STDs Expert Forum
Analingus risk
About This Forum:

The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

Analingus risk

Hello Doctor,

I am a male and I was recently in Singapore on a business trip. In a moment of mental weakness I decided to go to a licensed brothel. The following sex acts were involved:

1. Unprotected fellatio
2. Unprotected cunnilingus
3. Unprotected receptive analingus (she performed analingus on me - this was pretty superficial)
4. I performed unprotected analingus on her (I this act I also inserted my tongue into her anus, but not too deep, in addition to licking on the outside)
5. Protected vaginal sex

On the very next day, I developed a severe sore throat (which was with me for around 3 weeks - until I took 15 tablets of Amoxicillin 650mg 3 times a day). A week after the development of the sore throat, I also had a stuffy nose and dry cough. The stuffy nose and cough lasted for around 2 days and disappeared without further medication. I did not have any fever, noticeable rash, malaise, muscular aches, lymph node pain, etc.

Could you please assess my risk of contracting one of the several STDs? A few additional points worth mentioning:
1. Licensed CSWs in Singapore are tested monthly for HIV. I am not sure about tests for other STDs.
2. I did have an episode of pharyngeal gonorrhea last year after a similar encounter which was cured with a rocephin injection.
3. I have already scheduled a full battery of STD tests, but I am worried sick before I get an opportunity to see my results from the lab.

Your analysis of the situation and my potential risks with regard to STDs will be most appreciated in this difficult time.

Thank you.
Related Discussions
300980_tn?1194933000
Welcome to the Forum.  You've asked a number of questions.  I'll try to work through them.  

First, as you point out, there is little overall risk that your partner was infected. As you point out, CSWs in Singapore are tested regularly, both for STDs and for HIV.  Thus it was unlikely that your partner was infected.  Even if she was, the majority of exposures do not lead to infection.

Second.  There are no STDs that cause symptoms within a day of exposure, or even two.  I suspect your sore throat was relate to something other than an STD.

Third, your vaginal intercourse i not put you at risk for any STD, including HIV.  Condom protected sex when the condoms are use correctly and which stay intact are safe sex.  No risks an no testing needed related to this exposure.

Fourth, neither HIV nor hepatitis C or B are transmitted by oral sex (fellatio, cunnilingus, analingus -giving or receiving). There are no credible reports of these infections being transmitted through this sort of contact, thus this is not a concern an no testing for these agents is required.

So, this leads to the risk of oral sex, giving or receiving for other STDs.  In general, oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through receiving oral sex an only gonorrhea through performing it; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you had gotten gonorrhea or NGU you would have most likely developed symptoms of urethritis (penile infection). such as burning on urination or discharge from the penis.  If you ha acquired pharyngeal or anal gonorrhea it could well be asymptomatic.    Even if your partner had an STD (any STD and it is likely she did not), as I said, most exposures do not lead to infection.  Further, the amoxicillin you took might have cured gonorrhea if it had been present.  Nonetheless, depending on your level of concern, if you wished to be tested, you can seek testing at the sites of exposure.  I anticipate that the test results would be negative.  EWH
9 Comments
Blank
Avatar_m_tn
I would like to add that I did not also have any other symptoms such as any discharge from the penis, genital itching, sores, etc.
Blank
Avatar_m_tn
I apologize for constantly annotating my post with further information, but I am very concerned about Hepatitis-C. In addition to the above, if you could further elaborate on the transmission risk of Hepatitis-C, I would be grateful. Thank you for your time.
Blank
Avatar_m_tn
Thanks for your analysis doctor. Can you please comment on the likelihood of catching HSV-2 from this exposure? I have lower back pain and what looks like a herpes ulcer about an inch from the anal canal towards the tailbone. (just noticed it today). I am not sure if it is just a fissure (I am guessing not, since it is occurring about an inch away from the canal). I don't have any other symptoms.
Blank
300980_tn?1194933000
Hepatitis C is not sexually transmitted by oral sex of any sort.

It is quite late for an initial episode of HSV to be presenting an your description is not suggestive.  If your are concerned however, the only way to be really sure is to have a trained health care provider take a culture or PCR test from the lesion (blood tests will not be helpful).  My guess however is that this is yet another manifestation of your anxiety.  EWH
Blank
Avatar_m_tn
Hello Doctor,

The results came back today (blood + urine tests for HIV, HCV, Chlamydia, Gonorrhea, HSV1, HSV2, Syphilis and Hepatitis B). The testing was done approximately 26 days after exposure.

I tested negative for all except Oral Herpes, which I knew I already had.

I am still worried that I might have HSV2 since you mentioned that a blood test will not reveal it and it required a DNA PCR from the lesion. However, the lesion has almost healed (no crusting or scabbing - just normal skin has taken its place), so I am wondering what the best way is to get this done? Do you have any recommendations on how I can get tested for this?
I still have a lingering backache. I am not sure why that is occurring and if it is related to HSV2.

I am also thinking of getting a throat culture done to eliminate the possibility of pharyngeal gonorrhea.

Please advise.

Thank you very much!
Blank
300980_tn?1194933000
Your risk for getting HSV-2 from analingus is vanishingly low and for you further blood testing is a waste of time.  The backache you have is not due to HSV- tension (anxiety) perhaps?

Your risk of oral gonorrhea is likelywise low but at least it is a realistic possiblity.  If you wish to get tested, do so.   I anticipate thatthe result will be negative.  EWH
Blank
Avatar_m_tn
Thanks Doctor. One last question before I stop asking anymore - I really value your time.

I still have throat discomfort (pain in swallowing - the pain keeps moving from the left to right of the throat and back) and an acute lower back pain (not severe, but causes discomfort).

1. Are the above negative blood tests sufficient to prove that I do not have those conditions? As I mentioned before, the exposure was on Dec 10th and I got tested on Jan 07th - so approximately 27 days after exposure. I know you mentioned that additional blood tests are useless, but I am still having these symptoms which are making me uneasy. The back pain is usually more severe on one side of the spine and I have no shooting pains.

2. Do I need to test for any other diseases? I have heard that UTI and epididymitis can cause lower back pain? Any other STDs are not covered by the 8 panel test?

I am fixing up an appointment for a throat culture and I will keep you posted if I find something surprising. Unfortunately a PCR of the lesions is not possible since the lesions have disappeared.

Thank you very much and this will be my last question until I uncover further definitive information about my situation.



Blank
300980_tn?1194933000
This goes on an on.   It is time for this thread to end and for you to accept that you did not get herpes or other STDs from the exposure which seems to be the source of yoru anxieties.  Brief, last answers to your questions:

1.  The exposure was virtually no risk to start with.  How many times does this need to be said?  As a result, no matter when you test, the result willbe the same.  

2.  No!!!!

You need to look elsewhere for the cause of your symptoms.  My own expectation however is that as your anxieties come under control, your symptoms will either disappear as well or you will find that your back pain is due to some other cause.  EWH
Blank
Continue discussion Blank
This Forum's Experts
239123_tn?1267651214
H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
300980_tn?1194933000
Edward W Hook, MDBlank
University of Alabama at Birmingham
,
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
242532_tn?1269553979
Blank
The 3 Essentials to Ending Emotiona...
Sep 18 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank