Unprotected Oral Sex/Rimming Concerns

I visited a sex worker in a legal brothel in Australia for the first time.The sex worker first stuck her tongue in my anus kissed and licked my legs and genital area, then spat into a tissue and without washing her mouth proceeded to give me unprotected oral sex for 5 minutes (concerned about the transfer of my faeces to me penis). After the unprotected oral I had sex with her with a condom on covering my entire penis. 2 Days later I started feeling pain in my perineum so I was prescribed 1g single dose azythromycin which after about 6-7 days I think did the trick and now I don't have the pain anymore. I took a urine test and blood test at 8 days after exposure (all negative except positive for oral herpes - HSV1). Urethral swab and normal urine test was also negative so I presume I didn't have anything to start with or the azithromycin did it's job. I am thinking of taking a 10 day dose of doxycycline also as I sometimes get random feelings of pain in my perineum.
1. After 8 days with a negative result Gonnorhea (Gonorrhea), Chlamydia and NGU can be ruled out right? (I am having another urine test at 2 weeks just to be 100% sure). Is there a chance all of a sudden in a few months time these will suddenly pop up or am I in the clear for these?
2. Due to receiving anal sex should I also take an anal swab or was the urethral swab and urine test enough evidence I don't have gonnorhea (Gonorrhea) or ngu?
3. Is it true Syphyllis is rare in heterosexual sex? Is it possible some gay men with syphyllis went and saw this prostitute and passed syphyllis to her?
4. When do you recommend I take my next blood test?
5. Because I have oral HSV1 does that mean my chances of getting genital HSV1 is low? Could I still have contracted HSV-2?
6. Because my oral HSV1 infection and the low chances of getting Syphyllis am I most likely in the clear and can I return to unprotected sex with my partner?
7. Should I be worrying about trichomoniasis, chancroid, HPV or anything else from my encounter?

[Edward W Hook, MD]

Welcome to our Forum.  This was a low risk exposure for a number of reasons.  First, it was unlikely that your partner had an STD- commercial sex workers at licensed Australian brothels are required to be regularly checked for STDs and, as a result, this person was less likely to have an STD than someone you picked up at a bar.  Second, you used a condom for genital sex- condoms work.  Third, as you have already learned from the STD Community site, few STDs are transmitted by oral sex- rimming is a form or oral sex.  Fourth, even if your partner was infected, most exposures to infected partners do not lead to infection.  Fifth, ill-defined perineal pain is not a typical symptoms of STD, but is a symptom of anxiety, as is scrotal discomfort.  And finally, the azithromycin you took would cure or prevent most STDs.  Thus for all of these reasons, infection is unlikely and not something I would worry about.  

With these general statements, let's work through your specific questions:
  

1. After 8 days with a negative result Gonnorhea (Gonorrhea), Chlamydia and NGU can be ruled out right? (I am having another urine test at 2 weeks just to be 100% sure). Is there a chance all of a sudden in a few months time these will suddenly pop up or am I in the clear for these?

The tests are highly reliable and the antibiotics would have most likely taken care of these problems if they' occurred.  There really is no need for additional testing.

2. Due to receiving anal sex should I also take an anal swab or was the urethral swab and urine test enough evidence I don't have gonnorhea (Gonorrhea) or ngu?

Infections of the anus are only diagnosed with specimens taken from the anus.  The chance of anal infection however is low, particularly after your antibiotics.  To be 100% sure you could seek a test at this time but if you do, I am confident it will be negative.  

3. Is it true Syphyllis is rare in heterosexual sex? Is it possible some gay men with syphyllis went and saw this prostitute and passed syphyllis to her?

Anything is possible but syphilis is rare among heterosexual men and women at this time.  Further, your azithromycin likely would have prevented syphilis if exposed.

