[Question #812] Unprotected fellatio

51 months ago
05.27.16 received unprotected fellatio from a CSW. Next morning took 500mg of cipro, 1 gm of azithromycin & 2gm of flagyl as prophylaxis. Should I get ceftriaxone IM today (05.30.16)? If so, should I re-take azithromycin @ the same time? What other precautions should I take not to spread dz to my wife? (virgin before we married). Also I had what appeared to be gross hematuria the same night I took the abx - could that have been from the abx?  (known kidney stone, no pain)
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
Welcome to the forum. Thanks for your question.

You have overreacted to this exposure. Oral sex is safe sex -- not completely free of STD risk, but far lower chance than vaginal or anal sex, with low risk for all STDs and zero risk for som,e. The large majority of sex workers have no oral STDs, and when they do, they are difficult to transmit. I would have recommended against any antibiotics, and that you continue unprotected sex with your wife. At a personal level, that's what I would do if somehow I were in your situation.

There is no STD that would cause painless hematuria, which almost certainly is related to a new stone, regardless of absence of pain.

Ciprofloxacin is the wrong antibiotic for any STD -- not reliable against gonorrhea or chlamydia, and no effect against syphilis. Flagyl also made no sense, since you can't catch trichomonas by oral sex. Azithromycin would protect against gonorrhea or syphilis, without needing ceftriaxone. It would also prevent chlamydia, but that's one of the STDs virtually never acquired by fellatio.

So my advice is to take no more antibiotics, don't get tested for anything, and resume sex at home without worry.

I hope this has helped. Best wishes--  HHH, MD

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51 months ago
Thank you much Dr. Handsfield. Understood. If, however, out of an abundance/unreasonable, caution, I want to be certain about the gonorrhea, should I get the ceftriaxone, having read that gonorrhea can be resistant to azithromycin? I am not so worried about getting gonorrhea myself, knowing it can be treated, but am mortified by the idea of giving it to my wife; and with this same concern in mind, is there a period of time by which abstaining from from unprotected sex with my wife I will know if I picked up other infections? (herpes, hpv, ngu)
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
Of course you're worried about your wife; that's always the main concern in situations like this. People typically don't care all that much if they get a treatable STD.

Gonorrhea may sometimes resist azithromycin treatment, but not preventive treatment given within a day of exposure. Also, although ciprofloxacin isn't ideal, the combination of cipro with azithro for sure is 110% reliable for preventive therapy. No worries and for sure no need for ceftriaxone.
 
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51 months ago
Are there any bacterial NGU's ? And would I be covered for those as well? And to my earlier question, is a waiting period in order to see if I develop signs of HPV or herpes? Also, and you may not feel comfortable answering this, I'm wondering if it may have been false gross hematuria from flagyl? Or perhaps I should go see a urologist in any case, even though I already know I have a stone? Thank you so much for your time. I have read many of your posts (which means I probably shouldn't need to be asking you these questions) and I am very impressed with your expertise, conciseness and kindness. I find it both exciting and a little troubling  that experts in a particular field often give a much more useful understanding of medical problems than the general educational literature. 
51 months ago
What appeared to be gross hematuria occurred x 3, with decreasing amounts of blood, heavy in the beginning of the stream and then trailing off. No clots that I could see. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
You also were covered for NGU. You can assume no herpes if no symptoms within 10 days or so, but the chance of it is very low anyway. HPV is rarely if ever acquired by oral sex -- and takes up to a year for warts or other signs to appear.

The hematuria details don't change my opinions or advice. Neither flagyl nor any other antibiotic would do this. Almsot certainly it's the stone.

Thanks for the kind words about our services. Now I suggest you do me the honor of believing and acting on my advice! This exposure isn't worth anywhere near the concern you are devoting to it. Please resume sex with your wife and otherwise go on with your life without worry. You don't have anything from the event and will not harm your wife. Believe it, suck it up, and move on.

Best wishes and stay safe. 

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