inadvertently, while enjoying my massage, the provider began oral sex on me which caught me by surprise. This went on for a few short minutes before I stopped it and resumed the massage. Today is day 4 and so far no symptoms other than slightly sore testicles but I’m attributing that to hyper focus of that region. I’m in a long term relationship and I can’t avoid my GF for much longer. Questions:

1) What is the probability of contracting an sti during his event, even considering no knowledge of what she could have been doing right before my session? (I’m assuming only gono. I have hsv1 already)

2) It’s been 4 days without symptoms. Is it safe to resume relations with my GF? If not, how long should I wait?

3) Do I need to test for anything, even in absence of symptoms?

4) If I make it to tomorrow, day5, with no symptoms can I be assured gono is a non-factor and completely move forward without fear?

Thank you, the anxiety, what if, and regret is crippling....

H. Hunter Handsfield, MD

88 months ago

Welcome to the forum. Thanks for your question and reviewing others similar to your own. I'm happy to help.

Directly to your questions:

1) As you already seem to know, we consider oral sex to be safe sex: the risk is so low that if somehow a world sex czar could wave a wand and stop all vaginal and rectal penetration, leaving only oral sex, some STDs -- for example, chlamydia and HIV, would disappear from the earth. The main STDs for which there is modest risk are gonorrhea and nongonococcal urethritis (NGU), and not herpes because of your prior HSV1 infection. I would roughly guess the chance of either gonorrhea or NGU at under 1 in a thousand -- even lower for gonorrhea, since most cases would be causing discharge and painful urination by 4 days (although it could take a week).

To your specific questions:I

2,4) The risk is low enough that if I were in your circumstance, I would resume sex with my wife after a week with no symptoms. Gonorrhea usually becomes obvious within 5 days, but it can take a week.

3) Testing is optional. I cannot guarantee you didn't acquire gonorrhea. Symptomless urethral gonorrhea is rare, but happens, and a urine or urethral swab test is the only way to know for sure. But if I were you, I would take the chance and not be tested. There is no standardized, reliable test for NGU, and in any case, NGU from oral sex is rarely due to important pathogens like chlamydia or Mycoplasma genitalium; most seem to come from entirely normal oral bacteria that probably are not harmful to partners. Some experts would advise a syphilis blood test at 6 weeks, but heterosexually transmitted syphilis is very rare in most of the US. If you decide to be tested, I certainly would not suggest holding off sex at home in the meantime.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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88 months ago

Thank you for the detailed answer doc. Just a final few questions:

1) What would you guess is the estimated transmission rate per incident orally, assuming she was infected? In running through the event again and again in my head, I’m realizing that the exposure was very short, less than a minute. Would that short time frame have an affect? I was also washed with soap just a few short minutes afterwards. Any benefit there?

2) What percentage of men show symptoms by 5 days compared to those that take longer, or are asymptomatic? 5 days appears to be the number most lean to, so my assumption is a very high percentage show symptoms by then. I’m at 4.5 days now with nothing to report other than a hyper focus on the area.

3) I’ve read that over 1/2 of infections are attributed to young people, and the rest are filled by a majority of MSM and African Americans. That doesn’t leave much left for heterosexual transmission beyond the young adults. Would that be a fair statement even when considering what this masseuse must do fairly often? Could it be considered a bit more rare to have a throat infection?

4) Your earlier reply expressed confidence from afar that the probablity is good that I was not impacted negatively by this experience, and resuming sex at home would be recommended in a week’s time. We have a party to go to Saturday, and she will 100% want to be intimate afterwards. That would put me at 6.5 days post massage experience. Barring no symptoms by then still, would it be considered generally safe to participate? I’m afraid I’m going to be left with a choice to do so, or express my concerns which would lead to a severe reaction I’d rather not be involved with, especially if my fear/guilt is making this a bigger deal than it should be.

Thank you doc, this service is beyond helpful!

H. Hunter Handsfield, MD

88 months ago

1) No good data, but probably under 1 chance in a thousand.

2) 90-95% develop symptoms within 5 days. The symptoms of urethral gonorrhea usually are not subtle: pus dripping from the penis, painful urination.

3) You're misunderstanding the statistics. The overall rates of gonorrhea are 10-20 times higher in African Americans than in whites, but in many communities, there are 10 times more whites than blacks -- and the gonorrhea numbers in that community might be equal among racial groups. Gonorrhea rates also are a lot higher in 15-25 year olds than in men over 30, that doesn't mean it's rare in those older men.

4) Sorry, I can't make this choice for you. But given the overall safety of oral sex and your lack of symptoms so far, if you remain without symptoms at 6+ days, the chance you would be infected is very low. If I were in your situation, I probably would go ahead without worry.

Thanks for the thanks about our services. That's why we're here!

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88 months ago

Thank you so much! As my last avail post, please see below:

1) I went and tested at day 5, without symptoms, just for peace of mind. Is that sufficient time to be accurate?

2) Is dull aching pain which comes and goes in the lower abdomen a symptom if the urethra is asymptomatic? How about the same in testicles? I imagine my focus on the area is magnifying things. It’s come and go and fairly minor.

3) You say symptoms are not subtle. Is that true on the onset, as in it just comes on strong until fixed? Or does it gradually start with a general uneasy feeling into stronger pain?

4) What is the longest timeframe to be asymptomstic before symptoms start? Would 7 days be considered the longest? I read in another post that only 1% of men are asymptomatic and 95% will show signs by 5 days. That’s very encouraging as I’m on day 6 currently.

Many thanks for the opportunity to communicate directly with you here. I’m sure I speak for everyone; the value of this service is immeasurable. Once again, thank you all for this opportunity it’s!

H. Hunter Handsfield, MD

88 months ago

1) Yes. Gonorrhea testing is valid any time more than 2-3 days after exposure.

2) This kind of pain is not consistent with urethral origin, but entirely typical for genitally focused anxiety, both in its type and locations.

3) Usually strong symptoms right from the start, or builing up within a day or so. A typical example came up in the WWII miniseries Band of Brothers, with a soldier with gonorrhea saying "I'm pissing razor blades".

4) It could go 10+ days, or in theory even longer. But in my 40 years in the STD business, I've never seen it take more than 5 days.

Don't overthink this. There is no reason to suppose your situation would not be typical, with the standard advice and usual time frames applying across the board. You should be able to move on without further worry, especially after you get the negative test result. In the meantime, stay mellow: it will be negative for sure.

That makes two follow-up comments and replies, and so ends this thread. I hope the discussion has been helpful.

HHH, MD

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