[Question #5985] Possible Risk

20 months ago
Hi, Last week I visited an Asian massage parlor.  I received protected oral sex and protected vaginal sex with a condom.  She put it on and took it off but I think it stayed in tact but I do not know for sure.  I am guessing she knows what she is doing,.  She also performed a rim job and licked my testicles which obviously was not condom protected.  I have been very anxious the last week and seeking a risk assessment.  I am guessing the risk for HIV is quite low.  I am concerned also about hep b and syphillis.  My significant other has MS and if she would get HEP B it would cause serious damage to her because of her medication.  She is also pregnant.  I do not want to infect her or a baby with syphillis. I read that half of American infections are from people from Asian countries and it was an Asian massage parlor.  I also had strep throat two days later and was prescribed amoxicillin .875 twice a day for 10 days.  Will this mask the results of a syphillis test or possibly cure an infection.  Very stressed out and have lost 5 pounds in the last week.  

Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

Even without a condom, oral sex is safe sex in regard to HIV. There has never been a proved case of HIV acquired by oral to genital exposure. With a condom, there is absolutely no risk. These infections cannot be transmitted by mouth to skin contact. And it also is statistically unlikely your sex worker partner has HIV; the large majority do not. Hepatitis B virus and syphils are almost as low risk as HIV in this situation. It is true that the overall chance of HBV was once far higher in Asia than in North America, but that's now not so common; the large majority of Asians are now vaccinated and immune. (And assuming you're in say your 20s, probably you were vaccinated against HBV as well; it has been one of the routine childhood vaccines in the US and other industrialized countries for 10-20 years.)

In the very unlikely possibility you were exposed to syphilis, the amoxicillin would have aborted that infection, so it is totally impossible you have (or had) syphilis that could be transmitted to your wife. In other words, it would cure but not mask the infection.

If I were in your situation, I would not be tested for anything and I would continue unprotected sex with my wife, regardless of her pregnancy, MS, or whatever medications she is taking. I reallly don't see any need for worry here.

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

HHH, MD
---
20 months ago
Hi Dr. Handsfield, thankyou for the quick reply.  I am in my 40's so I was not given the vaccine for Hep B.  The Massage lady was around 40 as well.  I am just being cautious because I do not want to spread it to my significant other in case I did get it.  I have seen mixed answers from ASHA on the use of amoxicillin for syphilis.  Like I said I started a ten day regimine 2 days after the event.  .875 twice a day for ten days.  Is this enough that I do not need to test for sure?  Is this what they would have prescribed anyway if I had it?  I was also nervous because I read that Hep B is so much more contagious than HIV.  It seems you are not concerned but that may be because you thought we were vaccinated.  Will the Amoxicillin hinder any tests for other STD's that I take.  I am guessing the Early Det RNA test would be fine since it tests for the virus.  Would the medicine extend the window period for any other tests.

I really appreciate you answers in helping me seperate science from anxiety.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Amoxicillin works well for syphilis -- the only reason it isn't a routine recommendation is that experts don't like relying on patient compliance, i.e remembering to take the drug 2-4 times a day for 10 days or more. When taken in the dose you received, it absolutely would cure or abort syphilis. (Based on the dose, I'm pretty sure you're actually taking amoxicicllin with clavulanic acid, trade name Augmentin. But that makes no difference.) It is true that HBV is more easily transmitted by blood exposure or intercourse than HIV -- but not by oral sex, especially condom protected. In my 40 years in the STD business, I have seen no patients with new HBV after an oral sex exposure. If it occurs, it is exceedingly rare.

There are no other STDs you could have caught. This was a zero risk exposure for all practical purposes. Believe it! Don't confuse anxiety and fear from a sexual decision you regret with infection risk from that decision. They aren't the same.
---
20 months ago
Thanks again Dr. - The paperwork on the presicription says Amoxicillin 875MG tablets.  Take one tablet twice a day for 10 days.  I have not missed any dosages.  It does not say anything about Augmentin.  You said this does not make a difference?  Finally, would the medication extend a window period for hep b test or HIV RNA test?  Is 14 days good for the HIV Eearly detection test through stdcheck.com?  This is more for my anxiety as I respect your wisdom. Also - not sure if you skipped over the part on protected vaginal sex.  She was on top of me for this for about five minutes.  I did not take the condom off - she did - so I do not know if it broke but that seems unlikely - most likely I would have noticed.  I also think she probably knows what she is doing in putting it on correctly.

Thanks - best 25 dollars I have ever spent.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
No, makes no difference. Amox is usually given 500 mg or 1 g; amox/clav usually 875 mg. But undoubtedly the Rx label is correct -- but it doesn't matter one way or the other. And no, no antibiotic can have any effect on any viral infection or testing for it. 

Thanks for the thanks; I'm glad to have helped. That concludes this thread (two follow-up questions and replies). Best wishes and stay safe.
---