[Question #9383] Likelihood of STD from oral with Thai masseuse

33 months ago

This past Saturday (6 days ago), I received unprotected oral sex in a massage parlor in Thailand from a Thai masseuse. I have a lot of concern around this as I am in a relationship. While I understand oral sex is safe sex overall, I am curious about the likelihood I caught an STD/ STI.

The following day, Sunday (5 days ago), I went to a pharmacy and purchased 1g Azithromycin which I took that day, Acyclovir in 200 mg pills which I have taken 5x daily for the past 5 days, and Ciproflaxin in 500mg pills that I have taken 2x daily for the past 5 days. I know this probably wasn’t smart to mix these, but it was easier to get this medication than find an STI testing center where I am.

Today (Friday), I am finished with the medication. I haven’t had any symptoms throughout this whole process other than mild stomach pain, similar to being kicked in the testicles (which could be due to food in Thailand or a reaction to the medicine). No visible symptoms though and no painful urination or noticeable pus discharge/anything like that from my penis.

I was able to find an STI center on Wednesday (4 days after/2 days ago) and was tested for Gonnorhea and Chlymadia through a urine test and tested negative. However, I imagine this could have been a false negative due to the medication.

Should I be concerned that I have an STD? What are the chances I did, and if so did the antibiotics and antivirals I was taking likely cure them? How long should I wait to have sex with my girlfriend?

H. Hunter Handsfield, MD

33 months ago

Welcome to the forum. Thank you for your confidence in our services.

To start, I'm glad to see you're aware of the generally low STD risk from oral sex. I would have recommended against the antibiotic treatments you took. Not only was there no need based on the usual risks, the drugs you chose are not reliable against the single potentially serious STD acquired by oral sex-- gonorrhea. Especially in Thailand or elsewhere in east Asia, where the most antibiotic resistant strains of gonorrhea are more common than anywhere else. That said, even without testing, you could have been sure you didn't catch gonorrhea, as urethral (penile) infection almost always causes obvious symptoms (pus dripping from the penis, painful urination). As for the symptoms you do have, they are not consistent with any STD, but they fit perfectly with azithromycin as the likely cause. As for acyclovir, that was just as nonsensical: the chance of herpes from a single encounter of this sort is under one in many thousand.

You also have a misunderstanding about antibiotics and their effect on STD testing. They are unlikely to suppress a positive test unless they cure it; your negative gonorrhea test is proof you didn't catch it. As for chlamydia, it is never a risk from oral sex, despite a lot of inaccurate internet buzz to the contrary. Chlamydia is so uncommon in the oral cavity that the US Centers for Disease Control and Prevention recommends against ever testing for it; and if it's not in the mouth or throat, obvious it cannot be transmitted by oral sex. In fact, there has never been a reliably proved case of urethral gonorrhea acquired from oral exposure.

If you would like a final measure of protection and reassurance, have a syphilis blood test about 6 weeks after the exposure. However, that risk also is exceedingly low, since oral transmission is uncommon and azithromycin is active against most (but not all) syphilis strains. There are no worries at all about HIV, which has never been documented to transmitted mouth to penis and testing isn't necessary, unless you want to do it strictly for reassurance (6 weeks after exposure). If somehow I were in your situation, I would be continuing unprotected sex with my wife without any concern of infecting her with anything.

Next time an event like this happens, you would do best to lay off all treatment, see if you develop symptoms in the next few days, and if no symptoms just consider a urine gonorrhea test at 4 or 5 days -- no other tests.

I hope these comments are helpful. Best wishes and stay safe.

HHH, MD

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