On June 4, I met with a transexual CSW while traveling on business. I gave her unprotected oral and then I was the receptive partner in protected anal.  The condom did not break.  Before we started, I asked her health status and she told me that she tested negative for all standard STIs including HIV on May 6 and even showed me a screen shot of her results on her phone.  She informed me that she was on PrEP and had to get tested every 3 months to get her pills.

From reviewing the information on this site, I am clear that there was no risk of HIV from the protected anal and that giving unprotected oral was extremely low HIV risk (1 in 10,000 at the most--even less assuming she is on PrEP).  I guess I am most concerned about oral gonorrhea, herpes and syphilis.  I didn't notice any sores or rashes on her penis, but the lights were dimmed before we started fooling around so it is possible that I might have missed something.

What are my risks here?  It has been 11 days, and I haven't had any blisters that look like herpes and no sores in my mouth that might be syphilis.  How early would I see symptoms for these STIs?  I just want to be sure I'm not passing anything to my female partner. Could I pass anything to her by kissing?  Should I hold off on having sex with her until I have clear test results, or is the risk her so low that I shouldn't be concern?

Thanks for your advice.

I agree that your risk for acquisition of HIV from performance of fellatio and your partner is virtually zero. Regarding other STI’s, most persons are not infected, however the occurrence of other STI’s, and in particular gonorrhea and chlamydia, is relatively high among percent on PrEP.  If your only unprotected exposure was fellatio on your partner, your major risk is for acquisition of the pharyngeal gonorrhea.  On one hand because your partner was asymptomatic it is unlikely that she was infected (over 90% of gonococcal urethritis is obviously symptomatic). On the other hand about 10% of persons with gonococcal urethritis are asymptomatic. Thus there is a low risk that you acquired oral pharyngeal gonorrhea, an infection which most often is asymptomatic.  From a statistical perspective, I believe it is quite unlikely that you acquired any STI from the exposure you describe. On the other hand if you are at all concerned, the only testing I would recommend is a throat swab testing for Gonorrhea. (For reasons that are unclear chlamydial infections of the throat are very rare making chlamydial infection as a result of your encounter very low).

I hope this information is helpful to you. Testing is a personal choice and reflects your own degree of concern. It is substantially more likely than not that you did not acquire pharyngeal Gonorrhea or any other STI from the exposure you described. Risk however is not zero and if you wish to completely illuminate that possibility, testing is the way to go. EWH 

In addition, I would not hesitate about having unprotected sex with your wife. Were you to have aquired gonorrhea or syphilis I would not expect your wife to be at risk from kissing oral sex. EWH

If it is, can I transfer it to my wife or other family members by:

Were the Syphilis however, Syphilis is transmitted through direct contact with infectious lesions. Thus kissing, sharing of eating utensils or glasses and other forms of casual contact would not put those who shared utensils or kissed at risk for Syphilis.

If the lesion on your gum is due to syphilis (I am confident it is not) then a blood test for syphilis would be positive at this time. 

I hope the information I provided has been useful to you. As you note this will conclude this thread which will be close shortly without for the replies. Take care. Please don’t worry. EWH