STDs Expert Forum
Unprotected oral sex, genital rubbing and protected intercourse with co...
About This Forum:

The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

Unprotected oral sex, genital rubbing and protected intercourse with commercial sex worker - risk for HIV/other STDs?

I am a 30 year old male. Being heavily inebriated 3 nights ago, I had unprotected oral sex with 2 sex workers and intercourse with a condom on with one of them.
With the first sex worker, I french kissed her, fingered her vagina and anus and then she performed oral sex on me. I ejaculated in her mouth. The entire exposure lasted about 20 mins.
With the second sex worker, I french kissed her and fingered her vagina and anus. I also rubbed the side of my penis against her genital area - she did have a thin underwear on which i kept pushing to the side, so i will assume my penis made direct sideways contact with her genital area. This sex worker's vagina was very wet (on reading various literature on the internet, I am a little scared if it was discharge due to an STD that she had). Then I had intercourse with her with a condom on, for about 7-10 mins. After that she performed oral sex on me for a couple of mins. without the condom. I did not ejaculate this time.
This place is a busy operation, so I assume there would have been other men before me who would have done similar acts, putting me at higher risk.  I went to see my doctor today who told me to come back in another 4 days to get blood and urine tests done.
I want to know what is the likelihood that I get HIV, or any other STD? And which ones are more likely than others in this situation. Also, how early do the STDs show up in tests? Since then I have not had sex with my spouse - should I not have sex with her at all or protected sex until I find out? I do not want to pass on anything to her at all.

- Outstressed
Related Discussions
239123_tn?1267651214
Welcome to the STD forum.

You are over-analyzing the situation.  Oral sex and condom-protected vaginal sex are low risk for all STDs, although not zero risk for some of them.  Fingering is zero risk for all practical purposes, and non-penetrating contact with genital moisture carries theoretical but quite low risks for HPV, herpes and (rarely) syphilis.  All these risks are low enough that you really don't need STD testing at all, and certainly there is no need for HIV testing -- at least not on medical or risk assessment grounds.  (Whether you need testing for the psychological reassurance benefit of the negative results is up to you.)

Urine testing for gonorrhea and chlamydia is fine any time.  Although your doctor apparently wants to wait until a week has passed, that delay probably isn't necessary.  As for blood tests, it impossible that anything will show up that soon; it takes 4-6 weeks for syphilis and HIV blood tests to become positive.  If you have blood tests in a few days, perhaps your doctor is doing it as a baseline against which to compare the results of additiona testing in a few weeks.

As for sex with your wife, no distant online expert can guarantee it is safe.  But if I were in your situation, knowing what I know about STD and HIV risks, I would continue unprotected sex with my wife without fear of giving her anything.

I hope this helps.  Best wishes--- HHH, MD
22 Comments
Blank
Avatar_n_tn
Dr. Handsfield
I really appreciate your response. It alleviates my anxiety to a great degree. I still have a couple of follow up questions.
After reading a lot on the internet, what i am really concerned about is herpes, syphilis and HPV. First of all, are those the ones I should be the most concerned about? And what do you think are the odds of having contracted any of those?
Second, I have developed a rash on my glans (glands) about the size of a penny coin. Upon closer look, this is comprised of very tiny red blisters. There are also 4-5 of these blisters outside of the rash and on the inside of the foreskin (i am uncircumcised). The rash has become itchy over the last one day. I have also been noticing a strange sensation at the opening (tip) of the penis - it is not pain and not itch but there is a sensation there (if i press the glans (glands) i can feel it even more). Could these be symptoms of herpes?    

I would be really grateful if you could answer those questions.

- Outstressed
Blank
239123_tn?1267651214
The risk of syphilis is zero for practical purposes.  Herpes almost as low risk as syphilis.  No way to measure HPV risk, but every sexually active person gets genital HPV from time anyway, generally with no important health consequences.

