[Question #5544] MSM oral exposure

20 months ago
While on holiday in the Philippines (Cebu Island), during a night out I got involved in what could be a very risky exposure. After drinking a bit and on the way home a "girl" asked if I wanted to have some fun (I saw that person in the club during the night with other friends), which to I first said no and then yes. "She" didn't ask for any money at the beginning but after did - so that obviously tells me it is a sex worker.

exposure: oral sex (i received)

.It was VERY dark, so I couldn't inspect "her" mouth properly.  "she" did ask me if I wanted to have sex, to which I said no. 

After finishing, I asked about STDS and "she" said no, that got tested (I know what's your opinion about this but it didn't seem very reassuring from the way it was said). So the whole time I've been using "she", because at some point I tried to reach her genitals and "she" didn't let me, which makes me believe it was a ladyboy.
 From my research, syphilis is VERY rare in the Phillippines (seems like 1000 cases since 2011), on the other hand it is the SEA country with more HIV raising cases recently. From my knowledge, HIV testing and worry shouldn't be a case here (please confirm on this). Also from my knowledge, the only possible exposures would be bacterial infections (gono, ngu, syphilis, and skin infections like herpes/hpv)

. Also confirm this, please. It has been exactly 9 days after the encounter and I have had no discharge, no burning while peeing and no visible sores on my penis.

1 - I am in a heterosexual relationship, should I abstain from sex with my girlfriend?

2 - How concern should I be about syphilis?

3 - Should I go and test, or am I overreacting? If yes, for what?

20 months ago
Let me just add some other questions please:

4 - When I meant about abstaining from sex with my GF, I meant with condom. I won't have sex without it until I'm sure it is fine. I'm even thinking of no sort of oral sex. My main question with this is regarding syphilis as I'm not quite sure if I can pass anything without any visible sores AND wearing a condom.
 4.1 - Also, if wearing a condom I'm sure there's no risk for gono/NGU? Please, confirm.

5 - I didn't ask about probabilities, but if you could give me an insight on this, would be appreciated too. 
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
 Welcome to our forum and thanks for your questions. I'll be glad to answer them. Even if your partner was a transsexual woman your risk for acquisition of any STI from receipt of oral sex while wearing a condom is  vanishingly low.   As a generalization most commercial sex workers do not have STI's, when they do infection is ra rely present in the mouth, and transmission of oral infections during oral sex is exceedingly rare.   Further as you pointed out, the rate of HIV in particular is relatively low in the Philippines.    Finally, before I get to your specific questions, let me point out that precise estimates of STI transmission rates are not available. This is simply something that involves too many variables and is too difficult to measure to provide precise estimates. 

1.   Although you do not mention how long it has been since your exposure, if it has been more than five days, if a condom was worn for the entire exposure, and you have no symptoms I would not be concerned  and would not feel the need to abstain from sex with your girlfriend. 
2.   I would not be worried about syphilis. Acquisition of syphilis from receipt of oral sex is vanishingly rare. 
3.   If you have not been tested recently, testing is always a good idea although I see nothing about the exposure you describe that makes me feel that testing is urgently needed. With regard to testing, as it relates to this exposure, while testing for gonorrhea and chlamydia can be performed 3 to 5 days after exposure it would be too early to test for syphilis  unless 4 to 6 weeks had passed. 
4.   I believe these questions are answered above. I would not be worried. 
5.   Please see my earlier comment regarding the lack of precise numbers to calculate your risk for infection. 

 I hope this information is useful to you. If further clarification is needed please use your up to two follow up questions to seek clarification. Take care. EWH. 
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20 months ago
Hi again,

I never said I wore a condom, but I also never mentioned I didn't, so my bad. I didn't wear a condom during the reception of oral sex. Oral sex was performed without any condom. 

1.   Although you do not mention how long it has been since your exposure, if it has been more than five days, if a condom was worn for the entire exposure, and you have no symptoms I would not be concerned  and would not feel the need to abstain from sex with your girlfriend. 

 It has been exactly 9 days after the exposure and I haven't had any discharge, burning while peeing or sores (however I think this would be too soon for syphilis cankers to appear - therefore, my concern remains.

