Testing Timelines, Symptoms, and Unprotected Oral

[Jestersnotdead]

I kissed and received unprotected oral for 20-30 min with a 21yo escort today who said she has only been in the business for about a month. She said she got tested for STDs and HIV a week ago and said everything was negative. But I don't know if that includes HSV-1 and HSV-2 testing and if that includes testing for gonorrhea of the throat. I did not see any cold sores on her lips but can't see inside her mouth. Also, she just got a tattoo about a week ago so I don't know if that puts her more at risk for HIV or hepatitis, but she has several tattoos already so I'm assuming that she knows where to go for safe tattooing.
I would like to know a) what the symptoms are, b) what the timeline for symptoms are, c) what the timeline for definitive testing is, d) if you think I need testing for these STDs. As a reference, before seeing this escort I tested negative for everything except HSV-1 igg.

1. Gonorrhea
2. Syphilis
3. HSV-1, I have tested positive for HSV-1 igg so am I completely safe from getting HSV-1 on my penis?
4. HSV-2
5. NGU: does m. genitalium fall under NGU? and will it respond to antibiotics? I didn't know there was a test for NGU... what do I ask my doc for?

How many days without symptoms would it be for me to be in the clear? Or should I get tested regardless?

And for these a) what is the timeline for definitive testing, b) should I get tested for these?

1. HIV
2. Trichomonasis
3. Chlamydia
4. Hep B
5. Hep C
6. Are warts or HPV-16 or any other dangerous HPV strain possible from my exposure?

Lastly, is it possible for me to get infected from my exposure if she got infected with syphilis, gonorrhea, or HSV-1 from giving oral to the guy she saw a couple hours b4 me? Or does the disease need time to incubate? Anything else I'd need to know?

[H. Hunter Handsfield, M.D.]

1) Unknown; maybe.
2) WBCs may or may not be elevated on a routine urinalysis.  If normal, it doesn't exclude NGU; if elevated, often there are other causes.
3) Probably yes.
4) Nonchlamydial NGU has not been shown to be harmful to female partners.  In particular, NGU acquired by oral sex probably is harmless for patient and partners alike.
5) Speculation; no comment. Certainly elevated WBC alone would not be an indication for antibiotic therapy; other tests, exams, etc (i.e. expert professional assessment would be necessary).
6) No stats, but probably no higher than 1 in 1000.

That should end this thread.  Just accept the fact that oral sex is safe sex -- not completely risk free, but much safer than vaginal or anal sec -- and stop worrying about it.

[Jestersnotdead]

Good morning Dr. H,
    Just a couple of more questions for some clarification.
1. Can asymptomatic NGU become symptomatic later?
2. And as far as asymptomatic NGU is concerned, if I got a test that measured WBC count from a urine sample would it be elevated or would the WBC count be normal?
3. If asymptomatic NGU is left alone does the body eventually clear it on its own?
4. And you said it's not worth worrying about, but what about spreading it to future partners? Could it be a problem for future female partners?
5. And if so, if I don't have any symptoms of NGU but I have a high WBC count should I take antibiotics as a precaution to clear a potential NGU infection?
6. And finally, when you say oral sex carries little STD risk what kind of probabilities are we talking about? Like 1 in 100 or 1 in 1000? Or are there no stats about that...

Thanks for your answers Dr. H.

[H. Hunter Handsfield, M.D.]

There is no standard test for asymptomatic NGU.  And asymptomatic NGU, if chlamydia testing is negative, isn't an important health problem and not worth worrying about.  Tonsillitis doesn't suggest increased risk for any STD of the throat; oral gonorrhea usually causes no symptoms.

People infected with either HSV type are immune, or at least highly resistant, to new infections with the same virus type, anywhere on the body.  If you have oral HSV-1, you'll never get genital HSV-1.

[Jestersnotdead]

Thanks for your prompt reply. Just a short follow-up....What about NGU? How does one test for NGU and when would a test for NGU be reliable? Whether the NGU is caused by ureaplasma, m. genitalium, or some other bacteria would antibiotics clear the problem for all cases? A little worried about NGU and/or gonorrhea since she said she had tonsilitis about 8 days ago, but said she saw a doctor and she said she's fine now.

And as far as HSV-1, since I already have oral HSV-1 and I didn't see any overt sores on her lips, can I definitively say I'm in the clear from acquiring HSV-1 on my penis?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  But you're asking for a large amount of information that is readily available from many online sources; there is no way I can take the time to list all the symptoms and timelines of symptoms and testing for all possible STDs.

Oral sex carries little STD risk and no testing for any STD is necessary after this exposure unless there are symptoms.  The main STD symptoms are discharge of pus or mucus from the penis, often but not always accompanied by discomfort or pain on urination; and penile blisters or sores.  These can appear anywhere from 2-3 days to as late as 3-4 weeks after exposure.  Reliable tests are available for all STDs, including HIV, by about 6 weeks after exposure.  However, gonorrhea and chlamydia tests are reliable within a week of exposure.  There is no test for HPV, but HPV is almost never transmitted by oral sex.  There is no risk from oral sex for chlamydia, trichomonas, HSV-2, HPV, or hepatitis of any type.  And no, there is no risk of infection if your partner had herself been exposed only a few hours earlier.

Regards--  HHH, MD