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Unprotected Oral

Hi Doctors,

I'm not sure what to do. Last night I went to a strip club. During the private dance, the stripper performed oral sex on me without a condom.  This lasted for about 5 minutes.  At this point, the woman/stripper actually tried to go ahead and put my penis insider her.  I asked her if she had a condom and she said no.  Because she had no condom, I did not want to have intercourse.  So, she continued to perform unprotected oral sex on me.  Normally, I wouldn't be overly concerned after reading the archives on the STD and HIV forums, but this particular event has gotten me really nervous because of the fact that she tried to have unprotected intercourse with me.  She was African American and this was in the US.

My questions are:

1. What should I look out for in regard to STD's?
2. Should I start PEP because of the unprotected oral that was performed on me and her behavior seems quite risky?
3. How would you rate my risk for STD and HIV?

Also, this event has given me a wake up call.  I'm married, and this has gotten to me such that I don't want to do anything like this ever again. Looking back, I have had unprotected oral sex performed on my by about 7 different strippers over the recent past.  I'm confused about the risk of HIV as to being either 1/10000 or 1/20000. Having had 7 incidents of unprotected oral performed on me, does that mean that my risk in regard to HIV would be 7/10000 or 7/20000, making my risk higher?

Thanks very much for your help
10 Responses
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Avatar universal
Thanks Dr. Hook. That's all I needed to hear- no more questions from me. I'm sorry if I asked too many questions, didn't mean to be counter productive here. I'm moving on and just wanted to thank you for your generosity.
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
I said before that there would be no further answers but they seem to keep coming. From the sounds of things the evaluation you had was superb and I agree with everything that you were told.  FINAL ANSWERS

1.This is normal procedure
2.  No concern.
3.  This is the right test- you do not have NGU
4.  I would not be concerned,  I have interns drawm my blood.
5.  This evaluation was good and sounds as though it was well performed.  Time for you to stop worrying.  I do note that the clinician you saw agreed that your urethra was red but has ruled out STDs.  The redness could be from repeated self examination (if you are) or, if it persists some other, non-STD dermatological problem.  If it does not worry you optherwise, now that STDs have been ruled out, I would just try to wait it out.

Glad you were able to get evaluated. There will be no more answers. EWH
Helpful - 0
Avatar universal
Thanks for the directing me to a local health department, Dr. Hook!  I went to a walk in STD clinic at my local dept. of health today and was happy to find out that the woman who saw me seemed familiar with NGU.  I told her that I had some burning when I urinate but no discharge.  She said that anything non-gonorrhea is basically NGU, also telling me that chlamydia is a form of NGU.  She told me that she would take a swab from my urethra and look at it from under the microscope.  She told me she would be able to see signs of infection by white blood cells and probably be able to see the gonorrhea bacteria, if present.

She said the opening to my urethra looked red.  When she gave me the results; however, she said that she saw no white blood cells or signs of infection from the test.  I was obviously happy with this, but have some last remaining questions.  She also tested me for syphilis because it was protocol for them.  Questions:

1. I though the swab test was a gentle wiping of the urethra, but this was a long thin instrument that she actually inserted pretty deep inside my urethra, which obviously hurt a bit.  Is this the normal procedure for a swab test?

2. When I entered the patient room there was someone else's urine sample there. Without gloves on, she grabbed the sample and went into another room where I could hear her dump it out. Then she put gloves on and did my urethra test.  Is that a concern?

3. She said that she saw no white blood cells on the sample under the microscope, but official results would come from the state lab in a week. Based on this, did I have the right test done and can I be certain I don't have NGU?

4.  I agreed to let an intern perform the blood draw for syphilis.  Is this a concern or should I assume the intern knew what she was doing in terms of safety?

5. Is it more likely that this "burning" I feel is just in my head, and I should put this behind me (which I will do if you tell me you think everything is ok)?

Thanks again for pointing me in the right direction for testing!  I was getting quite worried that nobody was familiar with NGU until I went to the dept of health.  This was a big relief to get this testing done!
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
1. I'm assuming that NGU is not the same as Tichonomas?
Trichomonas is one cause of NGU but by no means the only one.  Why not just go to your local health department.

2. Should I try to pursue NGU testing, it seems hard to find?
Should not be.  See above.

3. This burning when urinating- in the absence of discharge could it be more psychological or should I just get treated? I was on doxy earlier in the year and didn't want to take another dose if unnecessary.
I don't recommend treatment without a diagnosis, particularly in a low risk person such as yourself.

4. Any value in the negative hiv rapid test at 10 days after exposure?
Very little.  As I siad earlier however, HIV is not spread by oral sex.,   Testing related to the exposure you described is a waste of time and money.  \
5. I won't post any more questions, but can post an update of my gonorreha results when they come?
Yes you may.  I am confident the result will be negative.

