[Question #6947] Protected Sex | Deep Kissing | STI Risk

10 months ago
Dear Doctor,

I am 45 years old male. I had protected vaginal sex twice  with  two different female sex workers almost 2.5 years back. It also involved deep kissing with both of them.
In one of the episodes she also had my testicles in her mouth.

I got the regular STI’s checks done multiple times after the window period including HIV, HSV 1and2, Chlamydia Trachomatis PCR , Neisseria Gonorrhoea  PCR,  , Hepatitis B and C, Syphilis/TPHA and all reports were negative.

Am I at risk of any other STI’s ? 
Especially reading about Oral ones , Oral HPV, Oral Gono?
 Also should one be worried about acquiring Herpes Viruses HHV4, HHV5 , HHV6-A &  HHV-6B, HHV7 and HHV8 by this route?
Also is it possible to have passed any of these viruses to my wife despite all tests as mentioned above coming negative?

Please confirm if I should be worried about any thing related to STI’s 

Thanks.

Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago

Welcome to our Forum and thanks for your questions.  I'll be glad to comment.  First several facts:

1.  Most commercial sex workers do not have STIs.

2.  Even when they do, most single unprotected exposures to persons with an STI do not lead to transmission of infection.

3.  Your exposures were condom protected. As long as they are worn throughout the exposure and do not break, condoms provide excellent protection against STIs.

4.  STIs are not transmitted by kissing with the exception of the small risk for oral herpes in persons who have not had the infection already (over 60% of adults have HSV-1, whether they know it or not).  Between your apparent lack of symptoms and negative tests, I would not worry about HSV-1.

Thus, realistically, the exposures you describe were low risk, apparently you have had no symptoms, and you have had negative tests.  I would not be worried in the least that you would have an STI or that you might have transmitted it to your wife.  Oral gonorrhea and HPV are acquired as the result  of performing oral sex on an infected partner, not from receiving it.  I would not worry about the other herpes viruses that you list- they are not STIs.

I hope this information is helpful.  Unless there is something you neglected to mention, I see no reason for concern about STI and no need for testing of any sort.  EWH

---
10 months ago
Thanks Doctor for your prompt reply.
Just to be reassured Deep kissing should not be be  a worry for  Oral HPV and Oral Gono right or for any other STI other than HSV 1? Also testicles in her mouth should not be a concern right? 
Also should one be worried about HPV even though i had protected sex and never had any symptoms.  

Other one , i missed that i also had a body massage where the massage girl rubbed her vaginal area briefly over my penis area ( i was not wearing a condom).  This was 1 years back and i never had  any symptoms There was no insertion.  She also for few seconds licked   my nipples with her tongue.  Should i be worried about this exposure.  After this episode I had all the test mentioned in my last post and results are negative. 
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago

Correct, no risk of oral gonorrhea or HPV from deep kissing.  Same for her placing your testicles in her mouth-still no risk.

Similarly, having your masseuse rub her uncovered vaginal over you during a massage is a no risk event.  No penetration, no risk.


I see no need for testing or concern. EWH

---
10 months ago
Thanks Doctor:
Few further clarification pls:
1) Though i had protected sex, should i be worried about HPV. I was never vaccinated and am 45+ now. i read almost all HPV infections resolve on their own and one should not be worried. I never had any symptoms.
2) Regarding the Herpes Virus family  HHV3 to HHV8 which are primarily transmitted by Saliva/Kissing.  Why are they not considered as STIs . Is it that these being mostly childhood disease are already prevalent in population? Should one be concerned about acquiring it sexually and its consequences?
3) The masseuse licking my nipples should not be a concern right?

thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago
Your questions suggest that you have been on the internet.  On This forum we spend much of a time trying to correct misinformation that is all to present on the Internet.

1.  Concerns about HPV infections are non-productive. As I suspect you know, most unvaccinated sexually active adults have acquired HPV. Most of those infections have or will resolve without consequence. Once they have resolved, there is at least a partial immunity to subsequent infections. Finally, Most single Unprotected exposures to HPV do not appear to lead to infection and condoms for reduce even that relatively low risk. Should you have gotten HPV, there would be nothing to do. I would not worry.

2.  These other herpesviruses are not considered important sexually transmitted infections. There is no clear-cut morbidity 40 deaths associated with them. Once again I would urge you not to be concerned.

3.  STIs not transmitted through kissing or licking a persons nipples. I would not worry.

I hope my responses have been helpful to you. Your description indicates that the event you described happened some time ago. Further, you were subsequently extensively tested and those tests were negative.  I’m not precisely sure why they are of concern now but in the absence of signs, symptoms, and given the very low risk nature of your exposure I would urge you to not be concerned. I hope that my responses will help you to move on. As perform guidelines, with this third reply, this thread will be closed shortly without for the replies. Take care. EWH
---