[Question #8109] MSM Oral sex

48 months ago

Hi doctors,

Yesterday night I received oral sex from another male for around 5 minutes.

I asked about his STD status and claimed to be all negative, I however know it is not common to get throat swabs as part of regular STD checks unless explicitly asked for one.

I also have a stable relationship with a woman and this was a one off experience, I am tested for HIV, chlamydia and gonorrhea, and have no reason to think I have any other STI like syphilis.

During this encounter I had no contact at all with his genitals or fluids (aside from saliva and any other fluid in his mouth).

I am really scared I can get some STI and pass it down to my regular partner.

What is my HIV risk, should I seek PEP? What about G/C, should I test for them and when would results be conclusive? What about syphilis, is tenting needed or only if I develop any symptoms? If so, when can I expect them to show up or to get tested? I would think herpes is only needed with symptoms (I know I have oral herpes, so I will tests positive for HSV 1 or 2 anyways)

Thanks

Edward W. Hook M.D.

48 months ago

Welcome to our forum and thanks for your questions. The encounter you describe was low risk for acquisition of STI’s including, HIV.

Let’s start with your concerns about HIV. This was a no risk event. It is statistically unlikely that your partner had HIV and much more importantly, there has never been a case of HIV proven to have been acquired from receipt of oral sex. You are not going to be the first. You absolutely do not need to receive PEP. Please do not worry about HIV related to this encounter.

Your risk for acquiring other STI’s is low, but not zero. By far, the STI most often acquired from receipt of oral sex is gonorrhea. This is relatively uncommon and when it occurs persons develop signs of urethritis (burning on urination and a visible penile discharge) within 3 to 4 days of their exposure. If you are concerned and feel the need for testing, test results will be conclusive for specimens and paint more than 3 to 4 days following exposure.

Syphilis is virtually never required from receipt of oral sex from opposite sex partners. Very rarely Syphilis is acquired through receive oral sex amongst men who have sex with men but this is as I said above, even this is quite unusual.

Finally, if you have not had cold sores or HSV-1 infection already, there is a low risk of acquiring genital HSV-1 from the exposure you describe. If you do not develop lesions within 7 to 10 days following exposure I would not be worried about herpes at all and would not encourage testing.

Thus, to summarize, this was a low risk exposure. Personally I would not be worried about development of STI’s and would not seek testing unless you develop signs or symptoms of infection. Take care. EWH.

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47 months ago

Hi doctor,

Following up 23 days later.

I have not developed any sign of urethritis (I sometimes think it stings a bit, but I am certain this is me just paying closer attention).

12 days after encounter, I however, noticed a small crust right in between the belly button and my pubes, a little to the right side. I would say it is where skin gets folded right at the bottom of the belly (right around where a belt would sit). I should say it looked to me as any other regular pimple or ingrown.

I removed the scab and I just had a small reddish coloration on the skin, not raised (again, just like when someone takes out any other pimple).

Regarding syphilis:

* I am 100 confident there was no contact on the area: As I said, there was no body contact other than oral, and the zone is far away from the contact area that I am certain nothing came close to it ( a few inches far, at least).

* Reddish area is really small (thing 2/3 pores wide) and right in the center I can see a small black "hole", just as if it were an empty pore.

* Skin is not raised (crust was a little bit, but after removing it is all flat), does not look like a chancre (although I know internet pictures are not reliable), not hard or raised borders.

* Timeline (12 days) seems a little bit early?

* No other symptom at all.

Does this sound concerning to you? If this were syphilis at all, would I get a positive test (11 days after finding it)?

Edward W. Hook M.D.

47 months ago

Nothing you describe raises concerns about an STI from the exposure you describe. I would not worry. EWH ---

47 months ago

Hi doctor,

Follow up questions here, I would love your input here given new details:

* Tested day 29 for Gonorrhea, Clamhydia and Syphilis (RPR) all negative, RPR was non - reactive.

* Today, day 35, I noticed a whitehead right in the middle of the shaft of my penis, no public hair grows in the area. I am pretty sure it was a white head: I felt a small bump under the skin, surface was white, and when pressed the white material left the skin completely into my finger, looked more like cebum/fat than pus (white and solid). After the fact, skin looks intact (aside from some little damage when pressing), bump cannot be fell, skin is a bit swollen, but appearance is normal.

* Does that sound like a chance or any other STD?

* Can I treat my week 4 test as conclussive?

* I should say, 4 days ago I engaded in mutual masturbatation with another male, but there was no contact aside from hand to penis (both sides) but no lesions were present on his penis, and more importantly, showed me neg labs for everything from a couple weeks ago. I am not worried about this encounter as I know risk is minimal, but just to not be concerned, if the lesion above mentioned was an sti, would 3-4 days be too soon to develop?

* Should I retest?

Edward W. Hook M.D.

47 months ago

Your tests for Gonorrhea and chlamydia are now conclusive. No need for further testing. Syphilis tests at 29 days are almost conclusive although if you’d had a know exposure, we might suggest repeat testosterone six weeks. Given that your only exposure was receipt of oral sex and the absence of symptoms (the white lesion you describe sounds nothing like Syphilis or any other STI. It is likely a cyst or possibly molluscum contagiosum. If it does not return I would not worry. If it returns, I would not squeeze it but have it looked at by a trained clinician. Participation in mutual masturbation is a no risk event for STI acquisition.

We provide up to three responses to each client’s questions. This is my 3rd and completes the thread. Please don’t worry. EWH

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