Unprotected Cunnilingis/Protected Fellatio/Protected Vaginal Intercoruse

[poorexcuse]

I am a married male in his mid-30s. On a recent business trip to Singapore, I had unprotected cunnilingus lasting approximately 30 seconds with a CSW, apparently from China. This was not deep either, rather it was very surface level licking, without deep penetration into the vagina. This was followed by about 30 seconds of protected fellatio, and 30 seconds of protected vaginal intercourse. In terms of the intercourse, it was not even full insertion, only about half way and our pubic areas never touched as my hand remained gripped at the base of my penis. There was no breakage of the condom. I also touched her vagina and clitoris with my bare finger, but did not insert it inside. I did brush my teeth immediately after.

I have no signs or symptoms, other a mildly sore throat, but I did a lot of public speaking during my trip, so that likely explains things. This is the fist time I have had sex with anyone other than my wife in over 10 years.

My questions are, what are my risks of exposure to HIV, clamidia, syphilis, gonorrhea, and other possible STIs/STDs? In particular, how long should I wait to be tested? The day of exposure was August 25th, 2008. And finally, what are the risks of passing anything to my wife or children through kissing? I am refraining from intercourse with my wife until I have been tested.

[Edward W Hook, MD]

If there is any risk for you at all, it is miniscule.  The only part of your experience which might lead to HIV/STD transmission is your unprotected oral sex on her.  Touching her with your finger, receipt of protected fellatio, or protected vaginal sex has no risk and does not need testing.  

Regarding your oral sex, again, little to worry about.  The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high.  Neither of us on this site has ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  As for other STDs, the only STD you might have gotten is gonorrhea unless there was a sore or lesion in her genitals that you came into contact.  If the latter occurred, there is a very small risk of getting herpes (you would see it as a cold sore) or syphilis (very, very rare).  Overall, given the brevity of your exposure and that your insertion was shallow, your risk is even lower than the already very low risk for an exposure of this sort.

In my opinion, you do not need testing of any sort.  If your anxiety requires you to get tested, a gonorrhea culture of your throat is appropriate.  An HIV test will mean virtually nothing until at least 4 weeks and preferably 8 weeks following your contact but I once again emphasize, your chance of having gotten HIV is close to zero.

You do not need to worry about giving your wife or kids infection.  You are not infected.  Even if you were, you would not transmit infection to them by kissing.  EWH  

[poorexcuse]

Update...

3 weeks after possible exposure from unprotected cunnilingus with a CSW in Singapore I tested negative for clamidia and gonorrhea. I didn't have an HIV test done because I knew the risk was very small from mouth-to-vagina oral and the window period had not yet passed.

I was also tested for syphilis, which came back negative as well. However, the nurse told me that after 3 weeks the result would be largely meaningless as well. She told me the window period for syphilis was 3 months, and that I should return then to be retested for syphilis at the same time as HIV.

My final question then is, is it really necessary to wait until 3 months post exposure for a syphilis test to be accurate, or can I be confident that my negative results at 3 weeks are accurate? Thanks.

[Edward W Hook, MD]

I suppose that a syphilitic chancre and a canker sore could appear similar  At the same time, oral chancres are so rare as to be medical curiosities.  In addition, for you to have syphilis of the mouth you would have had to had contact with a sore.  If your partner had had a sore, you would have seen it.  I would bet the  bank that what is on your mouth is not a syphilis lesion but a canker sore.  If you must get tested, a syphilis blood test would be positive if this is syphilis.  I consider your getting tested a waste of time.  EWH

[poorexcuse]

Update...

I have developed a canker sore on the roof of my mouth. My question is, how can one tell the difference between a normal canker sore and a syphilis chancre? I do tend to get normal canker sores with some degree of regularity, and this one looks and feels like one of those in that it is small and painful and I have heard that chancres are larger and painless, but I am of course having some anxiety over whether it might be a syphilis chancre. Can you please describe the difference?

Also you didn't mention how long one has to wait until after possible exposure for a syphilis test to be accurate. Thanks again.

[Edward W Hook, MD]

To get syphilis you must come into direct contact with a sore.  The incubation time of syphilis is about three weeks, not months as is the case for HIV.  You are worrying about thismore than is needed.  EWH

[poorexcuse]

Ok, but what about syphilis. You said its a possibility, but didn't really go into the risk factor. Lets say the person I came into contact with did have syphilis, but no "sore" at the time, is it still possible to get it, or is it necessary to have been in contact with a "sore"? And specifically, how long should one wait after possible exposure to be tested for syphilis? Is there a delayed incubation period like HIV?

[Edward W Hook, MD]

Re-read my answer. The risk is tiny.  EWH

[poorexcuse]

Thanks doctor, you have put my mind at ease. However, you didn't say what the risk factor for getting throat gonorrhea by performing cunnilingus is? I mean assuming the female is infected in the first place. Is it rare or something to be concerned about? Also, if one does acquire throat gonorrhea, is it necessary to have it treated, or will it resolve on its own after a few weeks or months?

[Edward W Hook, MD]

I would advise you to believe the syphilis result you got.  the nurse was being a bit more conseravtive than needbe.  eWH