[Question #637] Oral Stds

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97 months ago
Hello Experts, 
I performed unprotected cunnilingus and analingus on a female prostitute (age 35) about 6 months ago.  Was having throat/sinus problems for a few months, so I saw an ENT.  I was referred to him by an ER physician. I went to the ER because I was having problems swallowing. The ENT checked my mouth, nose and throat. He found no problems. Prior to seeing the ENT, I was prescribed Omnicef (300mg twice a day)by the ER doctor.  When I saw the ENT, I was still taking the antibiotic.  I finished the antibiotic two days after I saw the ENT.  In total, I took the Omnicef for 3 weeks.  Two days after finishing the Omnicef I developed a sore throat. That was about four weeks ago. The sore throat switched between the left and right side of my throat for about two weeks. It went away, but my tongue remains sore and swollen in the back area of my mouth.  At first it was on both sides of my tongue. Now it is only on the right side. During the four week period I also developed what appeared to be pink eye in my right eye. It went away.  Two days ago my right nostril became very sore both on the outside and inside. Yesterday I popped what I think was a pimple in my nose. It released some pus and blood. Today, the inside of my nose feels a little sore and there is some scabbing. The outside remains sore. There was never any pimple on the outside of my nose.  I have been tested for HIV, syphilis, hepatitis and HSV2(all by blood). I was tested for gonorhea and clamydia by urine. All these test were negative. I was not tested for HSV1. I was wondering if I should be tested for HSV1 and possibly retested for HSV2?  Also, should I be orally swabbed for gonorreah and chlamydia? Right now the right side of my tongue is very sore. I can't see any lesions. I may make an appointment to see the ENT again. Since these symptoms arose after I last saw him. Thanks in advance.
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H. Hunter Handsfield, MD
97 months ago
Welcome to the forum. Thanks for your question.

You needn't worry about STDs. Your symptoms are not from any STD, and almost certainly not any other infection, acquired during the oral sex event described.

First, at any point in time, most sex workers don't have active STDs. Second, cunnilingus is low risk for all STD. In my 40 years in the STD business, I don't think I've ever had a patient who appeared to have acquired any STD by performing oral sex on a female partner. Same for analingus, which risks various gastrointestinal infections but not STDs. Third, the cefdinir (Omnicef) treatment would have prevented or treated two STDs of theoretical concern, gonorrhea and syphilis. Fourth, your symptoms are not suggestive of any known STD, including herpes. Finally, even non-STD infections don't fit this story. If I correctly understand the timing, all your current symptoms started far too late to be related to an event so long previously -- such as sore tongue and nostril, pimple in your nose, and pink eye.

To the specific questions you have asked:

HSV1 and/or repeat HSV2 testing:  Definitely not. HSV1 is rarely acquired from genital exposure; even genital to genital HSV1 transmission is rare. If you had a positive result, I would ascribe it to a distant past infection (since 50% of all adults in the US have positive tests), entirely unrelated to your exposure or symptoms. HSV2 is the only HSV type for which there could have been risk, and your symptoms don't fit and you've already been tested.

Gonorrhea/chlamydia testing: Urine testing was pointless, since only your mouth was exposed. (STDs don't travel through the body and genital/urine testing only detects infections acquired genitally.) Oral chlamydia is rare and has never been known to be acquired by cunnilingus. And as noted above, had you happened to have acuiried oral gonorrhea, it would have been cured by the antibiotic you took and there is no test for past gonorrhea.

So my advice is to move on with absolutely no concern about the exposure 6 months ago. If your symptoms cotninue to concern you, work with your doctors. But for sure they are unrelated to the sexual event you have described.

I hope this has helped. Let me know if anything isn't clear. Best wishes and stay safe.