4. When do you recommend I take my next blood test?

Your blood tests for syphilis will be conclusive at 6-8 weeks.  HIV blood tests are reliable at 8 weeks.  We o not recommend bloo tests for herpes diagnosis- if you do not develop lesions, you should not worry.  

5. Because I have oral HSV1 does that mean my chances of getting genital HSV1 is low? Could I still have contracted HSV-2?

Correct, you will not get HSV-1 again, at any site.  HSV-2 from oral sex is a very, very rare and not a meaningful concern.   If you had gotten HSV-2 from this exposure, you would have had an outbreak by now

6. Because my oral HSV1 infection and the low chances of getting Syphyllis am I most likely in the clear and can I return to unprotected sex with my partner?

If I were you, I would not worry about unprotected sex with my partner.

7. Should I be worrying about trichomoniasis, chancroid, HPV or anything else from my encounter? .
No, it is time for you to move forward.

I hope my comments are helpful.  EWH

[metink11]

Hello Doctor, thanks so much.

Just a few further comments please.

Even after the azythromycin I still feel an occasional pain in my perineum. I also have  irritation of my anus and it appears red and there is a line running from my anus along my perineum (I'm not sure if this is ghonnorea or just from the diarrhea as a result of my antibiotics).

On Saturday I also got red spots on my buttocks and on the front of my waist near my pelvic bone, they are very tiny and have a small black dot in the middle. I was scared these were Herpes but they have been the same size for 5 days now. One doctor said folliculitis, one doctor said sweat rash and the other was unsure. I do not know what to think and am scared this is herpes as some people have stated the first outbreak is very mild and unnoticeable ( I just don't want to pass it to my girlfriend of 6 years).

Just one final thing, I just held my urine today for approximately 4 hours due to work and I noticed I was getting pains in my stomach area (possibly bladder), this never used to happen prior to my encounter I used to be able to hold my urine for a long time with no pain. Even after I urinated I still feel the slight pain in that area. Is it a bladder infection??

I am thinking of consuming the doxycycline to cover my bases in case it is an infection, and at the same time I will be treating my possible folliculitis? What do you think doctor?

Thanks and sorry for bothering you

[Edward W Hook, MD]

I think you are over reacting.  There is almost no possiblity that you have gonorrhea and the "perineal pains" that you have are not compatible with any STD.

Folliculitis and "sweat rash" are two words for the same process.  

Pain in the pelvis following holding your urine for a prolonged period is to be expected and is not a sign of STD or UTI.

The fact that you have seen three doctors about your concerns, as well as posted here suggests to me that your guilt/anxiety over this exposure is getting the better of you.  Believe the doctors and the tests that have been performed and relax.  You need to move forward, not perseverate on the past.  EWH

[metink11]

Okay I am also freaking out now, it seems as if the perineum pain is comeing back. I have started to do frequent urination with minimal urine even though it feels like my bladder is full. And when I press on my perineum it feels like its full of fluid. This is the same feeling which stopped for 5 days but has now returned. I am freaking out what should I do :( ?? I know I shouldn't be posting this much but I am so lost right now and think I am finally getting Chlamydia or Ghonnorea and it only showed up now. Was it possible for it to have passed my 2 previous urine tests undetected (the test used for me was SDA not PCR). Could I have prostatitis? Would holding my urine earlier have caused this?

Thanks so much, last post I promise

[Edward W Hook, MD]

You are freaking out.  As I said your ill defined perineal pain is not compatible with an STD, something that has also been ruled out by your tests (which would NOT have missed an infection).  Get a grip on yourself.  

I'll have nothing more to say.  EWH

[metink11]

Hi doctor, my 6 week results came back negative for herpes type 2, hiv, syphillis (syphilis), hepatitis and for all urinary stds. Is this 6 week result conclusive or should i continue worrying until 12 weeks? My symptoms are continuing mainly flu symptoms, very sore throat and vision/joint problems. Please help me out thanks

[Edward W Hook, MD]

Last answer - you need to believe these test results.  EWH