concerned...

my questions were partially covered in your reply to jdt101, thanks. but i thought i should post to complete the picture.

i saw a mature escort two days ago.  this was the first time for me and i've had only one sexual partner prior to this (whom i'm married to).  so now i'm concerned, given that the escort, i don't believe, practices safe sex with her customers.

here's what happened:  i'd planned to receive protected fellatio, but kind of lost my mind in the middle of it.  i did not have intercourse with her, but she did give me unprotected oral while i was lying prone (i.e. her saliva and gravity working down the urethra?).  we did french kiss and did rub groin to groin.  with my hands, i did not finger her between the legs though i did massage her all over.  i did shower after, and again within the hour at home.  also did probably ineffective things like use rubbing alcohol on my hands and penis and gargling with listerine.....

i'd like to know what i am at risk for (HIV & all the usual suspects) and what follow-up tests i should get and when (so that i can either rest easy or get treated).  also, should i go to my primary care physician or to an STD clinic?

btw, thanks for being here for all of us.  your wisdom and advice goes a long way in helping our bodies and our souls.

[H. Hunter Handsfield, M.D.]

No, your risk for HIV or most of the standard STDs--chlamydia, gonorrhea, hepatitis B, HPV--is very low (virtually zero) from that exposure.  There is some risk of herpes due to HSV-1, the usual cause of oral herpes but transmissible by oral sex--but that is unlikely unless your partner had a visible outbreak of oral herpes (cold sores).  Nongonococcal, nonchlamydial urethritis (NGU) due to oral bacteria may be possible, but isn't dangerous and probably not something you would transmit to your wife or other partners.  So I woldn't get any tests at all, unless symptoms (such as urethral discharge or genital lesions) develop; if no symptoms after 2 weeks you can consider yourself home-free.

That said, many people in your situation remain nervous about HIV despite being reassured of extremely low risk.  If you will sleep better with the reassurance of a negative HIV test, do it about 4-6 weeks after the exposure.  As to where, either a primary care physician or a public health STD clinic can do it, but the latter  will be cheaper and perhaps more expert at assessing the risks and providing further advice.

Good luck--  HHH, MD

[johnjohn]

Thank you for the response and your advice on HIV testing.

I just have a few clarification questions:

1.  Are there any STDs, particularly Hep A or B, that are sometimes asymptomatic?  And if so, should I get tested for any of those after a certain period.

2.  The cold sores that you mention, would they be around the outside of the mouth or inside or both?  I am wondering whether it's possible for them to have been only on the inside and undetectable upon casual observation.

3.  Can a person who has been diagnosed and vaccinated or otherwise become immune to the various forms of hepatitis, transmit an active virus to one who is unvaccinated?

4.  I have small children in the house (2 & 4).  I am very affectionate with them and kiss them on the cheeks.  At this time, should I be concerned about transmitting something via saliva or mouth?

Thank you.

[H. Hunter Handsfield, M.D.]

Yes, most STDs are asymptomatic most of the time, including hepatitis.  But the exposure you described doesn't risk hepatitis A, B, or C.  Cold sores are on the lips or around the mouth; recurrent herpes lesions occur rarely, if ever, inside the mouth.  No, an immune person can't have the infection, therefore can't transmit it to anyone; an immune person has nothing to transmit.  Even if you had acquired an STD, you cannot transmit anything to your kids; .  The only conceivable exception in this context would be hepatitis A or type 1 herpes.

Don't obsess about this; your risk truly is as close to zero as you can get.

HHH, MD