Unprotected Cunnilingus

Patient

Q: I am 34 yr male ,single from India.Need some consultation regarding my oral sex exposure.

I had only Cunnilingus and mutual masturbation with the prostitute in India on 7th August 2015 and don't know the sexual history of her.I was under wrong impression that oral sex is sex.I later realized by reading lot of article that there is possibility of lot of STD and very low risk of HIV.

To be on safer side I went to meet doctor 11th August 2015.Doctor prescribed me the below medicines and took blood sample .

1)P24 antigen Serum
2)Anti Chlamydia antibodies IgG
3)Anti Chlamydia antibodies IgM
4)HIV Elisa
5)Complete Blood Count with ESR.
6)VRDL /RPR

Its been two weeks now don't know the status of the result.They are taking long time which makes me worry.

Also Dr prescribed the below medicine ,
ZADY 500(Azithromycin 500 mg) for six days - one per day during night.
levocetirizine dihydrochloride and montelukast tablet for 10 days - one per day during night.

After completing the four day course i felt severe diarrhea (6 times in a day )and severe tiredness .I also have IBS.

As I could not contact the doctor immediately I contacted him after two days after stating problem.He advised to stop taking Azithromycin and continue with levocetirizine dihydrochloride and montelukast tablet.

However I have not felt any sores or symptoms in my mouth so I discontinued meaning I took only 4*500 mg of Azithromycin and 4 tablet of levocetirizine dihydrochloride montelukast tablet

Doctor asked me to come on 6 weeks and 12th week for the entire screening test including HIV and other std.


I am very much worried about ,about the following


1) I read in most of the forums saying 6 weeks is the window period of the Syphilis?Because of the antibiotic and other medicines I have taken does this
increase the window period of Syphilis further in my body?(Meaning it will show as non reactive in 6th week and turn positive later)

2)Does Oral Gonorrhea,NGU and Chlamydia will go way because of the 4 day course(500 mg for four days ) of Azithromycin in case if I acquired any STD.

3)Can I consider end of 6th week result of VDRL as the confirmative w.r.t to the antibiotic I have taken(1 dose of each Azithromycin 500 mg 4 tablets for four days
and levocetirizine dihydrochloride and montelukast tablets for four days)

4)What other test should I perform on six week after the post exposure of Cunnilingu w.r.t to the antibiotic I have taken .

5)I am having testicular pain .Does test pain is related to the NGU or any other urinary tract infections.Do i need to consult urlogist .If yes when can ?

6)I have hsv type 1 for the past 20 yrs.Do I get hsv2 on my mouth (I read if the person has hsv1 in his mouth he will not get HSV2 because of the immunity of hv1.Is that true ).Also do i need any testing for HPV.I had just one unprotected Cunnilingus in my life.

I am planning for my marriage in November please advice as I do not want to spoil other girl life?

Note:
My last sexual encounter was 2 yrs back and tested for HIV and STD .Everything was negative.

Thank you very much.

Symptoms:  No major Symptoms now apart from testicular pain.
Doctor

A:   Hello,
Thanks for the query to ATD for an opinion,

The likelihood of transmission of any infection from the woman to your mouth through cunnilingus is likely especially chlamydia but not gonorrhoea. Even HSV 2 can be transferred to you in spite of HSV 1 antibodies if the woman had genital sores or active lesions over the vulval region. Third likelihood is that of transmission of HIV through any oral sores ( your mouth) and vulval cuts or abrasions (woman partner), in that case there can be a transmission.

So the tests done:-

1. p24 antigen serum= HIV test, though HIV RNA PCR after 4 days would have been the best test in your case , more specific and confirmatory.
2. Anti-Chlamydia antibodies IgM/IgG are to check recent and chronic infection respectively. The tests take 5-7 days for serology reports to come.
3. VDRL for syphilis is fine but it shall not show a result so soon before the incubation period of 3 weeks to 3 months. azithromycin for 4 days can take care of chlamydia, gonorrhoea and syphilis as well. If the repeat test after 6 weeks is negative then you are free of syphilis.

The blood sample was taken before the blood samples were taken and hence the reports are important to be considered. Though the chances of std is likely to be averted with antibiotics taken, but the concern is HIV serology, which may take some time. I suggest you to please review with reports.

I hope have addressed your concerns,
Wishing you safe sexual practices,
Regards

Comments / Follow Ups

Patient: Thanks for your answer doctor.Do i need to go for Hepatitis B testing.What is the window period for hep b testing post exposure.What test should I take to confirm Hepatitis B doctor.
Thanks
Doctor: If your undergoing HIV then ideally you should undergo Hep Bas well. You can get a HBsAG IgM/IgG test done after one week of exposure . High IgM would confirm a recent infection.
Regards
Patient: Dear doctor ,
I took HEPATITIS B SURFACE ANTIGEN, SERUM on Thursday 2 days back.It came back as non reactive.We dont have test which differenciates IgM/IgG .Attached the picture of the report.Do I need any specific testing on Hepatitis B further.Can i consider this report as final with respect to Hep B.
Kindly sugest.
Doctor: yes you can take this report as final and be comforted that you don't have HBsAg infection.
Regards
Patient: Hello doctor I collected the final report today.p24 antigen serum ,hiv test and vdrl test is negative.Anti Chlamydia igg and igm also negative.CBC blood count does not have any recent bacterial and viral infection .Your advice and suggestion doctor .
Doctor: All reports are negative, thats good news . You are clean. :)
Patient: Thank u doctor .Do I need any further testing recommended sir
Doctor: No further testing required. :)

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