[Question #6835] Worried

10 months ago
Hi,

I had a lapse in judgment and I saw a sex worker in the DFW area yesterday 4/9/20, I had unprotected oral sex with her and that was it. This was a one time occurrence and I've been with no one else but my wife and she is disease free. She used a combination of hands and mouth and it took maybe 15mins. I washed off immediately afterwards with soap. 

I have a lot to lose with my wife and I'm afraid of my chances of an std primarily herpes. I never had a cold sore. I've had sores in my mouth but never one on the exterior of my lips so I'm very concerned about catching any kind of herpes. I'm also very concerned about other STDs but the HSV1 and 2 have me nervous. Also, right before the session I used a foil shaver to trim around the base of my penis and I'm afraid that may have opened up an opportunity for infection. It was a close shave but I didn't get any nicks because it was a foil but read somewhere that a too close a shave can have std consequences. 

Help me please. I'm afraid I caught every std know to man right now. Help help help

My world is falling apart. 


10 months ago
Sorry for this reply, I've read the other posts and I thought I saw conflicting advice in regard to HSV1 in that it sounds like its low risk from one doctor but highly infectious from another doctor even if the provider had no symptoms. I don't want to end up with sores on my genitals from this one time. I have no idea how many guys this provider has seen but she's been around for 10 years. My mind is everywhere...
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
10 months ago
Welcome to the forum. Thanks for your confidence in our services.

From your description, I gather the oral exposure was one way, i.e. her on you -- you didn't perform oral on her. The rest of this reply assumes that. (It wouldn;t make much difference:  fellatio oral to penis -- getting a BJ -- is low risk for all STDs, details to follow. Cunnilingus is even lower risk.)

First, having decided to have a sex worker adventure, congratulations for doing it safely! Oral sex can be viewed as safe sex -- not totally risk free, but a lot lower chance of infection than from unprotected vaginal or anal sex, with low risk for all STDs and virtually zero for some, including HIV. The highest risk, although still low, is gonorrhea, which is common in the throat of infected people and readily transmitted by oral sex. Nongonococcal urethritis (NGU) can occur, often believed to be from normal oral bacteria, probably not harmful in the long run and causing no known problem in affected men's sex partners. Syphilis is theoretically possible, but is so rare currently in heterosexuals -- including sex workers -- that it's very unlikely.

As for herpes, you can entirely dismiss HSV2, which is rare in the oral cavity; almost all herpes from oral sex is HSV1, the cause of oral herpes. The chance from any single exposure is probably under 1 in several thousand. (The first doctor you quote is right; the second is not.) Shaving the pubic area prior to sex is not known to increase the risk of herpes or any other STD; that issue is irrelevant. In addition, half of all adults in the US have had HSV1, usually in childhood, and most have no recognized oral herpes themselves. That means there's a 50% chance you're immune to a new HSV1 infection.

What to do now for reassurance? When at least 3 days have passed, you can have a valid urine test for gonorrhea and chlamydia. (Chlamydia is rare from oral sex, but testing is automatic along with gonorrhea testing.) Second, be on the lookout for symptoms. If in the next 10 days you do not develop abnormal discharge from the penis, painful urination, or penile blisters or sores, you can be quite confident you didn't catch herpes or NGU. Finally, have blood tests for syphilis and HIV 6 weeks after the event -- mostly for reassurance since the risks are so low, but both pretty much automatic in anyone being evaluated for STDs. Testing for HSV is not recommended after such an exposure, in absence of symptoms. The blood tests are too often unreliable and misleading.

When to resume sex with your wife? If I were in your shoes, I would do so as soon as I learned the negative results of gonorrhea/chlamydia testing. The risk that anything else will show up is too low, and I certainly would not recommend holding off for a full 6 weeks. Nobody can guarantee you're home free before those test results, but the chance of either one is in the lightning strike range.

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

HHH, MD
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10 months ago
Dr. Handsfield,

I have a hard time understanding what part of what I did was safe? Perhaps you can elaborate on this? Does washing after help? About 40mins after, I went home and also used Hibiclense.

Also, I was hoping to understand the chances of infection not relative to unprotected vaginal or anal sex. For the listed STDs does "low" mean 1 out of 100, 1000, etc. if she was infected with any of the listed STDs?

I'm hoping to get a better perspective on how little I should really be worried. I really can't bare it if I give my wife anything. I'd lose my family and rightfully so. I didn't understand the risks going into it but now I do and never again.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
10 months ago
Your emotions are interfering with your objectivity. My comments are very clear that your exposure was safe in not having unprotected vaginal or anal sex but only oral, which is nearly risk free.

Washing soon after the exposure might have reduced the already low infection risk; it's common sense, although there are no data to prove it one way or the other. I would guesstimate that the overall risk of you catching any STD at under 1 in a thousand. Those odds get increasingly better as you pursue the testing strategy described with negative results. But you're the only one who can decide what level of risk you're willing to take of infecting your wife at each stage. I've told you what I would do personally if I were in your situation.
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