[Question #376] Oral Sex STD and Risk

95 months ago

Hi Dr HHH, I'm living in Malaysia and sorry for the poor English as I don't really speak good English in my country. I have a few question for my recent exposure with a CSW and I'm very worry now.

I used to have past incident which I've posted 2 years ago in MedHelp regarding on the HIV/Herpes test from unprotected sex with CSW. I got the resulted after multiple  test within 6 month to 1 years after the exposure and my result was cleaned from all STD including HIV. After that incident, I've developed phobia and stopped myself from going for escort service. I'm so disappointed on myself for the recent incident to go and look for CSW again. I was considered drunk during that night but I still managed to walk and talk properly. Here is my incident :

I only asked the CSW to help me massage and handjob for happy ending as I never wanted to have sex at all. However, I received a brief blow job from CSW for about 1-2 minutes. Never too long and she started to perform handjob for me. She was naked but her virginal didn't contact with my penis for sure. I did suck her nipple but did not perform any french kiss. I did not have sexual contact (Insertive virginal) with the CSW due to my phobia of my past incident.

1. What is my chances of getting STD's and what kind of STD will happen on oral sex.
2. Is oral sex and Handjob consider a safe sex? I read many post mentioned that oral sex still carry risk for most of the STDs.
3. I'm very worry to get HIV and herpes. (I have HSV-1 Positive many years ago but negative for HSV-2). What is my real risk to new infection herpes?
4. Should I go for STD testing from these incident? 
5. I have a girl friend. Can I continue sex with her before testing?

Please help me doctor. I'm very worry now.

H. Hunter Handsfield, MD
95 months ago
Welcome to Ask the Expert. Thank you for your question. Your English seems fine to me!

As you may have seen on MedHelp and scanning this forum, we always say oral sex is safe sex. It isn't entirely free of risk, it is low risk for all STDs and zero risk for some-- much safer overall than unprotected vaginal or anal sex. To your specific questions:

1,2) Partly answered above. No risk at all from hand-genital contact; no STDs are transmitted that way. Oral sex carries virtually zero risk for HIV (especially from mouth to penis, with no proved cases of transmission in the entire history of the worldwide HIV/AIDS epidemic), HSV2, and trichomonas; and extremely low risks for chlamydia and HPV. Syphilis is possible but uncommon. The three main STDs we see in my STD clinic from oral-genital exposure are gonorrhea, nongonococcal urethritis not due to chlamydia (NGU), and herpes due to HSV1.

3) As already noted, there is no realistic risk of HIV. And although herpes due to HSV1 can happen, in your case it cannot: since you already have had HSV1, you are immune and cannot catch it again. So your "real risk" of new herpes is zero or very close to it.

4) From a medical or risk standpoint, no STD testing is necessary. If somehow I were in your situation, I would definitely not be tested unless there were symptoms (urethral discharge, penile sores, etc).

5) You also can safely continue sex with your girlfriend. Here too, if I were in your circumstances, I would continue unprotected sex with my wife.

However, I'm not you, and if you would feel better being tested, you are free to do it. If so, I would recommend a urine test for gonorrhea and chlamydia (about 5 days after the exposure) and blood tests for HIV and syphilis in 4-6 weeks. That's all. For sure DO NOT have any other STD tests of any kind.

I hope these comments have been helpful. Best wishes and happy new year--  HHH, MD

95 months ago
Thanks Dr HHH. I would like to add a few more questions before I move on.

1. I read some article mentioned that if someone who already has HSV-1 Positive , it's very unlikely to get new herpes infection such as HSV-2 due to certain scientific explanation which I don't really understand. In my case, I do have HSV-1 positive, its possible to infect with HSV-2 with oral sex exposure?
2. I believe my exposure is related to "fellatio". According to certain article it mentioned that the highest risk for oral sex is Receptive Fellatio while mine is more to Insertive fellatio. Can I have more details about this?
3. Probably when is the time the symptom will appear? I just had this incident not more than 2 days and I have yet to have any symptom at the moment . It's suggestive that I would be safe if I have not develop any symptom within the time frame?
4.I only have  around 30min - 1 min oral sex exposure from the CSW (Sorry to mentioned previously 1 - 2 minutes), With this brief exposure, it's sufficient for the bacteria to transmit STD? Should I need to worry?

H. Hunter Handsfield, MD
95 months ago
1) Either you found a misleading resource or you misunderstood. Prior HSV1 probably reduces the risk of HSV2 if exposed, but only a little bit. The reason you are at low risk of HSV2 isn't because of your prior HSV1, but because HSV2 is rarely transmitted mouth to genitals. Transmissible oral HSV2 infections are uncommon. In 4 decades in the STD business, I have never come across a case of genital HSV2 that appeared to be acquired from oral sex. (Note that HSV1 and 2 are the names of the viruses, not the sites of infection.)