2.   I would not be worried about syphilis. Acquisition of syphilis from receipt of oral sex is vanishingly rare.
I read on other forum (medhelp, where included answers from you and Dr H) saying that it is possible between MSM to acquire syphilis this way. 

---- I will also add more questions, please answer them as I believe I won't be able for additional questions from now on.

6 - Is there any way to pass syphilis to my GF (in case I have it) without a visible canker on my penis? WHILE wearing a condom. 

7 - I will get tested next week for gono and chlamydia, however if I wear a condom, is there a possibility to pass these to my GF? (in case I have them)

8 - Regarding what you said to 1 and 2 questions, please be aware that the exposure was without condom. 

9 - I CLEARLY shouldn't even think about testing for HIV regarding this exposure, correct?

10 - Let me empathize that the person in question seemed more like a street sex worker than a escort or something similar. 

I appreciate your time and responses. 

20 months ago
I would also like to add this comment from Dr H, as a response to another user 24 days ago.

"Your two statements are accurate, except that there are syphilitic lesions other than chancre that are infectious. Such lesions (condylomata lata, mucous patches, and others) occur primarily during the secondary stage of syphilis, after resolution of primary syphilis (chancre) and can be subtle and hard to see. They can involve any anatomic site (genital, anal, ora). So syphilis is a risk with having sex with anybody with syphilis wthin a year or so of catching, with or without visible chancres."

regarding my concern of syphilis and consequently possibility of transmission to my GF - while wearing a condom. Thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Thanks for the clarification on the oral sex.  This is helpful.  Replies below:
1. If you had acquired gonorrhea or NGU you would most probably developed symptoms by this time.  Thus it becomes more unlikely that you acquired one of these STIs.  The average time to syphilitic chancre appearance is 21 days so if you were going to develop a chancre it would be early. That said, syphilis remains quite unlikely.
2.  Possible is not the same thing as likely.  It is also possible that you will be struck by lightening today.  I would estimate your risk of syphilis from receipt of oral sex as being about the same as your risk of being struck by lightening.  It is not something I would be worried about.
6.  Not realistically (see comment about lightening strikes above)
7.  Same reply as no. 6
8.  Thanks, I appreciate the correction and am glad I sought to verify.
9.  Correct- no need related to the exposure you describe
10.  Understood

the lesions mentioned by Dr. Handsfield refer to syphilis lesions during established infection which had proceeded beyond the primary stage.  They are not relevant for your current concerns.  it is far too early for you to have such lesions. 

Hope this helps, you have one additional follow-up.   EWH
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20 months ago
Thanks for your replies. So from what I can understand now is:

I shouldn't really be concerned about gono/ngu as I haven't developed any symptoms 9days past (almost 10) the exposure.
Syphilis is VERY unlikely and I shouldn't also be concerned about this. Therefore, really shouldn't be concerned about any STI (that we mentioned) regarding this exposure. 

However, and because it is better to be safe than sorry, I should maybe get tested for them at the correct timelines just for peace of mind, even if it isn't something I should be worried. 

1- Meanwhile, as because again it is better to be safe than sorry, I should wear condoms until I test while having sex with my regular partner - not because there's a risk, but because it is better to be safe?

2- There's absolutely NO RISK to pass any of these while wearing a condom, even if I would have acquired any of these mentioned? So can keep having sex, then get tested and move on. IF not, please tell me.

I don't mean to repeat questions, but only to make everything clear before I move on from this thread. Thank you for your time. 
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Your summary is correct.  I also agree with your "better safe than sorry" comment.  There really is little downside to getting tested and, in my experience, most folks feel better having assurances of the sort I just and confirmed with a reliable lab test/  In answer to your final three questions:
1.  Correct.
2.  In science there is no such thing as "no risk".  Having said that, with a condom worn throughout penetrative sex that doesn't break, there is no appreciable risk for transmitting infection in the unlikely event that you are infected.  See my "lightening strike" question/comment above.

I hope my comments and information have been helpful./  As you know, as per Forum Guidelines, now that I have provided three responses, this thread will be closed shortly without further responses.  Take care.  Please don't worry.  EWH
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