[Question #8740] Should I get a STI (including herpes) check up?
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40 months ago
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Hello - thanks for having this helpful board.
I am a MALE with the following concern:
Over the past 6 years, I have had roughly 10 heterosexual encounters with female escorts and sex workers at spas (mostly Asian) that involved protected vaginal intercourse but UNPROTECTED oral sex (all blowjobs, I do not perform oral sex on the female). I do not know anything about the history/background of these sex workers, nor did I examine closely for any lesions. Throughout this whole time, I have NEVER had any STI symptoms. I am currently about to get involved into a serious relationship, and my partner who is a clean freak may request that she would like me and her to get tested for STDs before having sex.
Given my history above (sexual acts involving protected vaginal intercourse, but unprotected blowjob with 10 different sex workers) - how likely is it that I have contracted a STD? I am mainly concerned about Herpes Type 2 - since I read that is incurable and has stigma attached to it. I may already have Herpes Type 1 - since I recall having oral outbreaks when I was a child - but not certain.
Again, I have never developed any STD/STI symptoms.
3 Questions:
1) Without ever having developed STI symptoms, should I get tested for STI? (Ignore my partner's request...)
2) How likely is it that I had contracted a STI by always wearing a condom for vaginal intercourse, but not oral (blowjob only).
3) I am particularly concerned about Herpes Type 2 since that is incurable and has stigma associated with it...could I have contracted this from unprotected oral sex and protected vaginal intercourse?
I have previously read Dr. Hunter Handsfield response on prior messages that oral sex is "safe sex", and the chances of contracting HSV type 2 from unprotected blowjobs are very small and rare. I am again seeking some assurance for my peace of mind.
Thank you!
- Java Programmer
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Edward W. Hook M.D.
40 months ago
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Welcome to our firm. Thanks for your questions. I’ll be glad to comment. The sort of encounters you describe a very low risk. Condom protected sex is safe sex sex as long as the condom is worn throughout the encounter it does not break and receipt of oral sex is amongst the lowest risk mucosal sexual encounters one can experience. The main STI which is acquired from receipt of oral sex is gonorrhea which is usually symptomatic. HSV-2 is very, very rare from oral sex and there are no records of instances in which it has been proven someone acquired HIV from receiving oral sex. I will elaborate on these comments below.
1. Since STIs can occasionally occur asymptomaticly, your partner’s request is a reasonable one. That said, the likelihood that you were infected is also quite low. See my comments above about the close to zero risk of having acquired HSV-2 or HIV from the encounters you described. Finally, as you enter a serious relationship, I would have to advise you that choosing to not agree to your partners reasonable requests might not be the best idea.
2. See my comments above. Given the circumstances I would be very surprised if you discovered any STI’s to be present.
3. Again I will refer you to my comments above. It is extraordinarily rare for someone to acquire HSV-2 from receipt of oral sex. That combined with the fact that you are asymptomatic makes it very unlikely that you acquire HSV-2.
I hope the information I provided has been helpful to you. If any part of my responses unclear or there are additional questions, please don’t hesitate do you see were up to two follow-ups for that purpose. EWH
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40 months ago
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Thank you so much, Dr. Hook! I have now a follow up Q:
1) Dr. Hunter Handsfield in another recent thread about unprotected oral sex - stated "Same for herpes: no blisters/sores in the next few days will confirm you didn't catch it." My question is - doesn't statistics say vast majority of humans with infected HSV-2 don't even realize they have it, presumably they never had an outbreak? So how can you reconcile these 2 contradictory statements
2) I read online that even with protected penis in vagina intercourse, you can still have HSV-2 genital to genital transmission due to exposure of other skin areas surrounding the penis and her genital. Can you still reassure me that the risk is low with protected vaginal intercourse?
3) You and Dr. Handsfield say oral sex (blowjob in my case) is safe sex - but there are some studies that show transmission of herpes is HIGHER with oral sex than vaginal sex. Can you defend your statement?
Link: https://www.nurx.com/faq/can-you-get-herpes-from-oral-sex/#:~:text=You%20can%20give%20your%20partner%20genital%20herpes%20through%20genital%2Dto,mouth%2Dto%2Dmouth%20contact.
"The risk of contracting HSV-1 over the course of the study was 1.2 for sexually inactive women, 6.8 for women who had vaginal intercourse, and 9.8 for women who had receptive oral sex without vaginal intercourse. This demonstrates that receptive oral sex is a greater risk factor for HSV-1 transmission than vaginal intercourse."
4) Finally, if I am worried about HSV-1 infection. What are the chances of transmission with unprotected blowjob with 10 sex workers, assuming I have NOT previously had HSV-1 infection in childhood.
Thank you!!!!
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Edward W. Hook M.D.
40 months ago
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1. The two statements do not contradict one another. Persons who acquire herpes often attribute there initial (and even recurring) outbreaks to other problems, "zipper cuts", friction, etc. It is not that the outbreak is not experienced, it is just that it is attributed to other causes. You on the other hand are looking for any sign of infection.
2. You are adding 2+2 and getting 6 as your answer. You do not know that (or which) of your prior partners had herpes. Almost certainly not all did. Second, not even all unprotected exposures to infectedf partners lead to infection- in fact most do not. Finally condoms redfuce the risk of infection another 50-60% so while not perfect, condoms do reduce the risk for acquistion of HSV.
3. Once again, you are misreading whatever source of information you are going to (Given how many mis-interpretations you have stated, I'm guessing you've been reading about herpes on the internet which is full of misinformation). More and more genital herpes is now caused by HSV-1 and is acquired through receipt of oral sex. You've indicated you may already have HSV-1 (as do over 50% of adults) which means that you cannot get HSV-1 again and your likelyhood of getting HSV-2 is further reduced due to cross-reactive protection from your HSV-1.
4. Still low. While there are not precise data to inform the answer, unless your partner had a visible cold sore at the time you received oral sex, your risk of infection from any single exposure to an infected partner would be far less than 1% per episode.
Hope this clarifies things for you. Please stay off the internet. EWH
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40 months ago
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Dr. Hook - thank you so much for your expertise!
My 2nd and final follow up Q:
This is mainly for my assurance and peace of mind.
Overall, given my encounter with 10 different woman with protected vaginal intercourse but unprotected blowjob, how do you quantify my risk of having contracted a STD (specific concern for HSV2)? Let's assume I don't have HSV1, thus no cross immunity.
Again, I have never developed any symptoms.
Would you quantify my risk as 1 in 1000, 10K, 100K, or 1 in a million?
I know there is no precise data from studies, but I hope you can estimate from your experience...
This quantification of my low risk would go a long way to giving me a peace of mind.
Thank you once again!
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Edward W. Hook M.D.
40 months ago
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As you point out, this is an educated guess. I would estimate that the likelihood of you being found to have an STI is less than 1 in 1000 (i.e. there is a 99.9% chance you are not infected) and perhaps substantially less. How much lower is difficult to say.
Also, given your focus on HSV, I would specifically counsel you (and your GF) to NOT do blood tests for herpes. Testing of this sort is specifically recommended against by experts (see the most recent CDC STD Treatment Guidelines) because of the relatively high rates of false positive results. particularly in persons with past HSV-1. Testing for reassurance with a bad test is a bad idea.
I hope the information I have provided is helpful. This thread is now concluded. EWH
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