[Question #6085] Unprotected Oral Sex with a Tran sexual Sex Worker

16 months ago
To Whom it May Concern, 

I was in Miami for a week. Unfortunately, last night I made the mistake of visiting a transexual sex worker that I found online. I was intoxicated, so when I got to her place, I did not saw any lesions on her mouth. I only asked her to give me oral sex which she did unprotected. I came in her mouth and left. That's the only sexual exposure I had and it lasted maybe 5 to 10 minutes. My question is, what is the risk of my exposure. I do have Oral Herpes which I am not worried about that, but what about HSV 2, Syphilis, HIV or ther STI's? 

Thank you for your time, 

 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Welcome back to the forum.

Receiving fellatio (oral-penile sex) is low risk for all STDs and vritiually zero for some, especially for the penile partner. The chance of catching anything from any one exposure always is low, although not zero. Assuming your TS partner is pre-surgical (i.e. anatomically male) and frequently has sex with other me, it's a good bet she is at quite high risk and could well have oral gonorrhea or other STDs transmissible to your penis. Gonorrhea, nongonococcal urethritis (NGU), and genital herpes due to HSV1 are by far the most frequent STDs experienced by men in your situation (but not HSV1 in your case, since your prior infection makes you immune to new HSV1 infection). There is slight risk for syphilis as well. I wouldn't worry about any other infections. There has never been a proved case of HIV transmission oral to penis, and even among persons with HSV2, active oral infection is rare and I've never seen anyone with genital HSV2 from receiving oral sex.

What to do now? If no symptoms (urethral discharge, painful urination, or penile sore or blisters) after about 10 days, you can be very confident you weren't infected with anything. That said, the only 100% proof requires testing, because of rare asymptomatic infections. If you decide to be tested, I would suggest a urine test for gonorrhea and chlamydia, valid any time more than 4-5 days after exposure; and maybe a syphilis blood test at 6 weeks.

Chlamydia is extremely rare in this situation, if it happens at all, but chlamydia testing usually is automatic along with gonorrhea testing. Similarly, if you acquired syphilis, almost certainly you would develop a chancre -- syphilitic sore -- on your penis withint 2-3 weeks, so its absence will be reassuring. But still testing is rquired for 100% certainty.

HIV test? From a medical/risk standpoing, there is no need. But many people in your situation would be further reassured by a negative blood test, so you might consider it, especially if you haven't been tested for HIV in the last year or two. If so, have an antigen-antibody (AgAb, "duo", "4th generation") HIV blood test 6 or more weeks after the event.

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

HHH, MD
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16 months ago
Dr Hunter, 

Thank you for your reply. I would follow your suggestions and I will schedule gonorrhea and Chlamydia test for this Friday and then test for Syphilis and HIV at 6 weeks after exposure just for peace of mind. I know you mention that HSV 2 is very rare from receiving oral sex, should I take an HSV2 test or just forget about that? 

Thanks,  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Thanks for the thanks; I’m glad to have helped. 

Do not get tested for HSV2. The blood test isn’t perfect, and the possibility of a misleading result is more likely than the chance you were infected.
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