Kissing and Oral in Africa

[worried9834421]

Dr,

I am a married man and six weeks ago i was drunk and found myself in a situation where a prostitute in Western Africa french kissed me a couple of times and performed 30 secs of unprotected oral on me. I also had a mouth ulcer at the time she kissed me.  Worried about the situation i managed to see a Dr 60 Hours after the event who wouldn't consider PEP for HIV but did give me a booster for HEP B. I saw the Dr again 2 weeks later because of discomfort of the Urethra, he performed a Urine Dip test and said everything was fine. The discomfort has since gone away, probably anxiety focussed. I have had no other symptoms besides a sore throat which i still have. Due to my location i am unable to have an STI test until next month but i am seeing my wife next week.

I am concerned about HEP B. I have had all 3 shots in the past but learnt that they are only effective in 90% of people. My wife has never been vaccinated against it. Is this a cause for concern?

Should i be concerned about HIV? I know it's never been documented but a risk is a risk right? I might be able to get a rapid test at a centre next week, should i do this?

What is your advice? Should i use protection with my wife, as we usually don't?

Thanks

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

First, a comment on HIV and PEP:  I agree with the advice you were given.  HIV is rarely if ever transmitted by either oral sex (especially in the oral to genital direction), so even if you knew your CSW partner had HIV -- which of course may not be the case -- PEP would not be warranted.  You don't even need HIV testing, except perhaps for the reassurance value of the anticipated negative result.

Like HIV, hepatitis B virus (HBV) also is rarely if ever transmitted by oral sex or kissing.  In addition, you can safely assume you are in fact immune due to your past immunization.  The 90% effectiveness figure you found would be more appropriately stated as "ast least 90%"; most experts agree the true effectiveness is closer to 95-99%.

Of course no distant online expert can guarantee you don't have either of these infections -- but if this is your only potential exposure to HIV or HBV, you can consider yourself to be at essentially zero risk.  If I somehow found myself in your situation, I would not be tested for either infection and would continue unprotected sex with my wife without worry of infecting her.

I hope this has been helpful.  Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

There is no useful blood test for gonorrhea, and the chlamydia blood test is unreliable; it's never used for STD diagnosis in the US, UK, Australia, or other countries with the strongest STD expertise.  However, you are at little or no risk for either infection, especially chlamydia -- so I don't see testing as a high priority anyway.  Don't worry about it.

That will end this thread.  Take care.

[worried9834421]

Dr,

thanks again for your advice, one last question. I just had an sti test and I asked if they were doing a urine test for gonorrhea and she said no we do blood and wasn't aware that you could do a urine test. would a blood test work? its going to be a couple of months before I can be somewhere that will do a urine test and by that time it could have cleared itself then I'll never know.

thanks

[H. Hunter Handsfield, M.D.]

HBV vaccine boosters are sometimes given in situations like yours, but I am unaware of any data that they make any difference in infection risk.  I doubt they do, but it's sort of a chicken soup approach -- it might help and can't hurt.

Gonorrhea:  true, if you had acquired urethral gonorrhea almost certainly you would have had obvious symptoms.

The rates of syphilis indeed are higher in parts of Africa than in most of the US, but syphilis by kissing would still be a very rare outcome in situations like this.  You can safely assume your oral lesion isn't syphilis.  You might avoid kissing your wife while you have it, out of caution in case it's oral herpes (unrelated to your extramarital exposure) -- but otherwise I wouldn't worry about it.  

[worried9834421]

Thanks for your advice Dr,

From reading other posts i have gathered that Gonnorrhoea can also be spread in the manner described but i would most likely of seen symptoms by now. Also a risk of Syphilis. My question is as it is possible to transmit this by kissing although rare, the fact that this is Africa makes me think that this could make it more plausible. How would i differentiate between a normal mouth ulcer on the inside of my lip and a syphilis chancre? I have a small ulcer on the inside of my lip less than 1mm in diameter that occurred yesterday. I guess i'm just worried about passing this to my wife.

Also for information would the booster of HBV vaccine given after, provide any further defence against preventing the virus?

Thanks