[Question #6236] Risk assessment gay sex club

15 months ago

After some drinks, I visited a gay sex club in San Francisco—not the “safest” of places. There was a lot casual toing and froing between partners. I had intended to “keep myself to myself” but this didn’t totally workout, and now I am worried about risks, specifically:

1. 1. At two points people inserted my penis in their mouth for oral sex—as soon as I was aware that this was happening (probably a few seconds on each occasion), I stopped any more “action.” These people had been "doing the rounds."

2. 2. At one point, a guy who had been deep kissing another guy, forced his tongue in my mouth (French kissing)—I pushed him away but not before he had deep kissed me for a few seconds.

3. 3. I performed fairly light frottage, rubbing my penis (head and shaft) against two others at the same time, for a minute perhaps.

I’m concerned about oral infections as well as genital (HPV, HSV, gonnorhea, syphilis etc).

Thank you.

H. Hunter Handsfield, MD

15 months ago

Welcome to the forum. Thanks for your confidence in our services.

You are at little risk if any risk for STDs.

1) Oral sex is not completely safe, but the risks are much lower than for unprotected vaginal or anal sex. And with such brief contact, probably truly zero risk for all practical purposes. With more prolonged exposure, the main risks are for gonorrhea, herpes due to HSV1 (the usual cause of oral herpes), syphilis, and nongonococcal urethritis (NGU). But even for these, the risk is very low, probaby under one chance in a thousand, on average -- and that's for more typical (several minutes) exposure. The risk is zero or virtually zero for all others, including chlamydia and HIV. (There has never been a scientifcally proved case of either of these acquired from mouth to penis.) HPV is a bit uncertain: oral HPV is a lot less frequent than genital or anal infection, hence low risk for oral sex. However, on rare occasions, we see STD clinic patients whose genital warts likely were acquired by oral sex. But here too, I would guess the risk for any one exposure at under 1 chance in a thousand.

2) Kissing is risk free for STD -- not counting oral herpes, which isn't considered an STD. The main risk from kissing is for common colds, influenza, etc. Syphilis in theory could be transmitted, but this is exceedingly rare; in my 40 years in the STD business, I've never seen a case of syphllis from kissing. There is a current controversy among experts about the possibility of gonorrhea transmission by kissing, but suffice to say that most experts do not believe this is a serious consideration.

3) Frottage and genital-genital contact, without penetration, are risk free or at least very low risk.

Should you be tested? This is a judgment call. Assuming no symptoms, from a strictly medical and risk perspective, there is no need. However, not all infections cause symptoms, or do so only after 3-4 weeks or more. And testing may have reassurance value, beyond anything I can say. If you're going to stay awake nights worrrying, testing can help clear the air. If you decide to be tested, it's best to get expert care in person, and the San Francisco public health STD clinic is superb. (f you go there, give my greetings, especially if you happen to get seen by the clinic director, who is a friend and colleague.) They almost certainly will agree with me that testing is optional, but if done for reassurance, expect a urethral swab or urine for gonorrhea and chlamydia (valid any time more than 3-4 days after exposure); maybe a throat swab for gonorrhea and chlamydia (perhaps depending on your desires and maybe their perspectives on gonorrhea and kissing); and advice to return after ~6 weeks for HIV and syphilis blood tests.

In the meantime, stay mellow. It is very unlikely you caught any STD. I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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14 months ago

Hi Dr Handsfield,

I really appreciate your in-depth reply. It’s 3 weeks on from the event (gay sex club: extremely brief receipt of oral twice, twice; brief frottage; very brief deep kissing) and I have some follow-up information and questions.

1. Gonnorhea and chlamydia tests (oral and urine) were negative

2. I presume, realistically speaking, given the brevity of the encounters, that I can assume I am out of the woods as concerns HSV with no symptoms?

3. For 2 weeks or so, I have had balanitis. I will likely seek a consultant but since I will have to wait until Thanksgiving is over I would appreciate your advice.

My limited understanding is that balanitis could be fungal (I take low dose budesonide for colitis—not sure if this makes me more susceptible), it could be seborrheic dermatitis, or, I wonder, if there could have been some germ passed on?

The symptoms: blotchy redness on glans and pulled-back foreskin; tends to come and go (clears for a while after a bath, for example), no bumps, no discharge or whiteness, no itching, just patchy red. My question: is it okay to use a shampoo containing ketoconazole? Could I use an OTC antifungal or hydrocortisone?

I’ve had balanitis before—I think I use an antifungal but can’t really remember.

Many thanks again for your amazing service.

H. Hunter Handsfield, MD

14 months ago

1. Glad to hear of your negative test results, but of course not surprised.

2. This was a low risk event in regard to HSV, and the lack of symptoms also is evidence you were not infected. This isn't a lock -- in theory, there is a small risk you could have acquired HSV1. But the chance is low enough that you can consider it zero for all practical purposes.

3. No STDs cause balanitis. Most cases are either fungal, as you seem to know, or "nonspecific", perhaps related to hygiene. Beyond that, I have no advice; since it's not an STD, it's beyond the scope of this forum. Follow your doctor's advice.

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