ANOTHER oral sex question

[LennyBruce]

Doctor,

Would you recommend or do you believe it is justified -- from a medical, not psychological standpoint -- to have any sort of STD testing after a single incident of unprotected oral sex.  I was the insertive/penile participant.  I did have a small abrasion on the tip of my penis.  The incident lasted less than a minute.  It was with a "regular" woman (i.e., not a CSW) who swears she is "clean" but I guess one never knows.

My primary care physician says no testing necessary, but I'm not sure how educated she is in STD's.

BTW, the incident was 12 days ago and I remain asymptomatic (aside from stress, that is).

Thanks.

LB

[H. Hunter Handsfield, M.D.]

In general, your doctor is correct.  Oral sex is low risk for all STDs, and most STDs that are likely to be transmitted from mouth to penis would cause symptoms.  Therefore, STD testing after single episodes of oral sex generally is not necessary in people without symptoms.  However, if the risk were especially high -- for example, if you later learned that the oral partner had infectious syphilis, or if s/he was known to have gonorrhea of the throat, testing definitely should be done.  And of course if someone is nervous and just needs testing for psychological reassurance, that should be taken into account.

Which leads me to this:  Based on your multiple questions on this and the HIV forum, as well as some of the community forums, it seems you need continuing reassurance about STD/HIV after low risk exposures.  If you are nervous after any particular exposure, the way to handle it is to just get tested; hearing the same message repeatedly from Dr. Hook or me probably isn't going to help much.  Better yet, if you can't stand the heat, consider getting out of the kitchen -- that is, stop the activities that make you so fearful.  In any case, please note MedHelp's policy about a maximum of 2 questions every 6 months in the moderated forums.

HHH, MD

[LennyBruce]

Of course you're correct -- a smart person would stop engaging in risky activity.  It's easier said than done.

Today I took the following test package:

Hepatitis B Surface Antigen with Confirmation by Neutralization
HIV-1 Antibody Screen With Reflex to Western Blot Confirmation
Syphilis - RPR (Diagnosis) with Reflex to Titer and Confirmatory Testing
Herpes Simplex Virus 1 and 2 IgG, Type Specific Antibody (HerpeSelect®)
Hepatitis C Antibody
Chlamydia trachomatis by Amplified Detection (APTIMA®)
Neisseria gonorrhoeae by Amplified Detection (APTIMA®)

Will a negative result on these tests rule out infection? (I know an HIV test after 12 days is meaningless, but it was part of the "package" so I figured it could't hurt, especially because, as I understand it, receiving oral sex is not a HIV transmission risk).

Thanks.  

[H. Hunter Handsfield, M.D.]

You did all that after a single oral exposure? What a waste of money!

Hepatitis B Surface Antigen with Confirmation by Neutralization:  HBV not rtransmitted by oral sex, and test not useful until 3-6 weeks after exposure.

HIV-1 Antibody Screen With Reflex to Western Blot Confirmation:  Waste of money so early, but at least you realize this one.

Syphilis - RPR (Diagnosis) with Reflex to Titer and Confirmatory Testing:  No realistic risk of syphilis (without symptoms) and done too early; it takes 4-6 weeks for blood tests to become positive.

Herpes Simplex Virus 1 and 2 IgG, Type Specific Antibody (HerpeSelect®):  Zero risk for HSV-2, low risk for HSV-1, and done too early to be meaningful.

Hepatitis C Antibody:  No risk, done much too early.

Chlamydia trachomatis by Amplified Detection (APTIMA®):  Not possible to catch chlamydia from oral sex.

Neisseria gonorrhoeae by Amplified Detection (APTIMA®):  This is the single STD you were tested for that you could have caught from that exposure and for which the test timing is OK.  But it is have urethral gonorrhea without symptoms, so this also was a waste.

That is all for this thread.  No more comments of any kind, please.

[H. Hunter Handsfield, M.D.]

The gonorrhea statement should say "But it is rare to have urethral gonorrhea...."

If you were going to be tested anyway regardless of my advice, why did you post your question to start?  Sounds like you wasted your $15 fee to MedHelp, in addition to the substantial costs of the unnecessary testing.