2) Your exposure was not "related to" fellatio, it was fellatio (oral-penile sex). Overall STD risk is low for fellatio, as I said above. It's slightly higher in the penis to mouth direction, lowest for mouth to penis, as in your exposure.

3) Incubation time (until symptoms appear) is different for each STD. Typically 2-5 days for gonorrhea and herpes, 5-10 days for chlamydia or NGU, a few weeks for HIV and syphilis, and up to a year for HPV. Because syphilis, HIV, and HPV are extremely unlikely from any single exposure like this, you can consider yourself symptom free if nothing develops within 2 weeks.

4) It is logical to assume that transmission risk is lower with a brief exposure compared with a prolonged one. Therefore, you are correct that your risk even lower than average. But that doesn't mean zero risk.

94 months ago
Dear Dr HHH,

It's been 3 week after a brief oral sex and hand - genital exposure. I would like to follow up a few more question as I have a few suspicious symptom developed after 2 weeks.

You've mentioned that if I don't see any symptom such as penis discharges or sore and I'm considered symptoms free. However, exactly after 2 week I have developed a few minor red dots on my penis glans. I used to have this symptoms 2 years ago and I've tested STD especially HSV 1 and 2. I've done a few HSV test in the past 2 years and everything come back negative except for HSV 1. The last test was done 1 year ago due to I've developed a few minor red dots on my penis and everything come back negative as well.

Recently I developed the red dot on my penis glans again after the oral sex and hand - genital exposure (2 weeks later) . The dots was red on the first days and it slowly become pinkish color and slowly disappear within 2- 4 days without any treatment. I don't find any itch, pain, sore and tingle feeling. I don't see any blister or ulcer as well. When it's erected , I do hardly see any bump but its cover with obvious blood vessel. I'm so worry it's herpes or syphilis and I went to visit a doctor. He don't suggest any STD based on the symptom showed on my penis glans and suggest me to get a full STD test in order to be sure (Still waiting for the result). Few days later I'm still worry and I get consulted with online dermatologist . He suggest it's fordyce spot based on the explanation I gave him. By the way, I just received test result for HIV 1&2 AG/AB and VDRL(All negative) and I'm still waiting for the HSV 1&2 result.

1. It's a mild herpes symptoms? (I don't feel pain/itch/sore and etc)
2. I still waiting for the test result (IGG and IGM). What is the difference between these two?
3. Do you suggest its a herpes based on the symptom and do herpes act in that way?
4. Do you agree it's a fordyce spot as well?
5. If's not a herpes, what really cause these bump? Sometimes it come and go without any feeling and I'm tired of it.

I know this may be the last reply I can get from you but I hope to show my test result to you once I received it. The reason being is because
the GP I visited is not an STD expert. Their comment may not be accurate as you. I hope you will accept my next reply for my test result.

94 months ago
Sorry Dr HHH, just to be more clear. I have no idea whether it's bump or just a rash. (It's seem like a rash but overall shape just like having multi red dot). I don't actually feel it's a bump when I touched it. Its quite smooth but it's still make me wonder.
H. Hunter Handsfield, MD
94 months ago
As discussed above, you could not have acquired any STD from the exposures described. It follows logically that any symptoms you have are not STDs from that event. And no STD causes red spots of the sort you describe.

1,3) No, this is not herpes. Nothing like it.

2) It was a mistake to be tested for HSV. STD experts never use the IgM test; it is especially misleading. We do not even offer this test in my STD clinic. In theory, IgM testing reveals earlier infection than IgG, but it usually doesn't work reliably. Ignore that result for sure. The IgG result will tell whether you are infected with HSV1, HSV2, both, or neither virus. Half of all adults have HSV1, so you can expect that you may have a positive HSV1 test result. But even if positive for HSV2, I would conclude you have asymptomatic infection plus some other explanation for your symptoms.

4,5) This doesn't sound like Fordyce spots to me; I would have thought they are some sort of minor, harmless blood vessel anomalies. But I'm not a dermatologist. It is time for you to stop wasting your money and energy on online care, either for exam or lab tests. Get examined in person if you feel you really need to learn what the spots are. But I think you are seriously overreacting to a non-event sexually and to symptoms that don't matter and probably aren't abnormal.

That completes the two follow-up comments and replies included with each new question, and so ends this thread. Best wishes and stay safe.