Just over 2 weeks ago, I (male) visited a massage parlor and received condom-protected oral sex and gave unprotected oral sex to a female sex worker. Time spent doing this was 5-10min. I have no symptoms except that my throat is slightly tender when I swallow, very slight cough and my tongue seems to have "geographic tongue" (starting on day 10) - all of which could be totally unrelated. From what I've read, my activities were fairly low risk (but not no risk). I'm hoping you can provide some context.

1. Oral HSV 1 / 2 - As far as I know I do not have HSV. I have had few sexual partners and have never had a break out of any kind that I can recall. From what I can find the chance of transmission of HSV from Vagina to Mouth is low. What is my risk of getting either HSV 1 or 2? How likely is a breakout if after 2 weeks I have not had one (if indeed this would be my first breakout?)

6. When can I resume normal sexual activity, including kissing. After the syphilis results? I'm in a monogamous 12 year relationship and made a mistake I'll never make again.

Thank you for your assistance!

Your overall assessment the exposures you described were low risk for acquisition of STI’s is correct. Please remember that most commercial sex workers do not have STI’s and that when they do transmission of infection following any single exposure usually does not occur. In your case, your receipt of condomprotected oral sex it was a virtually no risk event. Performance of unprotected cunnilingus on a partner is slightly higher risk but still very, very low risk for STI’s.  In response to your specific questions:

1.  Although you have never had a cold sore to your knowledge, undetected infections are common and there remains about a 50% probability that you acquired HSV-1  at sometime in the past. Even if you have not had HSV, you risk of infection is very, very low.  HSV-2 is virtually never acquired from receipt of oral sex and your risk for HSV-1 is a small fraction of 1%.  If you were going to develop lesions, that would’ve occurred within 10 days of the exposure. You could be confident that you are not going to develop lesions from the exposure you describe.

2.  You are correct. It is unlikely that you acquired oral HPV from any single oral exposure. When oral HPV occurs, in most cases it resolves spontaneously. Oral HPV infections are typically asymptomatic. Oral HPV is not something for you to worry about.

3.  At the present time most syphilis is occurring amongst men who have sex with men. Oral syphilis is a very, very rare manifestation of this infection. Your risk of acquiring oral syphilis from the exposure you described is close to zero. If you wish to test for syphilis, results of a blood test for the infection will be conclusive at any time more than six weeks after your encounter. Personally, I would not even bother to test.

4.  You are correct. There has never been a proven case of HIV required for receipt of oral sex. There are a small handful of cases which have been acquired as a result of cunnilingus however this is very, very rare. Depending on your level of concern, results of an HIV test would be conclusive at any time more than six weeks following year and counter. As for Syphilis, personally, I probably would not bother to test.

5.  Correct. If you had a throat swab performed for detection of gonorrhea and chlamydia, I anticipate the results will be negative and you should consider them conclusive.

6.  As I’ve tried to convey in this reply, your risk of having required any STI is low. There is virtually no risk of infection from your receipt of condom protected fellatio and your risk of acquiring any STI from cunnilingus is tiny. As indicated above, your own level of anxiety will need to determine when you can return to your normal, unprotected sex with a regular partner. I would have little concern at the present time. On the other hand, if you wish to be completely confident that even these very, very rare infections have not occurred, you will need to wait until the six week point at which time your tests for HIV and Syphilis will be conclusive. 

I hope the information I have provided has been helpful. EWH

1. Could I have picked up some other infection from the unprotected cunnilingus? To my knowledge I’ve never had this before and there remains a patchwork look to my tongue with a film over it. Though it has definitely gotten better over the past week. Is it even possible to have picked up some form of oral thrush this way?

2. With respect to syphilis, is the first stage always the chancre at point of infection? I.e. I shouldn’t be presenting with this weird tongue as a first symptom correct? If it is the chancre and I haven’t seen it in the first three weeks post exposure, can I assume my likelihood of infection is close to nil? I understand that syphilis is the great imitator so I just want to know what to be on the lookout for in the next few weeks. 

Thank you!

1.  As already discussed, your risk for acquiring any STI from the cunnilingus you took part in is miniscule and you have ruled out the most common oral STIs which might have occurred.  FYI, oral STIs typically involve the throat rather than the tongue itself.  Oral thrush can be acquired through cunnilingus on an infected partner but what you have describes, as well as the time course is in to way suggestive of thrush.  

2.  Yes, the initial manifestation of syphilis is the chancre- a usually painless ulceration at the site of inoculation.  Had you, or were you going to develop a chancre, you likely would have done so by now.  Further, oral/tongue syphilis is exceedingly rare

I find myself wondering your lingering concern over your misstep may be causing you to self-evaluate/examine yourself far more than normally and, in doing so, whether you are focusing on normal findings which would otherwise be overlooked.  I remain confident that you have not acquired an STI of any sort from the encounter you have described.  EWH

My chlamydia and gonorrhoea iron came back not detected. So that is a relief. My only question is that I collected the urine mid-stream and not “first catch” as I had no direction and am used to doing urine tests mid stream. 

Should I worry about a false negative and re-test or would the test still likely have caught it?

Many thanks!

Hope this helps.  As you note, this completes this thread.  EWH