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Brief gay mutual fellatio - STD risk and testing
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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.

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Brief gay mutual fellatio - STD risk and testing

Dear Drs
I am a 30 y/o bisexual from RSA.  I have never engaged in any anal or vaginal sex before – only mutual masturbation.  However, about 2 weeks ago I did perform fellatio and received fellatio from a guy with no ejaculation on either part.  The duration of the fellatio both ways, only took about a few seconds to 1 min max.  Before the sexual act I did enquire about his status as well as any other STD and he claimed to be clean, but the next few days when I asked him to confirm he actually sounded unsure and even sometimes irritated.   Myself tested negative during a STD panel I had last November (2012) except for HSV1 - had cold sores since childhood.  Having access to medicines, I took 2 g of azithromycin (one stat) 4 days after the fellatio.    
I have read numerous posts on your forums before spending quite an amount on this post (currency rate) and realized that this was a very low risk for contracting any STD including HIV.  However,  I am I bid confused as to how I should go about seeking testing (if needed) and also what type of test I should request since my nerves are killing me at the moment.  Your professional evaluation of my situation and my specific questions will be highly appreciated.
1)Risk of contracting a STD including HIV, given the act and short duration of the fellatio?
2) Would the azythromycin have counter any incubating bacterial STD as I took it 4 days post-exposure - STDs like gonorrhea, syphilis? I see that some posts mentioned resistant strains to macrolides.
3)Any change of contracting HSV2 orally or genitally?
4)If you would suggest testing for HIV, syphilis and HSV2 would the following types of test and windows be correct and conclusive?(HIV = Duo @  4 weeks; syphilis = RPR @ 6 weeks and HSV HerpeSelect @ 2 months)
5)Would the RPR be an appropriate test?  I have read that some people experience false positives and that the RPR is on older type of test.  
Thank you so much for time. Your work here is really amazing!
Tags: Mutual fellatio, STD
239123_tn?1267651214
Welcome to the forum. Thanks for your question.  And thanks for researching questions similar to yours on the forum.

RSA isn't a frequently used abbreviation in my country -- I assume you're South African, yes?  Are you and your partner white or black?  (It makes a statistical difference in the probability your partner had HIV, as you likely know.)

To your specific questions:

1) Oral sex can be considered safe sex -- not entirely free of STD risk, but the chance of any infection is always low for any particular episode of fellatio.  The only infection for which any numerical risk data are available is HIV, for which one estimate is one transmission for every 10-20,000 exposures, if one partner has HIV.  My guess is that the highest likely risk for most other STDs (gonorrhea, HSV, NGU, syphilis) is on the order of 1 in 1,000.

2) The azithromycin treatment would have aborted or cured all the bacterial STDs (gonorrhea, syphilis, NGU).

3) "Any" chance of HSV-2?  Sure -- if your partner had an active genital HSV-2 outbreak, you could catch oral HSV-2.  But the chance probably under 1 in many thousand.  I wouldn't worry about it and would recommend against testing, in the absence of symptoms to suggest new oral herpes.

4) Given the azithromycin treatment, I recommend against any testing at all.  If you want additional reassurance against HIV, have a test for that alone.

5) There is no point in testing for syphilis by RPR or any other test.  The azithromycin would have aborted syphilis.  Even if you had been exposed and an infection had started up, any and all tests would remain negative. Don't waste your money.

I hope this has been helpful.  Best wishes--  HHH, MD
7 Comments
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Avatar_m_tn
i also forgot to mentioned that we deep kissed for +/- 30 min
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239123_tn?1267651214
Kissing carries no risk for any STD.  It's a good way to catch a cold, however -- and maybe oral HSV-1, which isn't considered an STD.
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Avatar_m_tn
Dear Dr
Thank you so much for your prompt response.  On a lighter/ironic note, we are literally thousands of miles apart and yet I received your response/evaluation much sooner than it usually takes me to get an appointment scheduled at my local family physician, a few blocks from where I live – and your consultation came at a much cheaper rate!! Well done!
I am indeed South-African and we are both white (“partner “ and I) – sorry for the lack of essential info and any confusion caused!  
Thank you once again for your reassurance and advice – I feel much better! One tiny concern is the topic of HSV2.  You said in your answer that if he had an active outbreak genitally, acquiring it orally is possible.  Is the opposite also true – if he had it orally can I get it genitally?  Because I also received fellatio, only briefly though.  Am I correct that HSV1 is not a problem here, since I already have it orally? The reason why I ask is that, after my post yesterday I noted a small spot on the tip of my penis, almost on the edge of the urethral opening.  It is very tiny (the size of2 needle pricks put together maybe) and it looks af if the top layer of skin is removed -  I actually had to use my flashlight to see better, but not even that helped that much.  It doesn’t fit the textbook description of initial genital HSV2 outbreak, but then again I read that it is possible to experience a mild outbreak if you are already infected with HSV1. My bet is it might be trauma caused by earlier masturbation *shy face*, but if this might make you suspicious, could you perhaps advise on the type and timing of testing?
You advised to have a HIV test in the case for additional assurance – I assume that a duo @ 4weeks would be conclusive?
Thank you once more, take care and God bless!
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239123_tn?1267651214
Oral HSV-2 is uncommon and, when present, causes few outbreaks and little subclincal viral shedding, so transmission risk is low.  I have never seen (nor heard of) a case of genital HSV-2 acquired from an orally infected partner.

I agree the red spot you describe isn't like to be herpes.

The duo test for HIV indeed is conclusive at 4 weeks.

Thanks for the thanks.  I'm glad to have helped.
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Avatar_m_tn
Dear Dr HHH
Thank you for your second response.  Sorry for posting again - my intention was not to, since I dont want to waste any more of your time. But I woke up this morning with a sore throat (not really that intense, but still noticeable). It is 20 days post exposure and I am a little bit worried - I hope that it could be due to my allergy problems or my current not-that-serious postnasal drip. Would the timing of the sore throat be aligned with the timing of ARS symptoms showing up? I have no other symptoms like fever, muscle aches etc. Would you recommend testing given the above?  
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239123_tn?1267651214
20 days is at the outside of the ARS onset range.  A sore throat, without fever, is unlikely to be ARS -- and even less likely here, given the nature of the exposure.  From a medical standpoint, I see no need for HIV testing.  However, if you remain nervous, you might want to do it for reassurance; negative tests are often more reassuring than expert opinion, no matter how expert it may be.  This isn't a hint that I believe you have HIV; I definitely do not and am sure that if you are tested, the result will be negative.
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