Dear Drs Hook & Handsfield

30 days ago I received oral sex from a TS escort

I have had no symptoms at all apart from the occasional sting when I urinate (though I think this may be normal and exaggerated due to my concerns).

 I undertook an STD panel at exactly 28 days.

Everything was negative (HIV, Syphilis, Gonorrhoea, Chlamydia).

I have a couple of questions however:

I have been having unprotected intercourse with my girlfriend and I am worried I passed on something to her in the interim, which was not picked up by the urine tests if they were too late..

Thank you for the great forum.

Oral sex is low risk for all STDs and virtually zero risk for some of them, including HIV. There has never been a scientifically proved case of HIV transmitted oral to penis, and only a few penis to oral. Also few or no cases of chlamydia transmitted oral to genital, and gonorrhea transmission is fairly uncommon. Syphilis is the main concern in situations like yours:  not all that common after a single oral sex exposure, but dangerous if not diagnosed.

Assuming your test panel included a urine test for gonorrhea and chlamydia, those results are conclusive any time more than a few days after exposure. (You are mis-remembering or misunderstood me about 4 weeks for G&C testing:  5 days is plenty.) Conceivably you were infected and the infection was cleared before you were tested, but that's quite unlikely; usually it takes a few weeks to a few months for spontaneous cure. However, you are correct that your syphilis and HIV blood tests were a bit early. The usual HIV blood tests detect over 95% of infections at 4 weeks, syphilis probably 80%. Six weeks is 100% for HIV, and detects almost all syphilis -- but some experts indeed recommend 3 months to be absolutely certain, so the local clinic policy is not unreasonable.

It is exceedingly unlikely you infected your regular partner. The risk of all these infections was very low; the absence of symptoms is further security against gonorrhea, chlamydia, and syphilis; and you've had those negative test results. I really wouldn't be worried at all at this point.

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

HHH, MD

1) in regards to gonorrhoea and Chlamydia, is there any data/anecdotal evidence on how often the 28 day test is negative after someone has caught infection? 

In most cases, would you take these negative results at face value and rule them out? 

2) in the worst case scenario that I did infect my gf, would I be re-infected via vaginal sex?

 I have had sex with her regularly, so would a further negative test  be further proof that I wasn't infected?

3) from what I read on here, gonorrhoea most likely would produce symptoms and not be asymptomatic in men, is this accurate

4) if I wear a condom for oral sex in the future, I presume none of the above will be a risk anymore - is this because the tip of the penis is where the danger is generally?

5) lastly, considering it's very unlikely I caught anything based on results, do you reckon I should hold out on sex until a last round of tests at 6 weeks (to cover all mentioned STDS and rule out genital reinfection)?

Than you sir

You're really over-thinking all this and splitting hairs in terms of the statistical odds. Just accept your test results and let it go!

1) No good data exist; I have heard estimates suggesting ~20% of infected people may have spontaneous cure by 4 weeks. But since there was little chance you were infected in the first place I think you can safely ignore this possibility.

2) Yes, if your partner became infected, you could be reinfected yourself.

3) Correct. Asymptomatic urethral gonorrhea in males is very rare.

4). Yes, condoms are highly effective against urethral infection, for the reason you say.

5) If I had somehow been in your situation, I would never have stopped having sex with my wife, even before being tested. Oral sex just isn't a sufficiently high risk. And certainly you should not keep holding off and should not be tested yet again.

Last question - so if I notice any discharge or pain or weirdness from my wife (which worried fellows like myself usually are usually hypervigilant for), I can safely assume it's nothing to do with this exposure?

Thank you again

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Thanks again for your kind words about our services.