How concerned should I be?

Hello. (I am a 43 year old GWM, healthy, in a relationship)

Question for you. I was referred to a massage therapist who was in town for the weekend (mine is on vacation). In general, the massage was great, but the therapist got a little "friendly" near the end. He started to perform oral on me... Although I am not a prude, I asked that he not do it. Except for that, and the usual body contact of a Thai massage, no other activity went on. Note: I asked him before I left if he had any STD's or HIV. He said he was completely clean and I have no worries whatsoever.

What are your thoughts? How "at risk" am I to catch an STD? I have no symptoms, but of course it has only been a day.

Is this the type of thing I should visit my doctor about? Should I share this with the person I have been dating at this point? (just a little mental about this since it was not planned)

[H. Hunter Handsfield, M.D.]

In general, oral sex is safe sex.  Not totally without STD risk, but much safer than vaginal or anal sex.  Some STDs are no risk at all (e.g., chlamydia, HSV type 2).  Further, among the possible STDs -- gonorrhea, nongonococcal urethritis [NGU], herpes due to HSV-1, syphilis -- obvious symptoms usually occur.  So in general it is not necessary to be tested for STDs -- and especially so after an apparently transient exposure like you describe.

On the other side of the coin, your massage partner apparently has less than ideal standards for sexual safety.  But then people rarely lie if asked directly, so his straightforward reply to your question seems reassuring.

Certainly you could see a provider to be tested if you wish; testing for gonorrhea is valid within a few days, but blood tests for herpes and syphilis take several weeks to become positive.  But if you develop no symptoms of urethral discharge, painful urination, or penile sores within the next few days, you can be quite confident you didn't catch NGU, gonorrhea, or HSV-1; and if no late onset penile sores (e.g. 2-4 weeks after exposure) you can be equally confident about syphilis.

In the meantime, I cannot give definitive guidance about whether to discuss this with your main partner.  On the one hand, it is not possible for me to guarantee you weren't infected.  On the other, the risk seems extremely low.

I see this is your second question on the forum in the past few weeks.  Be aware that MedHelp policy permits no more than 2 questions on the professionally moderated forums every 2 months; no more before next April.  (I don't want you to risk spending the nonrefundable fee only to have a question deleted without reply.)

Regards--  HHH, MD

[Copter1]

Again, I thank you for your advice. I have no patience...but in this case I will have to wait it out. To date, there are no issues to report.

What are your thoughts? I am due for a physical in the next month. At what point do you think it would be smart (how many days from the incident) to get a full STD screen. The doctor usually does one anyways, but at what time (days) would it give be a good bill of health. (in general).

Thanks.

[Copter1]

Hello.

I just wanted to update you on a couple of things and get your opinion. I did see my doctor and he examined me and did a whole battery of tests (everything!). They all came back negative at 7 days (it is now day ~9 and I have no symptoms). He told me to come back in about 2-3 weeks if I want to test again, but he thought it probably would not be necessary. Thoughts?

Also, I have been under treatment for a urinary issue (kidney stones and an irritated urethra for about 18 months now...completely separate from this posting). Yesterday, I had a check-up from my urologist and he was very interested in the situation and test results. It was his opinion that oral sex (even though there was no sex here...as he just started and was only on me for 10 seconds) was not a high risk in his mind and I should not worry or test anymore. I was a bit surprised. Thoughts here?

[H. Hunter Handsfield, M.D.]

Both your doctors are correct; their advice is the same as mine.  I also do not recommend HIV testing, at least not on the basis of any risk of significance.  Any testing you do is strictly for reassurance, i.e. if you will sleep better knowing the negative result.

[Copter1]

Dr.

I am really stressed-out now. It has been two weeks and I have no symptoms to speak of from my exposure (above). I got the clinic test results back and they said I was HSV 1 and 2 negative by IgG and HSV 1/2 equivocal by IgM. I am a wreck!!!

I spoke with my real doctor on the phone today and he is going to see me next Tuesday afternoon. He was pissed-off that the IgM test was performed as he says it has 4 possible results and not just two (HSV 1 positive/negative, HSV 2 positive/negative). He says there is nothing I can do at this point except to not have sex and to wait until next week for our talk and some re-testing.

What are your thoughts? The massage therapist (emailed him again) says that he is completely disease free. The test says I might have an infection.

I am a mess.

[H. Hunter Handsfield, M.D.]

I agree with your doctor's frustration.  The IgM test should not have been done and you should ignore the result entirely.  Here is a thread that explains why:  http://www.medhelp.org/posts/STDs/hsv-2--recent-vs-not-recent-infection/show/541451  You can also enter "HSV-2 IgM" in this forum's search window to see many other discussions about it.

You need to calm down and accept the reassurance you have been given.  But this isn't a psychological counseling service and I won't have anything more to say.  Just believe it:  you did not catch herpes or any other STD.