A Variation on the Regretful Husband Theme

[thestupidestmanalive]

Doctors,
Last night, I (male) received unprotected oral sex from her for a brief period of time-- 1-2 minutes-- with a commercial sex worker in the Philippines.  The person presented herself as a woman, although as I reflect on it, I now believe she was probably a biological male who had had surgery and cosmetic work to appear as a female.  I never saw his/her genatalia.

My initial concern was the potential HIV exposure.  But it didn't take me long on the Internet to realize that there were a lot of other STDs I should think about as well.

Within 20 minutes of the encounter, I scrubbed my genitals thoroughly with hot soap & water.  This evening I  started taking 100 mg doxycycline  2x/day as a preventive measure (it's available over the counter where I live).  I have not yet gone for any testing. Testing is an issue for me-- my medical provider is essentially a company doctor.  While I should probably be able to assume a certain amount of confidentiality, I am reluctant to approach him.  Complete candor about this incident would cause me to lose my job if it ever got back to my bosses.

I gather from the other responses on this site that you both strongly believe that oral sex is an extremely low-risk activity for the person being 'served.' But I still would appreciate your feedback.  Here are my questions:

1.  What do you recommend in the way of testing for me, and when should I get it?

2.  Neither my wife nor I have ever had any Herpes symptoms.  Is there anything I can do to minimize the risk that I would contract genital herpes?    

3.  Is there anything else I should do for prophylaxis, or is there anything I should be watching for?

4.  I am trying to decide whether I need to tell my wife about this.  We've been married 13 years and this is the first (and last) time I've had extramarital sexual activity.  I'm ashamed and heartbroken that I've done this, and I don't know how she will react.  Any thoughts on whether she needs to know?

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help. This was not a particularly high risk event as most people do not have STDs and most sex with infected partners does not lead to transmission of infection, this is particularly true with regard to oral sex.  Further, while we do not recommend it, taking doxycycline would prevent/cure the most common consequence of receipt of oral sex, NGU if taken for 7 days and prevent syphilis if taken for 14 days.  

As for your questions:
1.  What do you recommend in the way of testing for me, and when should I get it?
If you are taking the doxycycline, testing has little to add unless you develop symptoms.

2.  Neither my wife nor I have ever had any Herpes symptoms.  Is there anything I can do to minimize the risk that I would contract genital herpes?    
No, there is nothing to do but wait.  if you do not develop a rash or other signs of herpes in the 14 days following your encounter you can be comfortable that you did not get HSV.

3.  Is there anything else I should do for prophylaxis, or is there anything I should be watching for?
No.

4.  I am trying to decide whether I need to tell my wife about this.  Any thoughts on whether she needs to know.
This is a personal decision and involves many factors including how you think she might react, how heavily this encounter is weighing on your conscience, etc.  Disclosure is always the best policy but sometimes there are other considerations which cannot be overcome.

I hope this is helpful. EWH

[thestupidestmanalive]

Thank you, doctor.  This has been very helpful.

[Edward W Hook, MD]

1.  We try hard not to play the "what if..." game here.  I did not recommend HIV testing because that was not your question and I presumed you had learned about this by reading our Forum, something that is easy to do.  You can learn more on this answer be searching the Forum as we answer questions about HIV and oral sex on a nearly daily basis.  The short answer is that receipt of unprotected oral sex from an HIV infected partner is very, very low risk - no greater than a 1 in 10,000 chance and probably lower in your situation.   That’s if your partner had HIV- most commercial sex workers do not.  The choice about HIV testing is yours.

2.  Another question answered multiple times before.  Herpes is widespread but most encounters with infected partners do not lead to transmission of infection.  We do not recommend testing with blood tests for herpes.  If you develop genital lesions in the 14 days after your exposure you should have the lesions tested for HSV using culture or PCR.  

3.  Doxycycline is well known to cause gastrointestinal side effects of the sort you describe.  Sleepless ness and fatigue are not typical side effects and may be due to your anxiety over the event.

EWH

[thestupidestmanalive]

Thank you, doctor, this was very helpful.  If I could ask a few more questions:

1.  You didn't recommend HIV testing I notice.  I presume this follows the logic of what you have said elsewhere-- that males receiving oral sex are at a low risk of contracting HIV.  Would that be true even if we were to assume the worst, i.e. that my partner was infected?  I have read elsewhere about the possibility of infection through the urethra or cracks in the skin (I don't have any that I can perceive), but I can't tell if this is actually observed or hypothetical.

2.  I am confused by what I read about the prevalence of herpes and the ease of transmission. Some things I read make it sound like I should expect to get herpes from any sexual contact with a sex worker, even though there were no obvious sores on his/her mouth.  But it's not clear to me how frequently herpes sufferers are "shedding" absent lesions.  Was this encounter low-risk even for contracting herpes?

3.  I am also a little confused about what I read about doxacyclene.  Over the last 48 hours, I've had some reduction in appetite-- I think the medication doesn't sit particularly well in my stomach-- and I've also been tired and generally run down.  I attributed this to the disruption of my sleep schedule and the extreme anxiety I'm feeling about this situation, but some info on the Internet suggests these could be serious side effects of the drug. Do I need to worry?

Thanks again.