I am a male 36yr living in Hong Kong. A CSW (female mid 20s Chinese from shanghai) working in HK for 2 weeks performed oral sex on me (I was inserting my penis in her mouth) on 15 Feb 2019. I had asked her to only lick my penis/scrotum and only suck on the head of my penis as I hoped that would decrease my chances of getting bacterial infections from the back of her throat (please let me know if this logic is correct). 

The event lasted for 5 minutes and included sucking of testicles licking of whole penis and rigorous sucking of shaft and penis head. Condom protected intercourse followed and ended with me ejaculating in an intact condom. 

After the deed I noticed that she had a raised red bump on her lower right lip. The bump did not look like it was an open sore - certainly not the type you see when you google herpes or syphilis. I pointed at the bump and asked her if she was ok and she said she was fine and  it was due to her eating a lot of hot foods recently.  She then pinched and picked at it and scratched it a bit with her pinky nail. 

It is 18 Feb 2019 and I have no discharge or painful urination.  My penis head looks normal.  I have been pressing on the lymph nodes near my groin area - inner thighs and pubic hair and found no bumps. 

My Questions 

- does the red lip bump sound like herpes or syphilis to you? If not what could it be (if you weren’t to take a guess)

- what was my overall std risk also assuming the red lip bump was herpes/syphilis?

- I had started to feel some pain in the area just above my pubic hair I don’t know if it was because of my self examination or something else - is this a sign of an std?

- I have 2g of Zithromax and 9 100mg  doxycap tablets at home - should I take them for preventive measures?

- what tests do you recommend I do at this time/near future?

Many thanks for your time. 

I would also like to clarify that the oral exposure with The CSW in my message above was unprotected whereas the intercourses was condom protected

Many thanks again for your great work here doctors. 

Oral sex is safe sex -- not completely free of STD risk, but much lower risk than for vaginal or anal for all STDs and virtually zero risk for some. There are no data to judge whether STD risk is higher with deep throat exposures versus less deep -- probably not much; exposure to oral bacteria is probably pretty much the same either way. The main risks from oral to penile transmission are nongonococcal urethritis (NGU), often probably due to entirely normal oral bacteria, not traditional STDs; gonorrhea; and herpes due to HSV1. HIV, chlamydia, and HPV are extremely low risk (near zero risk) from oral. Basece of symptoms in the 10 days after exposure is good evidence (although not conclusive) that no infection was transmitted.

1. I have no way of judging whether a single "red bump" on your partner's lip was herpes. It doesn't sound like syphilis, which in any case is exceedingly rare in women like your partner. In any case, even if she has oral HSV1, this event probably was no more risky than your previous relationship, when you were repeatedly exposed. In people with active oral herpes with occasional outbreaks, it certatinly is wise to avoid contact at those times. However, all infected people also have virus present from time to time in absense of symptoms -- indeed, many (most?) HSV transmissions occur from partners not experiencing outbreaks at the time. In other words, you undoubtedly were at much higher risk of catching genital HSV1 from that previous relationship than from your single more recent expposure, regardlss of the "red bump".

2. Overall risk hard to judge. Probably under 1 chance in a thousand you caught anything at all.

3. No STD causes pubic area pain without other symptoms. The most common explanation for this sort of thing is genitally focused anxiety -- i.e. concern about STD risks, regret over a sexual decision, etc raising sensitivity to minor symptoms or normal body sensations that otherwise would be ignored or not even noticed.

4. I would recommended against self treatment after a single, low risk exposure of this kind. Better to wait and see if any symptoms within 10 days; and if anything shows up, get professionally evaluated, not self treated. Treating now will screw up any chance at successful diagnosis later in the event symptoms continue or develop.

5. Similarly, STD testing is generally not recommended after a single exposure of this sort. However, if you feel you need testing for emotional support -- i.e. if negative tests will be more reassuring than my opinion and advice (which I would not take personally!), then you can have a urine gonorrhea/chlamydia test at any time (valid 4+ days after exposure) and blood tests for HIV and syphilis at 6 weeks. I would recommend against another round of HSV testing after this single event.

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

HHH, MD

Many thanks for for your reply. I’ve been following your and Dr Hooks work since the Medhelp days and found it to be reallly helpful. 

A follow up couple of follow up question I have are:

1. Websites (which I know you and Dr hook advise against reading) indicate that herpes is highly contagious and it just takes 1 event of skin to skin contact.  It’s confusing. I know you say my exposure is considered low risk but what if the red bump was herpes and the blowjob she gave me was rigorous (I.e hard sucking for 5 minutes) would that put me at higher risk? In other words Does duration and rigor play a role? 

2. How is herpes transmitted? I found your reply above to be very assuring. It just contradicts a lot of other websites (I’m sorry for comparing) as it seems like my exposure had all the ingredients for transmission to occur. Is there a statistic for transmission of mouth to genital HSV-1 when the oral partner is having an outbreak? 

Many thanks again for your insights. I just want to hear it straight from an expert such as yourselves on how these things work and why you believe my exposure was low risk - with no intent of challenging your judgment. 

So yes, your exposure could have risked herpes; I'm not saying there is no risk. But I'm betting that your partner's red mark wasn't herpes. And in any case, the the chance of HSV transmission from any particular exposure to an infected partner (either vaginal or oral sex) probably averages 1 in a thousand. This is why you didn't get infected in your previous relationship -- not primarily because you avoided exposure during when she had visible outbreaks.