STD Risk

Dear Drs.

     My wife and I separated a few months ago in part due to sexual incomptability. 2 months after separating I went to work in Hong Kong for four weeks. I had been celibate from the separation until then. Two situations occured: 1. I went to a one person "massage" place and engaged in unprotected cunnilingus and protected felatio, followed by protected sex. 2. Two weeks later I went to a bar and met a woman who I had a lot in common with. We hit it off and fooled around that night and the next four. All sex was protected, but we had a huge amount of oral sex (one of the things I didn't have much of in 10 yrs. of marriage). This included unprotected cunnilingus and felatio. A week later my wife agreed to enter counseling (I had requested this for years). She now wants to work on the sex issues and we are going on a trip soon. I am worried about STDs.

I understand that: 1. Unprotected oral sex in either direction is basically zero risk for HIV (from 10,000-1 to zero) or Hep C (zero). Cunnilingus is even safer. 2. Herpes and Syphilis are generally not transferred through oral sex unless there are visible sores on the mouth (felatio) or vagina (cunnilingus). 3. Chlamydia is generally not transferred through oral sex. 4. Gonnoreah and NGU can be transferred through oral sex (either felatio or cunnilingus), but even if the person is infected transfer is not inevitable.

My questions are: 1. Based on the two exposures mentioned above what is the risk for Gonnoreah or NGU?  
2. How quickly could I be tested if high risk?   3. I know the risk for herpes is low unless there are visible sores, but what if she had a herpes sore in her mouth? And what about syphillis (syphilis)?   4. I have read about herpes "shedding" how does that play into the likelihood of getting herpes from cunnilingus or recieving fellatio?  5. Am I correct that there is no risk for Chlamydia outside of the NGU kind? I am feeling scared that this could cause my wife to change her mind again.

[Edward W Hook, MD]

Welcome back to the Forum.  I agree with the general statement you have made.  Let's get directly to your questions:

1.  Obviously I cannot give you a numerical answer to this question.  I presume that you have been back from your trip and that it has been at least a week since the exposures you describe.  If this is the case, the chance that you have gonorrhea is miniscule.  Over 95% of cases of gonorrhea cause symptoms and you would have experienced them by now.  As for NGU, about 40-50% of cases can be asymptomatic.  Thus this is 40-50% of relatively low probability to start with.  Probably not a lot to worry about.
2.  Testing for gonorrhea and NGU is reliable any time more than 3-4 days following exposure.
3.  Oral herpes occurs primarily on the lips, not inside the mouth.  Syphilis inside the mouth is also rare.  In either case, if you had gotten infected it would be expected that you would develop lesions -at 4-10 days following exposure for herpes and by 21 days (3 weeks) following exposure for syphilis.  If that amount of time has passed and you have not developed lesions, you have little to worry or nothing  about.
4.  Herpes can be present on infected surfaces without lesions., This is called asymptomatic shedding and accounts for a large proportion of HSV transmission.  When it is transmitted however, as I said before, you would expect to see lesions.
5.  Chlamydia causes 30-40% of NGU. Thus if a man gets NGU from vaginal sex, he MAY have chlamydia.  On the other hand, if a man gets NGU following receipt of oral sex, he does not have chlamydia since it is not transmitted by oral sex but he may have non-chlamydial NGU.


Hope these answers are helpful to you.  Your risk is rather low but in your efforts to get back with your wife the stakes are rather high.  My advice would be to go to your local STD clinic for a thorough evaluation.  EWH  

[flyer80]

Thank you for your answers. Two quick follow up questions. 1. It has not been three weeks yet, but has been more than one. So I guess Herpes and Syphillis (syphilis) are still possibilities?   2. I agree that I should get checked, but as a practical matter my concern is that if an std clinic shows up on my insurance it will raise serious questions for my wife. Due std clinics generally bill confidentially or can I go to another doctor who may not specialize in std's, but does have the ability to run the tests? Thank you again. Best wishes,

[Edward W Hook, MD]

1. I suppose syphilis is possible but unlikely - syphilis is rare.  In particular, without lesions appearing by now, you can be confident that you did not get HSV.
Most STD Clinics do not bill insurance for just the reasons you ask.  You can inquire.  If you have to pay, it will be much, much cheaper than what you would need at a private physician's office.  Sometimes going to other physicians works and sometimes it does not, depending on what they spend most of their time doing.  EWH

[flyer80]

Thank you! I found an STD clinic near here that is not terribly expensive and from the web looks like it has ome great Dr's (although I wish you and Dr. Handsfield were there since both of you have such a wide knowledge base). Based on some other posts I think I may need to wait a little to go though because I had a sinus infection when I returned to the U.S. (I get them sometime from allergies) and got a z-pac after returning (5 day pack, with another 5 days in the system). I take the last dose tomorrow and then it lasts for five more days. I promise this is the last question, but should I wait until then for Gon., NGU & syphillis (syphilis) tests? I know it wouldn't effect Herpes. Thanks again. I have gained a lot of reassurance from your posts. Best wishes,

[Edward W Hook, MD]

The Z-pack will markedly reduce any risk you might have had for NGU or gonorrhea.  How much effect on syphilis it might have is less clear.  EWH