[Question #5521] Outercourse, Oral Sex, and STI risks (MSM)

22 months ago
Good afternoon,

I had a couple questions about testing and risk related to a recent exposure.  A little over a month ago, I met a guy in a gay bar in NY and had a sexual encounter with him.  The encounter involved about a minute or two of insertive oral sex, mutual masturbation with hands and a fleshlight, and 3 rounds of very vigorous outercourse/frottage, with him rubbing his penis against my anus, perineal area, and thighs.  I dont think there was any penetration, though he may have had the tip near or barely inside my anus.  

In terms of symptoms, I had some very slight itching around the anus about 5 days after, though I have not noticed any blisters, chancres, or rashes in that area, and once I showered, the itching dissipated (I assume unrelated).

As a follow up, I went for testing, which coincided with my annual routine testing. It went as follows:
6 days post exposure - urine test for all bacterial STDs, rectal swabs for gonorrhea/chlamydia
14 days post exposure - rectal swabs for gonorrhea/chlamydia, throat swab for gonorrhea
31 days post exposure - urine test for gonorrhea/chlamydia, RPR for syphillis, HIV 1 RNA, HIV Ag/Ab with reflex

Questions:
All tests were negative/non-detected.  At this point, should I move on and resume unprotected sex with my partner?  I have abstained since the encounter.  Did I miss anything that I should test or re-test for?  

More specifically, I am concerned about syphilis and herpes.  My last HSV1/2 test a year ago was negative.  In the absence of symptoms, I know the CDC and ASHA advise against testing, due to the imperfect nature of the tests.  Given the absence of symptoms, I have not tested.  With syphilis, do I need to repeat the test, if a chancre hasn't appeared by day 31?  And, given the encounter, where would one likely occur?
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
Welcome to our Forum and thanks for your questions.  Let me start by congratulating you on your practice periodic screening following potential STD exposure- it will help keep you healthy.  In addition, it is my pleasure to tell you that your test results absolutely prove that you did not get gonorrhea (penile urethra, rectum, throat), chlamydia (urethra, rectm), syphilis, or HIV.  You are in the clear and there is no need for further testing, nor is there any reason related to the events you describe to abstain from unprotected sexual contact with your regular partner.

Also, just for informational purposes, let me assure you that frottage/outercourse without penetration is safe sex with no risk for infection, as is mutual masturbation.  With oral sex there is a modest risk for infection, if he were infected.

I hope this information is helpful to you.  I believe that I have addressed your questions but if I missed anything, please do not hesitate to use your up to two follow-up questions to seek clarification.  EWH
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22 months ago
Thanks Dr. Hook.  I really appreciate the information - the negative results and your professional reassurance have done much to put my mind at ease.  I was initially a little worried because of the potential of a false negative for the syphilis test, but I think at 31 days it should be reliable.  (Please let me know if you disagree)

On another note, my doctor recommended that I get the HPV vaccine (to my knowledge, I haven't had genital warts, but most likely have been exposed to the virus).  I am within the FDA age guidelines, but am worried about vaccine safety.  I am not an anti-vaxxer by any means, but am a garden-variety skeptic.  Further, several years ago, I had a neurological condition that was controlled with medication.  I'm off the meds now and have not had an episode in years; my concern is that I could have a relapse if I get the vaccine (I have heard of isolated cases of neurological disturbances after the vaccine is given) .  Likely, this fear is unfounded, and the millions of doses given without incident would confirm this, but I would love to get your opinion.   
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
Correct, your syphilis results at 31 days should be reliable (BTW, your risk for syphilis is lower than for more common STIs such as gonorrhea and chlamydia).

If you can get the HPV vaccine, I would urge you to get it. The vaccine has a terrific track record both in terms in minimal toxicity and in terms of providing >99% protection from the viruses contained in it.  I agree with your doctor.  EWH
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