Unprotected Oral from Sex Worker

[macca1979]

Hi Doctors,

I'm looking for some advice (and hopefully reassurance) regarding a recent exposure.

I received unprotected oral sex from a sex worker (street worker not a call girl). It was brief (less than 5 minutes), fairly gentle and I did not ejaculate in her mouth. She also sat on my legs at one point and I'm sure there was some brief genital-to-gential contact (her vaginal area may have brushed against the shaft of my penis).

I have a few questions for you:

1. Based on this oral exposure, what STDs/STIs have I foolishly put myself at risk for? From my understanding this includes, in order of most likely to least likely, gonorrohea, NGU, herpes and syphilis. How quickly would I expect to see symptoms if I have contracted any of the above?

2. I'm also wondering if the brief contact of our pubic regions could be enough to pass on pubic lice if they were present in the partner? Would there be any harm in applying a public lice lotion in any case?

3. If I decide to get tested, how long should I wait?

I appreciate that this question is similar to others posted on this forum but any reassurance you could give would be valuable as I am worried sick.

Kind regards

Steven

[Edward W Hook, MD]

Welcome to the Forum.  You are correct, the question posted immediately before yours (   http://www.medhelp.org/posts/STDs/STDs-from-Oral-sex-and-menses-or-other-blood/show/1365504 )  dealt with some of the same topics.  You may wish to review my answer there after you have read my response to you.  

Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through receipt of oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you had gotten gonorrhea or NGU (actually, NGU is probably more common than gonorrhea) you would most likely developed symptoms of urethritis (penile infection) within 3-5 days of exposure.  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection. For testing you can go to your local STD clinic or health care provider to be tested for the most common problems (gonorrhea and NGU) at any time more than 3 days following exposure.

We do not recommend routine testing for herpes in situations such as yours and the risk of syphilis is tiny however, you cannot get a definitive blood test for syphilis until about 4 weeks after exposure.  

I hope these comments are helpful.  EWH.  

[Edward W Hook, MD]

No, for several reasons.  Condom protected sex is safe sx and you now have testing proof that you do not have an STD  BTW, I would point out that it is not uncommon for women to get bladder infections (cystitis) due to sexual activity.  Try not to worry. EWH

[macca1979]

Doctor, plesae forgive me for re-opening this discussion but I'd really appreciate your advice on an unexpected (and hopefully unrelated) turn of events.

Having been tested for gonorrhea and NGU on the fifth day after exposure, I received negative results. On the 7th day after exposure I had protected sex with my girlfriend but within 12 hours she was complaining of extreme cystitis-like symptoms including pain when urinating and blood in her urine.

Considering the swift onset of these symptoms, is there any way they would be related to my indiscretion? Also, although we used a condom, I did put it on the wrong way at first so the outside of the condom did touch the tip of my penis. Would this be enough to transfer bacteria and cause infection.

Thank you in advance for your answer and I promise it will be my last on this subject.

[Edward W Hook, MD]

Yes, you can be confident that your test results will be accurate when tested for common STDs at 4 days. That you had urinated an hor before is OK as well.  EWH

[macca1979]

Hi Doctor,

Thanks again for the feedback, it has helped put my mind at rest.

Since posting, I have been tested and due to receive the results tomorrow.

One last question. I have been tested 4 days after the exposure (for bacterial infections) and provided a urine sample which was taken around an hour after I last urinated.

Bearing all this in mind, if the results come back negative, can I be sure that they are accurate?

Thanks

[uchimataman]

Your answer above has ended weeks of worry.  Thank you. Thank you.  Thank you.

[Edward W Hook, MD]

Pubic lice would be uncommon.  If you have them, youshould be able to see them.

The presence of an intact foreskin appears to increase risk for some STDs (the ones that cause genital ulcers- herpes, syphilis) somewhat, if exposed.  Your phimosis however does not change my opinion or recommendations regarding your risk for STDs.  EWH

[macca1979]

Thanks Doctor, your comments are helpful and the service you provide is invaluable and unique in my opinion.

Just one follow up question:

I have phymosis and I was wondering if this can be a contributing factor in contracting STDS i.e. does it make more or less likely or is it not a factor at all.

Also, how likely is it that I may have contracted pubic lice in this situation?

Thanks again