My bet is you are examining yourself too closely and nothing is really abnormal. But the only way to know for certain is to see a health care provider.  Feel free to report what if found when you are examined.  
Blank
Avatar_n_tn
Thanks again for your comment and reassurance. This morning I woke up with a burning sensation on the rash, the entire head of the penis and urethra. I also had some trouble passing stool. The burning has been continuous since morning. I am also using the bathroom more frequently than usual. The rash has become more prominent than last night. Is it herpes? Should I rush to the physician and get the blood/urine tests pre-poned to Thurs instead of Friday. Also, any other tests that you recommend.
This morning has stressed me out after I felt ok last night.

- Outstressed
Blank
239123_tn?1267651214
"...the only way to know for certain is to see a health care provider.  Feel free to report what if found when you are examined."
Blank
Avatar_n_tn
Thanks for the response. Over the past 12 hours, the rash has grown and I see many more tiny blisters on the inside of the foreskin. I am going in for the tests tomorrow. Do you know how long does it take for the results to come out (blood and urine tests). Is there anything else other than herpes which can cause these? I am FREAKING out. Can the tiny blisters spread so quickly? The rash appeared 2 or 3 days after exposure and now there's blisters in a day of that. Please help!

  
Blank
239123_tn?1267651214
"...the only way to know for certain is to see a health care provider.  Feel free to report what if found when you are examined."  ... and not until then! ...especially since you're seeing a health care provider in less than 24 hours.  (Do not just get tested at a lab without personal evaluation by a health care provider.)  You may not keep asking every addtional anxiety-provoked question that comes to mind.
Blank
Avatar_n_tn
I saw my doctor today. Right off the bat he said there's an 80percent chance that it is herpes. He has started me on valtrax. The results will come in on monday. Now realistically speaking, what is the risk of HIV? I have refrained and will be refraining from sex with my SO until the results are out. Any advice here?
Blank
239123_tn?1267651214
I hope he swabbed the lesions to test for the virus directly by culture or PCR.  If not, call and make sure that is done immediately, preferably before you start taking the Valtrex -- but even if you started the drug, testing probably will still be valid for 1-2 days.  This is not a situation that should depend only on blood tests for diagnosis.  And if the culture or PCR is positive, make sure the virus type (HSV-1 or 2) is determined.  Some labs don't take that step unless it is specifically requested.  Most likely it's HSV-1, since the unprotected oral sex is the likely exposure.

As discussed above, oral sex almost never results in HIV transmission, with or without herpes.  For maximum security you might want to have an HIV test about 6-8 weeks after the exposure, but you can expect it to be negative.  It's not a realistic possibility.

Let me know the test results when available.
Blank
Avatar_n_tn
If it is HSV1 or HSV2 - it will be detected in either the blood or urine or the swab test - correct? Wanted to know if there's any chance that it does not get detected because it has only been 5 days. The symptoms are there. Also, can I spread it by kissing as well to my SO?
Blank
Avatar_n_tn
If it is HSV1 or HSV2 - it will be detected in either the blood or urine or the swab test - correct? Wanted to know if there's any chance that it does not get detected because it has only been 5 days. The symptoms are there. Also, can I spread it by kissing as well to my SO?
Blank
239123_tn?1267651214
If your doctor has diagnosed herpes lesions of the mouth, it could be spread by kissing.  If your herpes is only genital, it can only be transmitted by genital contact.

There is no urine test for herpes.  The swab test is the important one at this point.  Do make sure they type the virus.  As I said above, I expect it to be HSV-1, not HSV-2.  The blood test probably will be negative; positive results take a few weeks.  That's why the swab test is important.  The blood test will be useful as a baseline; in case the swab test is negative, blood can be tested later to if it turned positive.

