STD Risk - Receiving Unprotected Oral Sex

[Ralph51]

Hi Doctors,  Here is my situation: Early morning on March 20th I (28 yr old male, married 4.5 years) had a sexual encounter with a 36 yr old female (married ten years, STD status unknown) I had met the night before.  Besides heavy petting and hugging, we deep kissed for over an hour, including me sucking her nipples.  Towards the end of the encounter she began stroking my penis vigorously without lubrication and proceeded to perform oral sex.  She sucked my penis for approximately 1-3 minutes until I ejaculated in her mouth.  After the encounter I noticed skin on my penis shaft had been broken apparently due to the stroking prior to her giving me oral sex.   I did not notice any sores of any kind on her mouth.  I am deeply ashamed and guilt-ridden for taking part in this encounter as it was the first time I have been unfaithful.  I am extremely worried about having contracted an STD and potentially passing it to my wife and having to confess as I would rather live with the guilt than lose her.  My questions are: 1) What STDs am I at risk for from receiving unprotected oral sex from this woman with broken skin on my penis?  2) Has the risk for contracting any of these STDs been increased due to the broken skin on my penis or does factor not matter?  3) How long and what symptoms should I be watching for and when should I be tested for any of these STDs?  4) How long should I abstain from sex with my wife to ensure that I don't pass anything to her?  5) I am mostly worried about having contracted herpes, is there a large risk in this scenario?  I am unsure of whether I have HSV-1 as I have never had any symptoms or been tested.  6) Today (March 21st) I woke up with a white tongue and a sore throat.  I presume it is unrelated to any STDs I potentially contracted due to its occurrence only a day later. Is this safe to presume?   Thank you so much for your help.  

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum. I'll try to help.  I'll start with the general reassurance that oral sex is safe sex. Not totally free of STD risk, but much safer than vaginal or anal intercourse.  The odds are strong you didn't catch any STD at all.  To the specific questions:

1) The most common STD after oral sex is nongonococcal urethritis (NGU), often due to normal oral bacteria.  When not due to chlamydia, which is not transmitted by oral sex, NGU is never serious and usually causes no problem in men's sex partners, so it's not a serious worry.  Other possibilities are gonorrhea, herpes due to HSV-1, and syphilis.  All these are rare outcomes of oral sex.  There is controversy about HIV; it is exceedingly rare after oral sex, if transmission occurs at all.

2) In theory, the chance of syphilis or herpes might be eleveted by local skin trauma, but by too little to matter.

3) Whether acquired orally or by vaginal/anal sex, the symptoms are the same:  discharge of abnormal pus or mucus from the penis, sometimes accompanied by painful urination (gonorrhea, NGU); or penile sores (herpes, syphilis).  Gonorrhea usually causes symptoms within 5 days, NGU 7-10 days, herpes 2-5 days, syphilis up to 3 weeks.  If you decide to be tested even without symptoms, a gonorrhea test can be done reliably any time now -- 2 days after exposure is plenty.  A syphilis blood test can be done at 6 weeks, and HIV testing could be done at the same time.  I recommend against testing for HSV unless there are symptoms that suggest herpes.

4) Almost certainly you will be in the clear if you have no symptoms within 10 days.  This isn't a guarantee, but if I were in your situation, I would feel comfortable resuming unprotected sex with my wife at that time.

5) The chance you caught herpes probably is under 1 in many thousand, maybe closer to 1 in a million.

6) Almost no infection of any kind can cause symptoms in under 24 hours.  Sounds like you caught a cold, not related to the sexual encounter.

The bottom line is that the chance you caught anything is low, and if there are no symptoms within 7-10 days you can be even more certain about it.  But feel free to be tested anyway is you need the additional assurance.

Regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

A) There is no point to worrying about oral herpes.  How many people have you kissed in your life, either sexually or socially?  Every one carried just as much risk for oral herpes as this event did.  You might get it someday, but who cares?  I cannot even guess at different risks for kissing versus oral sex.  I suppose kissing is higher risk.  But forget about it.

A1) Sure, this is possible.  Big deal.

2) If your partner had overt oral herpes (cold sores), the transmission risk would be higher.  But she didn't -- so what's the point?

There is a 50:50 chance you already have HSV-1.  If so, you are immune to a new HSV-1 infection.

[Ralph51]

Dr. HHH, Thank you so much for your prompt, informative reply and the reassurance.  It has been just over 4.5 days since the encounter and I have no noticeable symptoms you describe in 3) above.  I have, however, been checking myself obsessively due to phantom pains I feel are manifesting due to my extreme concern.  

I have been researching move about oral to genital transmission of HSV-1 and have the following questions regarding your response in 5) above:

A) Since I kissed this woman for an extended period of time before receiving oral sex, are the odds that I potentially contract oral HSV-1 much higher than contracting genital HSV-1 (i.e. how much more likely would it be to contract HSV-1 orally given the same circumstances?)

A1) Related to A), is it possible to contract HSV-1 both genitally and orally from the same encounter?

2) If I had noticed cold sores, would your answer to either question 5) above or A) change and how?  Hopefully these questions are clear.  Thanks again!!