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Exposure Risk?

Dr, thanks for this incredible service.

To be short I need to ask if you'll address a few questions about an encounter I had at a strip club in Lousianna 3 weeks ago tomorrow.  There was very brief unprotected oral sex (fellatio) and also brief contact to vaginal fluids on hands/clothes from masterbation on her.  The fellatio on me was very brief lasting less than 1 minute and there were no noticeable sores on her mouth/lips.  So far no noticeable symptoms except yesterday I noticed a small red spot on the shaft smaller than a pin head, could be oil gland.

1) What are the risks of STD from this encounter.

2) 3 days after exposure I took Keflex 500mg 3 x daily for 6 days for an infected insect bite.  Would this be effective treatment against Gonorrhea and Syphilis?  I read Dr HHH said in its usual dose it would but was this dose enough?

3) Are Syphilis chancers very noticeable on penis?  Could the red spot I noticed be one forming?

4) I have a zpak 6x250mg which I read would be effective for syphillis if taken in 1 dose.  Is that a lethal amount to take 6 x 250mg?

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239123 tn?1267651214
Welcome to the forum. Thanks for your question.

There was no risk from the possible indirect exposure to vaginal fluids.  The unprotected fellatio carried small risk, but in general oral sex is safe sex -- not totally free of STD risk, but with much lower chance of STD transmission than vaginal or anal sex.  And given how brief that contact was, the risk probably was zero or close to it.  The red spot on your penis doesn't sound significant; my guess is you're looking too closely and noticing a minor normal variation in the penile skin.  To tthe specific questions:

1) You are at little or no risk of STD from this event.

2) Cefalexin (Keflex) is not reliable against any STD.  If you had been at significant risk of gonorrhea or syphilis, it might delay symptoms and interfere with early diagnostic testing, but would not reliably prevent them.  (You may be confusing cephalexin with cefixime, which is one of the recommended drugs against gonorrhea.  I never said cephalexin would be effective.)

3) The red spot cannot be an early chancre.  Chancres show up no sooner than 2-3 weeks after exposure.  And the statistical chance the stripper had syphilis is very low.  Most syphilis in the US occurs in gay men.

4) I recommend against azithromycin (Z-pak) in this situation.  Azithromycin is no longer reliable against syphilis.

You really should not be so worried about this event.  If I were in your circumstance, I would not get treated, would not be tested for any STD, and would confidently continue unprotected sex with my wife without fear of infecting her.

I hope this has helped.  Best wishes--  HHH, MD
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