Take care  EWH

Helpful - 0
Avatar universal
Hi Dr. Hook,

I went this past Friday for a gonorrhea test that they said will take until the end of the month to get the results back. They said it goes to the state lab. I asked about NGU testing, and it sounded as like the woman said NGU is trichomonas, saying something similar to a parasite.  At that point, I elected to just get tested for gonorrhea and had a HIV rapid test done for prior oral exposures.  The HIV rapid was negative.  My concern is this NGU possibility in the meantime.  I haven't had any obvious discharge other than that clear liquid a couple mornings- no irritation at the urethra and no color white or green discharge. Since day 7 or so, I have noticed some burning when urinating.  These will be my last questions, as I appreciate your time and don't want to waste it:

1. I'm assuming that NGU is not the same as Tichonomas?
2. Should I try to pursue NGU testing, it seems hard to find?
3. This burning when urinating- in the absence of discharge could it be more psychological or should I just get treated? I was on doxy earlier in the year and didn't want to take another dose if unnecessary.
4. Any value in the negative hiv rapid test at 10 days after exposure?
5. I won't post any more questions, but can post an update of my gonorreha results when they come?

Thanks for all the help.
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
1.  Yes, they should.
2.  It is a test for white blood cells, either in a urine specimen collected just as urination begins or in a swab specimen from the penis.
3.  It means gonorrhea is very unlikely.
EWH
Helpful - 0
Avatar universal
Thanks Dr. Hook.  I'm going to get tested for gonorrhea tomorrow at Planned Parenthood. Having been there before for std testing, they never offered a test for NGU.

1. Do all places, like Planned Parenthood, offer testing for NGU?
2. What kind of test is it for NGU when no discharge is present (regular urine test)?
3. Tomorrow will be day 10 since my exposure and haven't noticed any colored discharge or pus. Does this mean I should didn't catch gonorrhea?

Many thanks Dr.
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
1. Does this liquid that I saw leaking from my penis after waking up seem like gonorrhea or NGU (thus far, I haven't seen anything later on during the day)?
No this oes not sound like an STD, STD symptoms tend to occur throughout the day and do not come and go.  

2. What is the time frame that symptoms would develop for gonorrhea, NGU, and herpes?
Typically symptoms would develop in 3-5 days with gonorrhea or NGU an before 14 days ha passe for herpes.  

3. Is it safe to have sex with my wife before I get tested for gonorrhea and NGU?
It is probably safe to have sex with your wife.  If you plan to get tested however, why not wait until you have your test results.

4. Does that urine test (dip stick test) that just showed vitamin C and no white cells 3 days after my exposure have any value?
If there had been increased numbers of white blood cells it might have suggested a STD.  The fact that none were seen is good news.  EWH

Helpful - 0
Avatar universal
Hi Dr. Hook,

Thank you for answering my question last week.  Tomorrow will be 7 days since my exposure, and I just wanted to run the following by you. I haven't noticed any thick or colored (white, green, yellow) discharge coming from my penis, and I haven't really noticed burning when urinating.  There were 2 morning, however, when I went to urinate after waking up and saw a thin clear liquid leaking out of my urethra. I wasn't sure if this was a STD symptom or if it was from having had an erection during the middle of the night, which I did have (this was like 3 days ago and also this morning).  In the meantime, I have been examining my urethra by opening it up and trying to squeeze some discharge out, but nothing has come out, with the exception of these two mornings that I mentioned.

I went to a my doctor 3 days after my encounter for something different but asked him to check my urine anyway.  He said lots of vitamin C (I drank orange juice 30 min before), but no white cells in the dipstick test.

I read online that gonorrhea symptoms occur more in the morning and wanted to see what you think about:

1. Does this liquid that I saw leaking from my penis after waking up seem like gonorrhea or NGU (thus far, I haven't seen anything later on during the day)?

2. What is the time frame that symptoms would develop for gonorrhea, NGU, and herpes?

3. Is it safe to have sex with my wife before I get tested for gonorrhea and NGU?

4. Does that urine test (dip stick test) that just showed vitamin C and no white cells 3 days after my exposure have any value?

Thanks for your response and your help.
Helpful - 0
300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome to the Forum.  I'll be please to comment, starting with the most important advice I can provide- you have no reason to worry about HIV and if I were to see you in my practice there is simply no way I would prescribe PEP for you.  Now let's go into more detail, HIV first.

The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  After looking for evidence for HIV transmission following either giving or receiving oral sex, Dr. Handsfield and I have come to the conclusion that there is virtually no risk and that the risk of such infection is so low as to be useless to even test following exposures such as the ones you describe.

As for other STDs, oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through 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 develop gonorrhea or NGU you will most likely develop symptoms of urethritis (penile infection).  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  In your case, following this single exposure I would urge you not to worry. If you are concerned, you could go to your local STD clinic or health care provider to be tested at this time.  

finally, the issue of cumulative risk is just that, cumulative. Thus if you assume that the risk of HIV, IF all of your oral sex your partners had HIV, your risk would be 7 X 1 in 10,000 or less (we would say far less).  Overall, your risk of getting hit by lightening is far higher than your risk of having HIV form the exposures you describe. EWH
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