[Question #8637] Oral Sex
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41 months ago
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Specific question. I am a heterosexual male. About 3.5 weeks ago, I performed oral sex on a female heterosexual CSW. She was "high end" if that matters. Her STD status is unknown, although I asked and she said she is "tested all of the time."
My concern is syphilis. Specifically, risk of transmission to me and need for testing. At this time, I have no symptoms. I don't believe the woman had symptoms. but this is just a guess on my part.
I am aware that you all addressed this question in a general way before, but I do not find anything recent or right on point.
Thank you very much!
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Edward W. Hook M.D.
41 months ago
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Welcome to our form. I would consider the exposure that you describe very little low risk for acquisition of any STI including HIV. Commercial sex workers, particularly “high end” commercial sex workers tend to be quite cautious about the possibility of STI‘s and indeed do get tested regularly. The risk of sex with a high-end commercial sex worker is probably considerably lower than the risk associated with sex with the casual partner picked up for a one night stand in a bar.
Second, among possible STI’s, syphilis is particularly unlikely. Syphilis is a relatively rare STI compared to gonorrhea or chlamydia and is almost never associated with cunnilingus.
Bottom line, the exposure you described is very, very low risk for acquisition of Syphilis and is not a problem I would be worried about. Quite frankly, I see no reason for testing related to this exposure.
I hope this information is helpful. If any part of my response is unclear, please don’t hesitate to use your update to follow ups for clarification. EWH
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41 months ago
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Thank you Doctor. Extremely helpful.
I have a follow-up.
The exposure was in SF. I have read that SF has high levels of syphilis.
Second, I have read that transmission rate for syphilis for one-time exposure is pretty high, i.e., 40-60%. But I think this includes vaginal exposure.
Do either of these change your answer?
I have tested negative for the usual STD's, including syphilis, but now I realize I may have tested too soon for syphilis--at 2.5 weeks after exposure.
Thank you again.
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Edward W. Hook M.D.
41 months ago
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Thanks for your follow up and get additional information. You are correct, Syphilis rates are high in San Francisco however, at the present time in the United States anywhere from 2/3 to 3/4 of all syphilis is occurring amongst men who have sex with men and the infection remains uncommon among women. All that I said above about commercial sex workers being cautious about STI’s would apply in San Francisco as well as elsewhere.
Regarding exposure risk, most persons exposed to a partner with Syphilis will not acquire the infection. Estimates of persons exposed to an untreated syphilitic chancre are there in about 30% of persons will be infected following a single exposure. Most of these estimates are many years old are based almost entirely on penile vaginal sex.
No change in my assessment or advice. Your risk of a acquisition of Syphilis was very, very low. EWH
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41 months ago
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My second and last follow-up.
Thank you Doctor.
I am not planning on further testing, and will assume sex with my wife is ok.
This is subject to me not developing symptoms, of course.
Please do let me know if you disagree.
Many thanks for your time and expertise.
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Edward W. Hook M.D.
41 months ago
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Your summary is right on target. I am confident that you will not develop symptoms and see no reason for you to abstain from unprotected intercourse with your wife.
Take care EWH
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