[Question #9405] Oral Sex, Deep Kissing, and Genital Rubbing/Frottage with Sex Workers

33 months ago

Dear Doctor -- I am a 42-year old male and had sexual encounters with two female sex workers in Morocco. With both, I engaged in deep kissing and received unprotected oral sex. Also, for several minutes, one of the girls slid back-and-forth on top of my penis, both facing me and with her back to me (i.e. my penis came in contact with her vagina and anus). I am concerned because I am married and my wife and I are trying to get pregnant. I have three questions, if you don't mind: First, which STDs would you recommend I test for, if any? Please note that I am not even sure which STDs can be transmitted in the acts I described. Second, how long after an encounter is one able to test? Third, do you have stats/data on how likely transmission for these STDs would be in the encounters I described? The last question is important because if the chances are 1 in a million, I may simply forego testing. Thank you. - anonymous

Edward W. Hook M.D.

33 months ago

Welcome to our forum. Thanks for your question and for your confidence in our service. I’ll be glad to provide some information.

Before we talk about specifics sex acts and risk let me tell you that, as a generalization , most commercial sex workers do not have STI‘s and this is true in morocco, and, even when they do, most unprotected sexual exposures to infected partners do not result in infection. Now let’s address your specific questions:

1. sliding back-and-forth over a naked partner without penile penetration is a no risk event for acquisition of STI’s. This is true even with direct contact but not penetration of the vagina. On the other hand receipt of oral sex and, more rarely, deep kissing can lead to acquisition of STI’s. Neither exposure however is particularly likely to lead to infection and, as a guess, certainly far less than 1 in 10 and probably far less than 1 in 20 exposures to infected partners would lead to infection. The infection most likely to be transmitted through deep kissing or receipt of oral sex would be gonorrhea. Transmission of chlamydia is very, very rare in this sort of exposure. Detest for the search of exposure you describe you would need to have both a throat swab specimen tested for Gonorrhea and possibly chlamydia, as well as a urine test for Gonorrhea.

2. Testing for the STI Switzer most likely to be transmitted through deep kissing or receipt of oral sex, gonorrhea, could be performed with accuracy at any time more than 3 to 5 days following the encounter.

3. The precise frequency with which transmission occurs it has not been determined however, as I mentioned above, transmission if, in the unlikely circumstance that your partner was infected, is quite uncommon.

Overall, the risk of acquiring an STI from the exposures you described is certainly less than 1% and probably substantially lower. There is no risk of acquiring HIV from the sorts of exposures you describe.

I hope this information is helpful to you. If there are additional questions, please don’t hesitate to use you were up to follow ups for clarification. I would not be worried. EWH

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33 months ago

Thank you, Dr. Hook! Based on your response, gonorrhea sounds like the only STI I'm realistically at risk for. I did some research, and there is moderate prevalence of gonorrhea among FSWs in Morocco. So I'll try to find a testing site here and do a test in a week or 10 days. My only follow-up for you is regarding my penis's contact with one of the FSW's anus. You didn't mention that in your answer and I'm not sure if you saw it in my original. There was contact during the body sliding for a couple minutes, but there was no penetration. Thanks again. - Anonymous

33 months ago

I apologize for asking both of my additional questions at once, but I'm going to go ahead and ask my final question now, in hopes you can answer both of these last two posts at the same time. My final question is this: can I go ahead and start treatment now (just in case I have been infected)? I've read that a single dose of 500 mg ceftriaxone and a single dose of 1g azithromycin would be highly effective. Where I am, I don't need a prescription (and nurses are readily available for injections). Do I have to wait until the incubation period ends, or would taking the treatment now work just as well? Would there by any harm in taking this treatment in the event I do NOT have gonorrhea? Thanks. - Anonymous

Edward W. Hook M.D.

33 months ago

Once again, in the absence of penetration, that you penis contacted your partner's anus does not represent a risk for STIU or HIV.

While treatment in the absence of proven contact or infection is not recommended because of the contribution to development of antibiotic resistant bacteria. if you took ceftriaxone and azithromycin as described, it would almost certainly cure gonorrhea if present. There would be no need to wait for treatment and in fact, treatment would, if anything, be more effective when taken sooner, before the development of symptoms.

I hope this information is helpful. You have one follow-up remaining. EWH

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32 months ago

Thanks, Dr Hook. I’ve done the treatment and would like to ask my final follow up. Three days ago I went to a pharmacy and purchased the single dose of 500 mg ceftriaxone and had a nurse administer. About one hour later, I took one single dose of 1g azithromycin (orally). Today (three days later) l developed pain in both testes. I hadn’t had any other symptoms and I can’t recall ever having this sort of pain in my testicles before. Is the pain an indication that the medications/treatments may not have worked and that I actually do have gonorrhea? Should I proceed to get tested for gonorrhea (and/or something else) just in case? Thanks.

Edward W. Hook M.D.

32 months ago

Your encounter was a nearly no risk event and, whether or not you needed it (I doubt that you did), you have been treated with recommended therapy for gonorrhea and, if present chlamydia. To experiince progression to epididymitis (manifest as testicular discomfort) three days following therapy would be virtually unheard of. Further, when STIs cause testicular discomfort, the pain is typically on one side or the other, not both. I am confident that your testicular discomfort is not due to gonorrhea or other STI acquired from the encounter you have described. There are other possible causes of testicular discomfort but few, if any result in discomfort on both sides.

While I suspect the discomfort will improve, if the discomfort persist or gets worse, my advice would be to seek evaluation from a trained clinician. I am confident your discomfort is not due to an STI.

This completes this thread which will be closed shortly without further responses. Take care. Please don't worry. EWH

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