[Question #5400] General Non-inserstion Question

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75 months ago
Hello Dr,

I was hoping to get some knowledge on a few items given the fantastic job you all do providing honest and real world advice. 

Although I've read previous post of yours regarding this, just for clarification, a guy giving oral to a female would be little risk for STIs and testing would not be recommended? Proceeding with regular sex with sex partner? What about brief contact of a penis around a wet vagina without insertion?

The other is more around symptoms and timelines. Would any symptom in the mouth as a result of say syphilis or herpes show up in 2-3 days? Are these sores quite distinguishable from say what might be a small red mark or scratch that might otherwise regularly occur in and around the mouth?

I have also always wondered about the differences around the 2 herpes type. Specifically around why it seems testing is only done if symptoms are present and also around the fact that they apparently lay dorment for long periods on many people. Could a person have had a oral or genital infection says years ago from a previous partner and then experience symptoms for the first time years later when with someone else or nobody at that time? Is it only a recent exposure that will set off a outbreak?

Lastly, if someone was taking Doxy would that kill the bacteria of the 3 main bacterial STIs (Gon, Syphilis, clym) In their early stages?

Thank you


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Edward W. Hook M.D.
75 months ago
Welcome to the Forum. Your questions are varied and quite broad.  I'll try to briefly answer each one:
1.  Cunnilingus.  Cunnilingus, for anatomic reasons is an inefficient mechanism for acquisition of STIs.  Most STIs infect the cervix, deep within the vagina and the tongue rarely gets that deep into the vaginal during oral sex.  This is not to say that STIs cannot be acquired through cunnilingus but that the process is biologically inefficient and rarely leads to infection.  Thus following cunnilingus with new or at risk partners, oral screening is probably a wise thing although there will be few infections diagnosed in that way.

Non-penetrative contact with a wet vagina- no risk for STIs.

2.  Few oral STIs are symptomatic and for lesions to appear 2-3 days after contact would be quite rare.

3.  Blood tests for herpes are not recommended because the tests are not very good. They have a relatively high false positive rate and miss infections.  They are commonly misleading and do not perform well for diagnosis of recent infections.  I have nothing to say about your "what if" scenario.  It seems unlikely

4.  Doxycycline might reduce the risk for acquisition of gonorrhea, chlamydia and syphilis if someone was exposed to those infections while taking it but the protect would not be absolute.

I hope these comments are helpful. Please limit your follow-up questions to clarifications.  EWH
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75 months ago
Thanks Doc,

Definitely mostly along the lines of what I have come to know. Just a few clarifications would be:

1. Am I right In assuming that screening after Cunnilingus for certain things(i.e HIV, syphilis) ,are probably not nessecary? Meaning would I be suggested to wait the 1-2 months and go get tested everytime an oral experience happened. I just know that I've read both you and the other doctors on here state that is an excessive approach and that oral is generally considered safe sex, does that still hold true? And then maybe just a clarification on which ones Cunnilingus does pose a risk for?

2. Understand now the Doxy pre acquisition part.. what about taken post acquisition for killing those bacteria?

3. Lastly,  the inconsistency in the blood testing for herpes does make sense now. With respect to the asymptomatic and dormant part. Is it possible to  acquire one of the strains and then not know/become symptomatic for the first time until years later?

Thanks again doc... Valuable information
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Edward W. Hook M.D.
75 months ago
1.  HIV has never been described to have been transmitted through cunnilingus.  Syphilis is transmitted through lesion contact. No lesion no need for screening. The primary infections which would be theoretically transmitted, albeit rarely, are gonorrhea and chlamydia

2.  This statement is unclear.  Are you asking if doxycycline can be used for treatment of STIs.  The answer is yes for several STIs (chlamydia and syphilis).  Doxycycline is not recommended for gonorrhea treatment.

3.  This is a "what if" question.  The scenario you describe is theoretically possible but not typical 
EWH
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