[Question #4082] Isolated incident

32 months ago
Thank you for offering this great service.

I decided to visit a strip club on Friday with a couple of friends while on vacation. I went to the back with one of the strippers and had a lap dance.  We kissed a little (mostly tap) with the occasional flick of a tongue. One thing led to another and she began to perform oral sex. About 5 minutes in, I told her that I had too much to drink and was not interested. At that time, I failed to mention that I had a tremendous amount of regret and shame for what I had just done.

On Monday, I visited a sexual health clinic and tested negative for HIV (which I expected given the 3 day duration). They did not have results for chlamydia or gonorrhea and the provider knew that I was overly anxious. He decided to prescribe ceftriaxone and doxacycline.

I am experiencing some GI issues, which I believe are caused by the medication and nerves from this incident. I have not seen any discharge from my penis and continue to my groin area for bumps. I did purchase an early detection HIV kit, which I plan to use on Monday.

With that being said, I have a couple of questions:

1. Is it possible to get HIV in this scenario?
2. What is the likelihood of getting HPV from an isolated incident such as this one?

Thank you again for this amazing services.
32 months ago
Meant HSV not HPV ** typo
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Welcome to the forum. Thanks for your question.

The news is good:  you really needn't be worried. There is absolutely no chance of HIV and the risk of any other STD is extremely low.

Oral sex is safe sex -- not completely free of risk, but low chance of all STDs and zero for some, including HIV. There has never been a proved case of HIV transmission mouth to penis. Also, it is statistically unlikely that any particular woman in the US, including a stripper or sex worker, has HIV. I don't recommend testing for HIV on account of this event.

The main STDs possible from receiving oral sex are gonorrhea; nongonococcal urethritis (NGU), which often is due to entirely normal oral bacteria and is considered harmless; and genital herpes due to HSV1, the usual cause of oral herpes. The chance of any of these is extremely low. Gonorrhea is already ruled out, for all practical purposes, because you haven't had gonorrhea symptoms, which usually show up within 5 days. Despite what you may have assumed from the tests done by the sexual health clinic, oral to genital chlamydia transmission is extremely rare (until recently not believed to occur at all). In any case, you can expect negative test results for both gonorrhea and chlamydia. As for NGU, the main sign would be discharge from the penis, typically starting 7-14 days after exposure. But on top of all this, the treatments you had would have aborted all three of these problems.

Syphilis also is possible from such an exposure. However, the chance of syphilis in such a partner is extremely low, and transmission risk from brief oral sex is low, although not zero. In any case, the ceftriaxone shot would have aborted any brewing case of syphilis, if you had been exposed, so no need for worry or for testing.

Herpes? Very unlikely in this situation, but no way to be certain except to wait on symptoms. If you acquired genital herpes, you could expect penile blisters, sores, and/or urethritis (discharge, painful urination) within 2 weeks. So you can consider yourself home free if no such symptoms by then. Also, if you have had previous HSV1 (i.e. oral herpes -- cold sores, fever blisters, etc) you are immune to a new HSV1 infection, i.e. no risk from this event.

HPV might occasionally be transmitted by oral sex, but the large majority of genital HPV infections are from vaginal or anal exposure. Anyway, assuming you are otherwise sexually active -- i.e. not a virgin, and have had perhaps a handful of sex partners -- then for sure you already have (or have had) HPV, and this incident doesn't significantly raise that chance any higher than it was. If and when HPV causes warts or other symptoms, they don't show up for at least several weeks and often not until many months later. Should that happen someday, there will be no reason to assume the infection came from this particular sexual exposure.

Thanks for your kind words about our services. I hope my response is as helpful and "amazing" as you would wish. Let me know if anything isn't clear.

HHH, MD
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32 months ago
Thank you for the response and for significantly calming down my anxiety.  I am happy to know there is no risk for HIV.  The early detection kit was my idea - not my provider.  Just so you know!  He, like yourself, discouraged it and feel it was overkill. This incident has thrown me for a loop and valuable lessons have been learned from this experience.  Definitely going to watch my alcohol intake, even on special occasions.

I was happy to learn more about the ceftriaxone shot because I felt syphillis was still on the table. I thought the ceftriaxone shot and 2 doxycline pills were for GON/CHL only. I am happy to know this combination will take care of all three and not require a penicillin shot. My provider looked at me like I had 3 heads when I said, “can you just give that one to me as well?” 

I know that my partner has HPV and is checked every year, so I probably have that one already. Your post has been very educational and has calmed my brain down! 

My only concern at this point is herpes, which I might already have?  I have been with a handful of women and some had fever blisters, cold stores, etc. I never thought much of it. Just a quick kiss on the cheek and kept it moving. I never thought it was herpes. We kissed when they did not have break outs and engaged in fellatio and vaginal course. Probably have it already and just never had a noticeable break out?

Is hepatitis off the table as well in my above scenario? Oral and kissing.

And Yes, you are still amazing.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Genital herpes is not as common or as easily transmissible as you might assume. Statistically it is unlikely you have genital herpes. OTOH, half of all adults have oral HSV1 infections, mostly acquired in childhood. Most have no known history of past oral herpes, cold sores, etc. However, "a quick kiss on the cheek" is not sufficient contact to transmit it.

Hepatitis definitely is not an issue for this sort of contact. Only unprotected intercourse -- and even that carries no appreciable risk for hepatitis C, only hep B.
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32 months ago
Well Dr. Handsfield, I must express my most sincere thanks to you. It has been a rough couple of days, but this dialogue has certainly calmed me down.  This is an amazing service that you provide to us all. 

I hope that you were not offended by the “kiss on the cheek” comment. Pardon my ignorance, but I was not aware that it could be oral herpes. For this reason, I never thought to question it and figured the sore/blister on the lip was more of a nuisance for a few days. I would always try to be supportive during this time.

Thank you again for all that you do. In closing, I read your message about that ceftriaxone shot and wanted to clarify for my peace of mind. That injection and two capsules of doxycycline will get rid of Gonorrhea, Syphillis and Chlamydia. There is no need to follow up on syphillis.

My sincerest gratitude to you. Thank you Dr. Handsfield and hope you have a great night!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Your "ignorance" was in fact the exactly right attitude, and it shouldn't change now that you know the cause of such outbreaks on your friends' faces. Oral herpes is just that, "a nuisance for a few days", nothing more. Same for genital herpes as well, at least for 90% of affected persons. Continue to be supportive of your friends who have what might be oral herpes, but don't assume they need all that much support. It's probably no big deal to them, and shouldn't be to you.

And by the way, for the occasional friend for whom it's more than a nuisance, let them know that treatment is simple and highly effective:  a single dose of valacyclovir (Valtrex), taken at first sign of an outbreak, shuts it down and heals it, sometimes in a couple of days.

Yes, I confirm that ceftriaxone and doxycycline would get rid of gonorrhea and syphilis. Actually, probably not chlamydia, which requires a few days treatment with doxycycline. But there is no realistic chance of chlamydia from oral sex anyway, so it's a moot point.

Thanks again for your kind comments about our services. Spread the word to friends and acquaintances who might benefit.
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