[Question #9096] STD risk and next step

36 months ago

I had a protected (Male condom) sexual encounter with an asian female masseuse 4 days ago at a parlor.

Unfortunately i performed unprotected oral sex on her for about 30 seconds then stopped. Terrible decision and judgment. I was panicked about it and was having mild throat ache 3 days after, so I took 2g of Azithromycin. I am worried about the risks associated with the encounter as I don't want to give my partner any illnesses. How risky was my behavior and what should I do next.

H. Hunter Handsfield, MD

36 months ago

Welcome to the forum. Thanks for your confidence in our services.

Oral sex is safe sex in regard to HIV. There has never been a reported case of scientifically validated HIV transmission by cunnilingus. It also is statistically unlikely that any particular massage worker (including those who really are commercial sex workers) has HIV, so your partner probably isn't infected. Your "mild sore throat" also started too soon to be due to a new HIV infection; it probably was a garden variety respiratory virus (and the azithromycin treatment almost certainly wasn't necessary).

To answer your closing question, this was essentially a zero risk event in regard to HIV and you don't even need to be tested. The risk of other STIs also was near zero, given the condom use and the fact that cunnilingus also is very low risk for other STIs.

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

HHH, MD

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36 months ago

Thanks for the reply. While I get the risk of fluid transmitted sti is near 0, what about the contact spread sti? Herpes, syphilis? Do you recommend prophylactic penicillin or doxycycline, or testing in 8 weeks?

H. Hunter Handsfield, MD

36 months ago

Prophylactic treatments are not generally recommended unless there is known exposure to an infected partner. The chance any particular partner has active, transmissible syphilis or herpes is well under one chance in a thousand; and the nature of the contacts you describe further lowers that risk -- the chance you caught either of these is under one chance in maybe a hundred thousand, tops. Also, anti herpes treatment doesn't work at all: giving anti-HSV drugs after exposure has been studied and found to have zero benefit in preventing herpes from taking hold. (In order to prevent infection, the drug must be taken before exposure). The chance of other infections (e.g. gonorrhea, chlamydia) is just as low -- so for sure I would not recommend any antibiotics.

As for testing, the risk is so low that it's optional, but of course you're free to do it if the negative result would improve your reassurance level. But really I wouldn't even know what to test you for. There is a minuscule chance of oral gonorrhea, virtually no risk of oral chlamydia, zero risk for HIV, and close to zero for HIV. If I were you, I would look at this event as one that is sufficiently risk free that no testing is needed, and it is OK to continue sex with your regular partner, if you have one.

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