Risk Assessment & Advice Please

Dr. Sean,
A few days ago I had an encounter with a transsexual sex worker in SE Asia (I’ve had occasional other encounters with sex workers in the past and always end up with anxiety over the potential risk) and thought I was doing better regarding safer sex. But now I’m having some doubts & anxiety is creeping back. I did the following:

(1) Gave her oral until she ejaculated – fully condom protected. She then removed the condom & cleaned / dried up with tissues
(2) She then gave me oral – again fully protected.

So far so good …….!!

However, during her giving me oral, she assumed a 69 position, with her flaccid penis brushing against my face and lips. During this act (which lasted about 5 minutes) I briefly gently took the head of her penis into my mouth three times, each time for about 10-20 seconds. I didn’t take the penis in deep and have it didn’t touch my throat or top of my mouth, however, there may have been small amounts of still moist semen present (I didn’t taste anything). I immediately swilled my mouth with cold water afterwards. In addition, I'd had a meal earlier and used a toothpick (which may have caused small cuts in my mouth).

Afterwards, as usual, anxiety has begun to build up regarding this episode and potential risks. I would be grateful if you could give me a risk assessment and any testing required (if any) from this episode. I’m obviously most concerned about any risk for HIV (I think low) but also any other STDs that may be a possibility (if any given the brief unprotected oral).

Many thanks in advance & once again, thank you for the excellent website & service you provide.

[Dr Jose]

Hello,
Thank you fro your post and welcome to our forum.
All the protected sexual practices were safe and there is no need to worry about. The brief oral sex that you performed would not pose any risk of HIV as there was no ejaculation inside of your mouth (and small traces of dried semen would not be enough to infect you). Therefore no need to worry about HIV and no need to get tested. However other possible STDs that are much more common and much easier to transmit through oral sex would be throat Chlamydia and Gonorrhoea, possible Herpes, and Syphilis. Therefore I would recommend that you get a throat swab after a couple of weeks and a syphilis blood test after 4 weeks.
Best wishes,
José

Dr Jose,

Thanks you for the reply & assurance. I feel a lot of relief - I have only had about 3 encounters with CSW in my life, usually every couple of years & I always regret it afterwards. Time to stop I think!

Unfortunately, where I am in SE Asia makes proper testing difficult. I've taken 1g of azithromycin as a prophylactic (not best practice I know) - that should deal with the syphilis & chlamydia risk, shouldn't it? do you think that the risk for bacterial infections & herpes is significant, given the brief & gentle oral given? I'll have to wait until I can get decent testing when I'm next back in the UK.

One other quesiton - how long is the window period for a symptomatic herpes outbreak. I've read that if nothing shows by 7 days I should be in the clear - is that correct advice? Or should I expect symptoms earlier if affected.

Many, many thanks.

[Dr Jose]

The risk for all these is possibly relatively low.
Azithromycin would only cover you for Chlamydia and other infections that could cause NSU (Non-specific urethritis), not against Syphilis. Herpes would normally cause symptoms after 3 weeks, but it could be anytime up to 3 months.
Best wishes,
José

Dr. Jose / Dr. Sean

Anxiety got the better of me and I decided to test for peace of mind for the event described.
I got the following results at 27days & 9 hours post-exposure:

- HIV 4th Generation Ab/Ag (Roche Cobas Elecsys HIV Combi) - Non-reactive
- Syphilis TP Ab - Non-reactive
- Throat swab & urine Chlamydia/Gonorrhea by PCR - Not-Detected

My final questions:

(1) Can I consider the HIV conclusive (i.e. it was taken on the 28th day post-exposure - is this the valid time frame or a touch too early - I'm not sure exactly how you count the days)
(2) Is the syphilis conclusive at this time-frame or do I need a further test at 3 months (I know there are different test types & am not sure which if this is the valid test from 4 weeks)

Many thanks once again.

[Dr Jose]

Hello again.
These negative tests are all conclusive at that window period, both HIV and syphilis (it was the serology), as well as the other STDs.
No need to have any further tests.
Best wishes,
José