You will undoubtedly have lots of questions about herpes.  But let's hold off on them until we know the test results.  In the meantime, do some reading on your own.  Some websites with excellent genital herpes information are the American Social Health Association (http://www.ashastd.org), the Westover Heights Clinic of Portland, OR (http://www.westoverheights.com), and CDC (http://www.cdc.gov/std).  Full disclosure:  Dr. Hook and I are on ASHA's board of directors and WHC is run by Terri Warren, moderator of MedHelp's herpes forum.
Blank
Avatar_n_tn
I spoke to my doctor but he insists that I do not need the swab test. He says that blood test is better and because the bumps are very small at this point nothing will show up. It almost got to the point of argument with him. What should I do if he is not prescribing the swab test. Can I get it done on my own? He says the blood test will well determine the type as well. Also he says I do not need PCB.
Blank
239123_tn?1267651214
Herpes doesn't cause "bumps" that are not blister or pimple-like lesions, that then open up and later develop scabs.  Your description of "bumps" makes me question whether this is herpes after all.

STD experts always recommend direct culture or PCR when new herpes is suspected, unless the lesions are well on the way to healing.  But if the lesions already are dry and healing, it may be too late for culture or PCR.  And if the description of "bumps" is accurate, your doctor may be entirely correct in not recommending culture or PCR.  But if there are persisting blisters, pimple-like lesions, or open/raw sores, then testing probably would be positive if herpes is the cause, especially by PCR.  The blood test definitely is not "better".  If that's all that is going to be done, it probably will work out, especially if your current test is negative for HSV.  In that case, a repeat test will probably sort things out in a few weeks.  However, it will take that long for you to know for sure whether or not you have herpes, and maybe not even then, since 10-15% of people with HSV-1 never get positive blood tests.

You might consider printing out this reply and showing it to your doctor. Alternatively, you could visit your local health department STD clinic and get both a second opinion about the cause of the problem and maybe a culture or PCR.

I don't know what PCB means.
Blank
Avatar_n_tn
Thank you for your response earlier. I meant PCR when i said PCB.

So here are the detailed symptoms - There is a large red rash on the upper side of my glans (glands) - right in the middle. On this rash, there are very tiny red bumps. Sometimes the bumps go away and look like a rash may be a skin inflammation. Sometimes they are slightly visible. When I pull down the foreskin, the inside skin on the shaft - below the glans (glands) big rashes on both sides which are not going away. These rashes look like they are full of minute blisters - but sometimes it looks like just the texture.
I also noticed 3 small blisters on my upper left thigh inside - with a reddish base and white heads but each one of them has a hair growing right through them. One similar one on the right thigh. I also have 2 small red bumps on my left arm.
I also have a pimple on my left cheek - which has come up in the last 2 days.
The burning on the penis comes and goes - it is pronounced after i check the bumps (i do that 5-6 times a day).

Starting today, I have developed a pain in my upper back, right in the middle, my neck, and my right thigh. Also i get some tingling in entire arms. My legs and arms feel very weak - a couple of times I couldn't even type or walk. Are these typical symptoms - it is the 6th day today.  

I plan to visit the STD center tomorrow or day after and see if they can do the swab test. I have started the valtrex though as i do not want the symptoms to get worse.

Could you please let me know if it is herpes? And I apologize for asking so many questions - you can imagine my anxiety.

- Outstressed
Blank
239123_tn?1267651214
From the expanded description, I doubt you have herpes.  But let's see what they say at the STD clinic.
Blank
Avatar_n_tn
I just woke up and despite good sleep, i have the weakness in my legs and to some extent the arms.
The bumps on the inside of the foreskin seem to be developing into a read elevated rash running across the penis - it is beginning to give the appearance of a sore now.
On the left arm, it seems like there are more bumps coming up around the existing ones. There seem to be 2 bumps coming up on my hand as well.
I did start the valtrex last night.
Does it still not seem like herpes?
Blank
239123_tn?1267651214
No, it doesn't sound like herpes and for sure the weakness and hand lesions aren't herpes.  Report back after the STD clinic visit but let's hold off on other comments until then.
Blank
Avatar_n_tn
First of all I want to extend a big thank you for all your help and your patience. I just came back from the STD clinic. The doctor examined me very thoroughly and patiently answered my questions.
He thinks that the bumps/rash on my penis is a likely a fungal infection which will either go away on its own or I can use 1% clotrimazole cream. He does not think that it is herpes and said that there was nothing to swab there.
He also thinks that the bumps on the thigh, the rash inside my mouth or the face pimple are not herpes-related either.
He took the swabs from the bumps on my thigh and from the rash inside my mouth.
Other than that, he did the urine test.
He has asked me to come back in 2-3 weeks for the culture test for HIV, RPR for syphilis and at that point he will repeat the urine tests also do the blood tests. He saw no point in doing the blood tests today.

