[Question #8788] Risk assessment on casual sex date
40 months ago
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Dear Doctors
I would like to thank you once again for providing a safe and informative platform for people like me to ask sensitive questions. I am Male in Hong Kong. Yesterday I met a 27 yr old girl from China stranded in Hong Kong due to closing of borders on a social media site. We decided to meet up at a hourly hotel for casual sex. At the hotel we showered separately. On the bed we cuddled and kissed each others bodies breast nipples groin area. She wouldn’t let me go near her vagina with my mouth but eventually let me kiss her clitoris and labia. She had a lot of hair and her vagina was quite dark. She gave me an unprotected blowjob that included light kissing of penis head and shaft, sucking of testicles and inserting my penis on her mouth. This lasted for 1-2 minutes. I then engaged in 1-2 minutes of frottage where i rubbed my bare penis on her clitoris and labia. There was a lot of vaginal secretion. On one of the thrusts, the bottom half of my penis head hit something hard like a bone so I think I may have penetrated her slightly but I could still see the top half of the head of my penis. I then put on a condom and proceeded with missionary sex where I gave her 2-3 light pecks on her lips (no French kissing or locking of lips). That’s when I noticed 3 scabs on her upper lip - not on the edge of the lip but right on the lip itself. The scabs looked like peeling/flaky skin stuck on her lip. She had some light lipstick on so it was hard to see at first. I stopped kissing her. After we finished I asked her about the scabs on her lip and she told me casually that she had a blister outbreak before due to lack of sleep and it’s all better now. She didn’t want to touch or peel the scabs so just left them there. Given the above, I would be grateful for your advice on my risk exposure following the unprotected frottage, blowjob, and light kisses on her lips given the scabs from her previous outbreak. From reading other threads on this forum I understand that my other exposures (Ie condom protected sex and cunninlingus) are low risk exposures but please let me know if this assessment has changed.
How worried should I be from this event and would you recommend immediate testing?
Many thanks.
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Edward W. Hook M.D.
40 months ago
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Welcome to our foreman thanks for your detailed description of your activities. I agree with your assessment that this was a low risk event and will briefly describe how are you associated risks and comment about testing. I presume you do not know about your partner’s HIV status however I suspect it is safe to assume that her likelihood of being HIV infected is quite low.
1. Condom protected sex is 66. It is a virtually no risk as long as the condom is Warren throughout the encounter it does not break.
2. Cunnilingus is a very, very low risk event but not no risk. There are a few occasions in which persons have acquired gonorrhea and chlamydia from performing oral sex on an infected partner. The risk associated with such exposures is so low that it is difficult to calculate the risk numerically however. I am unaware of any instances in which a person has acquired HIV from performing cunnilingus on an infected partner.
3. Receipt of oral sex from an infected partner with oral gonorrhea (uncommon) is occasionally associated with acquisition of gonorrhea or very, very rarely chlamydia. following the acquisition of gonorrhea over 90% of people become symptomatic within 3 to 5 days. The other STI which may be acquired from receipt of oral sex is non-chlamydial NGU which arises from introduction of a partner’s oral bacteria into the penis. Nonchlamydial NGU presents as mild discomfort upon urination or rarely discharge. Non-chlamydial NGU May go away by or is easily results with doxycycline. Non-chlamydial NGU does not pose a threat to sexual partners health if exposed.
4. There is no Appreciable risk from kissing a partners buddy, mouth, or nipples.
5. The lesions that you describe on your partners lips sound like they may be resolving cold sores which would be caused by HSV-1. If so, and you have not had HSV-1/cold sores yourself, there is a less than one and 1000 chance that you will acquire genital HSV-1. If so, lesions of genital HSV-1 would typically occur within 10 days of your encounter.
6. Overall, you have done a good job practicing safe sex and this is a very low risk event. I do not feel strongly that you need testing related to the event however, if you choose to test, the most important test for you is a urine test for gonorrhea and chlamydia based on your receipt of unprotected oral sex from your partner.
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40 months ago
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Dear Dr Hook
Thank you for your reply.
Regarding the comments on my partners recovering cold sores, does the fact that the sores have scabbed and she is recovering from the outbreak mitigate the chances of transmission? Would viral load present on her lip decrease under such circumstances?
I couldn’t help looking at some sites which say that hsv-1 can be easily transmitted via oral sex even when no blisters are present.
As such I would be grateful for some further insight/advice on my situation where i exposed myself to someone with recovering blisters. The flaky skin was attached to the lip and looked like a crater as the middle of the skin patch was lower (more attached to the lip) whereas the sides or edges were peeling off. There were three spots like this on her lip. Would you also rule out syphillis?
Separately, grateful for your risk assessment on the frottage event as well mentioned in my initial post which may have included partial/very little/shallow accidental penetration. Please see my initial post for description.
Many thanks!
40 months ago
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Dear Dr Hook
Regarding testing, do you recommend that i test for herpes and if so when should i do the test? Also do you think i should test for syphilis? You hadnt recommend a herpes test initially and i was wondering if that had to do with the fact that my partner was recovering from the outbreak. I guess im most concerned with this point as i exposed myself to a real risk of catching herpes/syphilis (ie receiving oral sex from someone with sores present).
Also, When should i go get tested for gonorrhea and chlamydia?
Many thanks again for your advice. Its much appreciated!
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Edward W. Hook M.D.
40 months ago
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Yes, the viral load in cold sore declines as lesions heal, making transmission/acquisition less likely.
It appears that you are searching the Internet for information. Please don’t. Much of what is there is incorrect ( out of date, taken out of context, or just plain wrong) and there is no way to tell that. Only a small proportion of direct exposures to cold sores result in transmission.
The lesions you describe sounds nothing like syphilis.
My advice here is that your risk for herpes is quite low. FYI, if you had acquired herpes you would expect to develop lesions at sites of exposure within 10 days of your exposure. Please don’t worry. EWH
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40 months ago
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Dear Dr Hook
Thanks for your reply.
Am I correct to believe that your advice is to Wait for 10 days and if no sores develop then I should not test for herpes as it’s unlikely that I got it? Or should I still get tested for herpes after 10 days regardless?
For the urine test when can I get tested?
Finally grateful for your thoughts and risk assessment in the frottage event in my original post and follow up post from a couple of hours ago. Pasted below from my original post for your reference :
“ I then engaged in 1-2 minutes of frottage where i rubbed my bare penis on her clitoris and labia. There was a lot of vaginal secretion. On one of the thrusts, the bottom half of my penis head hit something hard like a bone so I think I may have penetrated her slightly but I could still see the top half of the head of my penis. ”
Many thanks
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Edward W. Hook M.D.
40 months ago
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Yes, if you do not develop lesions of genital herpes within 10 days of your encounter, I would not worry further and I recommend against testing for HSV (too many false positives and confusing results)
A urine test for Gonorrhea and chlamydia can be done any time more than 3 days after your encounter.
No need for additional concern or testing related to the encounter you describe.
This completes this thread. Please don’t worry. EWH
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