2 incidents of Oral sex  with some escorts(unprotected  ). first 3 months ago . did intense Cunnilingus  ( she didnt wear dental dam . I really didn't swallow any of her secretions as I always spat it away every few minutes , but i can't really guarantee  ) and Received fellatio ( no condom). similar activities for  second incident and it was 10 days ago. 

Symptoms : off late ( from past 2  months or so) , I have been having  tingling sensation (on and off) around my neck area and behind ears etc multiple times . Today is the 10th day after incident 2 and I again had these tingling sensations on my neck. Its not pain , but I felt sensitive behind the ears , around the sides of the neck . I tried to feel around and see if I notice any unusual bulges ( like swollen lymph nodes I see in the internet) but I can't really feel anything. (I am not trained either to feel these things , I just know something feels odd occasionally behind my ears and sides of neck  but nothing feels bumpy) . I also had a mild fever / sore throat for half a day today and it subsided naturally after taking an ibuprofen. (I did not vacuum my floor for a week and it could have been I caught some sore throat from it as I was too sleepy and slept on my carpet last night. Just giving facts , not concluding anything). since few monthI feel  a v tiny bump inside my mouth where my right tonsil used to be( got tonsiles removed). Its painless and its tiny . not sure if related.

Testing:  at 2 month mark from 1st incident , I did an OraCure in home testing and I think I saw a negative. 

Some questions 1. Does this warrant additional testing for HIV given I had an exposure 10 days ago?2. Do  I need to get tested for other STIs given my exposure and symptoms ? If so , I am at the 10th day from my second exposure. When should I be getting tested and for what. 3. Can I use some precautionary antibiotics . I think I have some Nova Mox from my visit and I can use it for a week just to be safe. (twice a day, 500 mg)

Oral sex is quite safe:  not completely free of STI risk, but with far lower chance of infection than unprotected vaginal or anal sex. Neither the cunnilingus nor fellatio events you describe were likely to result in any infection. In fact, there has never been a scientifically validated transmission of HIV from mouth to penis or by cunnilingus -- so for all practical purposes, these events did not put you at risk for HIV, even if your partner has it herself.  As for your symptoms, they are not typical HIV or any STI. 

1. From a medical or risk standpoint, there was no need for testing. However, you're obviously concerned about it, and you have already started down that path. Therefore, I suggest you have additional, conclusive testing for reassurance. Have an antigen-antibody (AgAb, "4th generation") test. If you do that 4 weeks after the fellatio even, it will be about 98% conclusive -- which you can consider 100%, given the near-zero HIV risk from the event itself. For a truly conclusive result, have an AgAb test 6 weeks after that event.

2. The risk of other STIs was also nearly zero, and absence of typical symptoms is further reassurance. But here too, perhaps you will be more reassured by negative test results than by professional opinion, whether from me or anyone else. If so, you can have a valid urine and throat swab tests for gonorrhea and chlamydia; those would be valid now, no need to wait. Finally, you could consider a syphils blood test in a few weeks, e.g. 6+ weeks after the second event.

3. I strongly recommend you take no antibiotics. There is simply no need -- there is no realistic chance you were infected with any bacterial STI that would be prevented; and you would screw up the test results if you take antibiotics before being tested. And if treated for some reason, amoxicillin (Nova-mox) would be absolutely the worst choice:  it would not reliably prevent or treat chlamydia, gonorrhea, or syphilis, and definitely would screw up all test results.

Just sit tight and stop worrying. You had a couple of trivially risky sexual exposures. If you have a regular partner, it is entirely safe to continue sex with that person while you wait for the results of the tests suggested, to confirm you are not infected.

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

HHH, MD

  Also , what are the odds of catching STIs with unprotected oral sex .  I understand you say they are trivial but  I am trying to understand if  "use of a dental dam  and condom  for oral sex is a necessary action " to take in any such future encounters .   Condom is doable. But dental dam for mouth to vagina gets impractical many times. Is there an alternative. Does spitting away any vaginal fluids when performing mouth to vagina help.  Should i make sure to have a dental dam on my partner.

For oral exposure of your penis, the three most likely STIs are gonorrhea, herpes due to HSV1, and nongonococcal urethritis (NGU) that might usually be caused by entirely normal oral bacteria. With entirely unprotected exposure, I would estimate the chance of any of these is under 1 in a thousand, and zero with a condom. Cunnilingus (oral-vaginal contact) is even lower risk -- the lowest STI risk of all common sexual exposures except for kissing and hand-genital contact. Most experts do not strongly recommend dental dams:  we agree with your comments about them (often considered unpleasant and impractical), and the risk low enough that such protection is optional. In theory, it risks most STIs, but probably under one chance in several thousand, if I had to guess a numerical risk. As for HIV, there has never been a proved infection transmitted oral to penis or by cunnilingus for either partner.