[Question #5323] Unprotected oral risk?

23 months ago
Hello and thank you for the help I have received here in the past.
I have cleaned up my act quite a bit since I last asked a question.  But I messed up last Friday I recieved unprotected oral sex and a bit of rimming from a escort. A few days later my pelvic area and a bit of my penis was itching pretty bad. No lesions would the lesions be very noticeable? Just itching and irritation from scratching. It seems to be better today which is Friday. I don't know if that counts as 7 days, like if you count the day of the exposure. My worry is herpes or syphilis. I've also had a fever and white tongue. Now if I have one of those does that mean I might also have gotten HIV? Should i test or should i stop worrying? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Welcome back. Thanks for your continued confidence in our services.

As we may have discussed in one or more of your past threads, oral sex is low risk for all STDs and virtually zero for some. Not zero risk, but with a lower chance of infection that unprotected vaginal or anal sex.

Your symptoms are not typical for any STD. No STDs itch.  Herpes lesions may itch, but itching without blisters/sores is never due to herpes. Fever and white tongue are not due to any STD in the absence of other obvious STD symptoms. It's too soon for syphilis, which also wouldn't itch; the first sign is an open sore, typcially starting 10-20 days after exposure. Anyway, heterosexually transmtited syphilis in this situation is rare (the large majority of syphilis in teh US and other industrialized countries is in men having sex with men). Further, I'll add (maybe discussed with you previously?) that escorts -- i.e. expensive female sex workers by appointment -- tend to have low frequencies of STDs, due to safe sex, frequent testing, etc (and the fact that most of their clients are men at low risk, i.e. men like you!)

If the itching continues, see a doctor -- either an STD specialist (e.g. a local public health clinic) or dermatologist would be fine; or your primary care provider, if you have one. In the absence of more typical symptoms -- discharge from the penis, penile blisters, sores, etc -- I would not advise testing after a single oral exposure. However, some people in your situation are more reassured by negative lab tests than by expert opinion. If you think that applies to you, then you could have a urine gonorrhea/chlamydia test at any time; and a blood test for syphliis after 6 weeks (sooner if an actual sore appears at a site of exposure, i.e. your penis or anal area). I do not recommend HSV testing in this circumstance:  the tests are not entirely reliable, and when the risk is so low, a miseading test result is more likely than a helpful one.

As for HIV, there has never been proved case acquired by transmission mouth to penis, or mouth to anus. That doesn't prove it can't occur, but I've never seen a case or heard of one. Therefore, I don't recommend HIV testing -- but here too, you're free to be tested if you would find the negative result reassuring. If so, have an HIV antigen-antibody (4th generation, "duo") test at 6 weeks. In the meantime, I would encourage you to continue your usual sexual practices with your wife or regular partner. 

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

HHH, MD
---
23 months ago
Thank you for that very detailed response. 

Would the lesions be very noticeable?

I know I said itchy but if I used the word tingling would that change your assessment? I think the 2 are similar but I've read that description used in symptoms as well. Just want to make sure.

Last year when I first asked a question on this site it was for a unprotected vaginal exposure and my main concern was HIV. I have a strange question. Since that exposure and with all my testing ( a lot ) I was always negative. But I find it strange that I never got sick. No flu, no cold nothing is that strange? I've been wondering about that. Everyone around me got sick but I did not. I know this is borderline anxiety but even after almost a year is it at all possible the many tests missed something? From all I have read it is up to the individual body when antibodies are created. Has there ever been someone that you know of to go this long? And if I didn't create antibodies how sick would I be by now? I'm just wondering.
23 months ago
**Would the herpes lesions be more noticeable when erect or flaccid? Or does it not matter?
Would they hurt? To the touch or in general?
Sorry I forgot to ask these 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
Yes, initial herpes lesions generally are very obvious -- multiple painful blisters that soon turn into open sores.

I don't understand your question. Why is it peculiar not to have gotten symptoms? You didn't have HIV, and apparently nothing else that causes symptoms. Sounds like others around you caught a cold, and may have been sharing the same cold:  but when that happens, typically 30-60% of exposed persons catch it. So nothing unusual about your not catching it. (Anyway, maybe you did. Sometimes people catch cold viruses and remain asymptomatic. As for HIV, the answer is no:  nobody ever goes more than 6 weeks without getting a positive blood test. There is no such thing as getting HIV and not developing antibodies, using up to date testing methods. And anyway, the main tests don't look only for antibodies, but also for the virus itself. A negative result beyond 6 weeks is proof HIV infection did nbot occur. There are no exceptions. (About half get no symptoms either -- but it's the blood test that matters.)
---
23 months ago
*** One more quick kind of dumb question.. I tried Cialis this week for the first time, just to try it out. Might that cause fever? It was generic, it was blue chew which just has the main ingredient. Thanks again.
23 months ago
I tried to get that cialis question in before you had a chance to answer. Thank you. I was asking the HIV question as if I was infected and it wasn't detected. I understand that is crazy at this point. May 5th is the anniversary of that exposure and it lingers in the back of my head. But this fever has me worried the most. My genital area is feeling way better than 2 days ago. I still have tingling around the head/ crown area but nothing compared to before. Thank you for all the help. 
23 months ago
Blue chew has the same main ingredient as Cialis. I know it stays in the system for a day or two. I know I worded it very wrong.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
What is your temperature?---
23 months ago
I'm using a temple thermometer and it's been between 100 and 102.
23 months ago
I do have that temperature but other than that I feel fine. Is this cause for concern? Or was it a pill I took that is causing it.
23 months ago
Just checked it and it is at 98.6? I'm very anxious now. Could this be adding to my situation? 
23 months ago
99.7 now.  So its fluctuating.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
23 months ago
You have a very low grade fever, and maybe trending downward. It started too soon for HIV acquired during the oral sex event -- and you're not likely to be the first person in the world to acquire HIV in this way. You probably have had a minor viral infection (cold virus etc), perhaps acquired during the sexual event -- but not HIV or any other STD. If you remain concerned, you'll need to see a doctor -- we've gone as far as we can on this forum, and we're beyond the two follow-up comments and replies normally included with each question.

I hope the discussion has been helpful.
---