What are my risks for any and all STD's?

[badmistakes]

46 hours ago, i had sex with a 26 yr old Latin escort, well reviewed online. Dozens of hobbyists have engaged in the same behavior described in the next paragraph. She was previously married, two kids and offers escort service on a part time basis. She is mature and has a great attitude. She is NOT a street walker and nor is she some elite provider. I mention all these things without knowing if it even matters at all. The encounter took place in Jersey City, NJ where i currently reside. Following are the details of the encounter(chronological order) and i'm requesting Dr. HHH or Dr. Hook for their opinions regarding my risks for each of the following STD's: Chlamydia, Gonorrhea, Hepatitis, Herpes, HPV, Syphilis, NGU and last but most important of all, HIV.

(Chron Order)

We engaged in aggressive french kissing. She gave me unprotected oral for 5 minutes. Lots of saliva. I performed (unprotected) aggressive cunnilingus on her(http://iomfats.org/resources/health/hiv/riskfactors.html associates different risk factors with "Licking Vagina(Cunnilingus)" and "Sucking Vagina"). She got very wet but she did not climax. I inserted my tongue in her vagina many times. I'm not sure if i swallowed any of the fluids mix(my saliva and her juices). I sucked on her clitoris several times for about ten seconds each time. We then proceeded to have intercourse with a condom. We french kissed during intercourse. At the end, the condom was intact. I rinsed my mouth with water.

At home, when i rinsed with Listerine, i felt a stinging sensation under my tongue on the vertical skin that connects the tongue with the bottom of the mouth. I confirmed mild skin abrasions(must have happened during cunnilingus?) and no bleeding.

I saw no rashes or pimples or whatever, anywhere on her body. Nothing suspicious. So far, i've had no physical symptoms or pain or whatever of ANY sort. What are my risks for each of the above STD's? My worries are killing me. Thank you so much.

[Edward W Hook, MD]

If you are going to develop urethritis (penile) symptoms from your expsoure (i.e. NGU or gonrrhea), they should typically occur within 3-7 days following your exposure.  I should also mention however that these STDs can also occur asymptomatically so if you are really concnerned (personally, I would not be) you could go get checked at any time.   The diagnosis should be able to be made with a urine or swab test if you have either of these disases.  

The abrasions under your tongue do not change or alter my advice.  EWH

[badmistakes]

Dr Hook, thank you very much for taking the time to write a convincing response.

-     I'm convinced i don't have HIV(phew!), Chlamydia and Syphilis.
-     You said herpes symptoms take 4-6 days to show up so i'll wait another couple  
      days to get rid of the herpes ghost from my mind
-     You mentioned that i am at a low risk for Gonorrhea and NGU. Can you also
      specify what the expected or typical wait time is for related symptoms to show
      up?

I think my main concern was the discovery of the mild skin abrasions on the vertical skin under my tongue after i came back home. If she had any of the above STD's that can be transmitted through oral sex, am i at a significantly higher risk for catching those STD's? I have no clue when those abrasions developed. I'm going to assume the abrasions developed while i was giving her oral. Please advise. Thank You so much again.

[Edward W Hook, MD]

To summarize, you gave and received unprotected oral sex and engaged in protected vaginal sex with a commercial sex worker (CSW) who, among CSWs was probably somewhat lower risk than many CSWs.   Now for a few comments:

Given what you report about your partner, the chances she had HIV are low.  Her chances of having a bacterial STD such as gonorrhea or chlamydia are somewhat higher, as are the chances she has herpes;  nonetheless it is more likely than not that she did not have any of these STDs.  Syphilis is a very rare infection in the US and the risk, overall is low. At the moment most syphilis occurs in MSM.

Oral sex is oral sex.  Whether a person swallows or not has not been studied.  Similarly, there is no data regarding risk related to what part of the body was sucked or kissed.

Now to your questions:

Protected sex is protected and condoms protect.  No further comment on the genital exposure

Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you get gonorrhea or NGU you will most likely develop symptoms of urethritis (penile infection).  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  In your case, if you are worried you could go to your local STD clinic or health care provider to be tested at this time.    

You asked about herpes.  Indeed genital herpes due to HSV-1 is occasionally spread through oral sex but when it does, the person giving the sex usually has a cold sore and the person who gets infection then develops the sores/lesions of herpes 4-6 days after the exposure.  

HIV Oral- The mouth is a hostile environment for HIV.  There are enzymes and other components of saliva which make it a difficult place for HIV to survive. HIV transmission during oral sex is very inefficient.  Studies suggest that the risk of getting HIV from oral sex, if your partner was infected, are less than 1 in 10,000 and in fact they are much lower.

Hope this helps.  EWH