He gave me 2 tablets of Azithromycin 500mg and 4 tablets of metronidazole 500mg right there. He also gave me a Hep B shot as I was not sure if I have got it. Also, he asked me to stop taking Valtrex.

After that, he says that I should come back in another 3 months for another RPR for syphilis.  

He did advise me to refrain from sex until the results from the first culture come out. That way it will be safer for my SO.

I feel less anxious now but my anxiety will not be fully resolved until all of these are negative - so probably another 3 months or so.
I also think my GP contributed to my anxiety as he did not check me thoroughly and was quick to suggest herpes as most likely.

I just have one question for you regarding refraining from sex (not even oral) for a month. I am going to follow it to be sure. Is kissing ok - or is there risk of spreading herpes in that until I'm sure that I don't have it.

I am really grateful to you Dr. Handsfield and I think going to the STD clinic was a good decision.

- Outstressed

Blank
239123_tn?1267651214
Thanks for the thanks.  Sound like you had excellent evaluation and treatment -- I'm not sure why the antibiotic treatment, and it seems exceedingly unlikely you had any STD.  The caution against new sexual contact is also very conservative. However, you're obviously in competent hands so I won't get into that further.  In the event you do have an STD, kissing isn't a risk for transmission.

Anyway, for sure you don't have herpes.

That should end this thread.  Take care.
Blank
Avatar_n_tn
Dr. Handsfield

I apologize profusely for carrying on this post further. But I do have a few more symptoms - this time of oral herpes. 2 days ago - the day i came back from the STD specialist, I got a mild fever which lasted 1.5 days.
Yesterday evening, I noticed an elongated abrasion on the edge of my tongue - at the tip and on the left side towards the front. I can't tell if it is just an abrasion or is it a sore. I noticed a white sore on my upper gums, a little towards the right, right under the lip. This is an area which the specialist did not look at. It is not painful. Since the last few hours, i am noticing a definite tingling and slight redness on the outer edge of my entire lower lip.

- Is it possible that any of these symptoms is oral herpes? Which one is more likely - HSV1 or 2? What is the likelihood? I have not stopped taking the valtrex yet.

- I have been avoiding anything other than kissing on the cheeks with my SO (except an occasional peck on the lips)? If I do have oral herpes, could I have infected her already?

- I am getting an igg and igm test tomorrow. The online consultant told me these should be valid after 8 days of exposure. Is this correct? Should I rely on these tests?

- How long would it be before it can be concluded with any validity that i do not have herpes of any kind? What tests would be conclusive, and how long from the exposure can i take them?

Again I profusely apologize for the continuation. If you think it is better, i can start a new thread.

Many thanks
- Outstressed
Blank
239123_tn?1267651214
No, these symptoms do not even hint at herpes.  Neither HSV-1 or 2 is likely.

It takes at least 3 weeks,usually 6 weeks, and sometimes up to 3 months for HSV blood tests to become positive.  The purpose of an HSV blood test at this time is to show negative, as a baseline for future testing. I suggest you ask the doctor or clinic who orders the test to request only the IgG test and specifically instruct the lab not to run the IgM test, which is never helpful and often isleading.  Here is a thread that explains why:  http://www.medhelp.org/posts/show/541451

Since you are now under the care of an STD specialist, it is inappropriate to continue to seek advice here.  Rely on that doctor.  That will end this thread; I will delete any further comments.
Blank
Continue discussion Blank
This Forum's Experts
239123_tn?1267651214
H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
300980_tn?1194933000
Edward W Hook, MDBlank
University of Alabama at Birmingham
,
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
242532_tn?1269553979
Blank
The 3 Essentials to Ending Emotiona...
Sep 18 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank