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Risk of STDs by receptive oral sex. HELP!
Hello Dr Hunter
I'm a 23 year old guy currently in Boston and I've only received unprotected oral 3 times in my life, all from escorts. The first one in April '13; second one in late June and one last night. I deeply regret doing all this. The first escort is in the UK and she gets checked every month and has never had anything. The second escort also gets checked every month. Since April I'm symptom free and my latest hepB/hep C and HIV test done last week have been negative. What concerns me is the third escort from last night as she moved from Singapore 2-3 months previously. I received unprotected oral for 3-5 minutes. All of a sudden I feel like I've ruined my life and that I'm gonna get genital herpes, warts, syphilis or even chlamydia or gonorrhoea. HERPES is the biggest concern. Could you please reassure me in some way about HIV and herpes. What is my likelihood of acquiring them? I really can't focus on anything at the moment! HELP
I'm a 23 year old guy currently in Boston and I've only received unprotected oral 3 times in my life, all from escorts. The first one in April '13; second one in late June and one last night. I deeply regret doing all this. The first escort is in the UK and she gets checked every month and has never had anything. The second escort also gets checked every month. Since April I'm symptom free and my latest hepB/hep C and HIV test done last week have been negative. What concerns me is the third escort from last night as she moved from Singapore 2-3 months previously. I received unprotected oral for 3-5 minutes. All of a sudden I feel like I've ruined my life and that I'm gonna get genital herpes, warts, syphilis or even chlamydia or gonorrhoea. HERPES is the biggest concern. Could you please reassure me in some way about HIV and herpes. What is my likelihood of acquiring them? I really can't focus on anything at the moment! HELP
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
Escorts (which I define as expensive female sex workers by appointment) are generally believed to have low rates of HIV and other STDs. Most use condoms consistently, especially for vaginal or anal sex, and are tested frequently.
But even if your three escort partners were thought to have STDs, you are at little risk. Oral sex can be considered safe sex -- not completely free of risk, but zero risk for some STDs (including HIV and probably viral hepatitis) and low risk for all others. For all STDs, the transmission risk is a lot lower than for unprotected vaginal or anal sex. The chance you caught anything from a total of only 3 oral to penile exposures is very, very low. Your apparent lack of symptoms also is reassuring: if you had acquired herpes, gonorrhea, or syphilis, probably you would know it from the symptoms. Chlamydia rarely infects the oral cavity, and therefore rarely if ever transmitted by oral to penile sex. HPV is not usually transmitted by oral sex either.
From a strict risk assessment or medical standpoint, you don't need testing for any STD. However, most anxious persons probably are more reassured by negative tests than by the opinion or an expert. So I recommend a urine test for gonorrhea and chlamydia (these are valid any time more than 2-3 days after exposure) and blood tests for HIV and syphilis (which should be done at 6 weeks or more after your last exposure). No other tests are necessary or recommended.
Feel free to let me know the results after you are tested. Stay mellow in the meantime; you definitely can expect negative results.
Best wishes-- HHH, MD
Escorts (which I define as expensive female sex workers by appointment) are generally believed to have low rates of HIV and other STDs. Most use condoms consistently, especially for vaginal or anal sex, and are tested frequently.
But even if your three escort partners were thought to have STDs, you are at little risk. Oral sex can be considered safe sex -- not completely free of risk, but zero risk for some STDs (including HIV and probably viral hepatitis) and low risk for all others. For all STDs, the transmission risk is a lot lower than for unprotected vaginal or anal sex. The chance you caught anything from a total of only 3 oral to penile exposures is very, very low. Your apparent lack of symptoms also is reassuring: if you had acquired herpes, gonorrhea, or syphilis, probably you would know it from the symptoms. Chlamydia rarely infects the oral cavity, and therefore rarely if ever transmitted by oral to penile sex. HPV is not usually transmitted by oral sex either.
From a strict risk assessment or medical standpoint, you don't need testing for any STD. However, most anxious persons probably are more reassured by negative tests than by the opinion or an expert. So I recommend a urine test for gonorrhea and chlamydia (these are valid any time more than 2-3 days after exposure) and blood tests for HIV and syphilis (which should be done at 6 weeks or more after your last exposure). No other tests are necessary or recommended.
Feel free to let me know the results after you are tested. Stay mellow in the meantime; you definitely can expect negative results.
Best wishes-- HHH, MD
A related discussion, Tested for blood borne viruses 12 weeks after exposure was started.
MEDICAL PROFESSIONAL
The former. The blood antibody tests are virtually 100% sensitive once antibody is present.
Dr Hansfield!
Thanks for your comment. Does this mean that this test has 95% sensitivity at 31 days? Or does this mean that 95 out of 100 would have seroconverted by now in order to be detected by the above tests? Sorry I'm a little confused.
Thanks for your comment. Does this mean that this test has 95% sensitivity at 31 days? Or does this mean that 95 out of 100 would have seroconverted by now in order to be detected by the above tests? Sorry I'm a little confused.
MEDICAL PROFESSIONAL
By 31 days, the antibody tests (both rapid and lab-based) pick up at least 95% of HIV infections -- so this is a very reassuring result.
hello dr hansfield. hope you are well. i've taken your advice as stated above. i took a hiv rapid test on day 31 post the above event. i did it for some peace of mind as for the next 2weeks i'm busy . its true that this negative result is not conclusive. but is it ok to feel a little relieved at this outcome? i havent tested for chlamydia, gonorrhoea or syphilis as they didnt worry me at all plus no symptoms so.far. would you like to.comment on the result at all? many thanks sir
Thanks so much Doc for this and for wishing me luck. Say if I don't get symptoms until the next 7-10 days, is it reasonable to be almost certain that I didn't catch it?
MEDICAL PROFESSIONAL
From an oral to genital exposure, you are at risk only for HSV-1, not HSV-2. The latter could theoretically be an issue, but oral HSV-2 infections are uncommon and I've never seen or heard of a genital HSV-2 infection that was acquired by orogenital exposure. For HSV-1, the average risk probably is no higher than 1 in 1,000 for oral sex exposure. Also, half of all adults have positive HSV-1 serological tests, generally dating to unrecognized childhood infection. If you're among that half the population, you are immune (or at least highly resistant) to a new HSV-1 infection. Finally, I would point out that although nobody wants genital herpes, if it happens, HSV-1 is the preferred type; in general there are few long term consequences of it and little risk of transmission to future partners. So even if you had the unusual bad luck to be infected after so few exposures, it probably wouldn't have much impact on your life. If you do a quick PubMed search, you can find literature on the differing natural courses of genital HSV-1 versus HSV-2. The thread below also addresses it.
http://www.medhelp.org/posts/STDs/Herpes-Confuses-Me/show/1414935
Best wishes for success in your medical career.
http://www.medhelp.org/posts/STDs/Herpes-Confuses-Me/show/1414935
Best wishes for success in your medical career.
Hello Dr Hunter. Many thanks for giving me some reassurance. The sad thing is that I'm a medical student about to graduate next year and despite knowing all this, I'm getting up to these risky activities. It has been almost two days since that encounter I spoke about above. I guess I'll know by this coming sunday if anything's up at all. Herpes is the only real worry of mine. I'm glad you mentioned that it is low risk. Would you mind giving me a number at all? Say 1 in a....? Many thanks again!
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