[Question #10179] pharyngeal stds

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25 months ago
My boyfriend and I have had genital STD testing prior to engaging in sex, all came back negative. Since the negative test, we have had unprotected sex 6 times over 2 months. We are in our late 30's, if that matters.  However, I was searching the internet and came across pharyngeal chlamydia/gonnoreah and how it is commonly aquired ( I was never orally tested). What is the probability that I (female) have a pharyngeal std and passed it to My boyfriend, via oral sex and then he infected me vaginally and now we have an asymptomatic STD?
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25 months ago
edit to state... genital std testing was done before any and all sex, and since negative testing we have had unprotected oral and vaginal sex- what is the probability of me having a pharyngeal infection ( from previous relationships) and passing it on to my boyfriend and then him passing it on to me vaginally, and now we both have an asymptomatic infection?
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H. Hunter Handsfield, MD
25 months ago
Welcome to the forum. Thank you for your confidence in our forum.

You really needn't worry about having a pharyngeal STD or about the consequences you're concerned about --your partner and reinfection yourself. Gonorrhea is by far the most common and most important oral STD. However, even among the most sexually active women with multiple male partners, including those who regularly perform oral sex on their partners, typically under one percent have pharyngeal infection; and among those with gonorrhea at any anatomic site, generally about 5% have pharyngeal infection. And the pharynx is rarely the only infected site -- so your negative genital test results go a long way in indicating there is little chance. Equally important, pharyngeal gonorrhea is cleared by the immune system within several weeks and almost always within 3 months. So even if you had it, you can be sure it is long gone.

There also has been media attention about pharyngeal chlamydia, but that's even rarer. Chlamydia doesn't take well to the pharynx and when present is gone in most patients within two weeks, without treatment. And it is almost never transmitted by oral sex. (Some research suggests that many positive pharyngeal tests actually have only a small amount of chlsamydia RNA present, not live bacteria, and therefore no infectious organisms to be transmitted.) Even among persons at maximum risk for oral STDs, CDC recommends against even testing for chlamydia. (It's still done commonly, but that's only because chlamydia testing is pretty much automatic when gonorrhea is tested.)

For those reasons, you really needn't be concerned. Of course you could be tested if you like, but if somehow I were in your situation (or if I were your partner), I wouldn't do it. However, if you feel you would sleep more soundly by having a throat swab test for gonorrhea, you could do that. If you do so, I am confident it would be negative.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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25 months ago
Yes, the internet has heightened my fear of contracting chlamydia or gonorrhea via oral sex significantly. Since you are the expert, you are saying it is highly unlikely that I had oral chlamydia and transmitted it to my partner and then he retransmitted it to me? In the event that, that happened... I know gonorrhea would shoow symptoms ( in males), but how likely would chlamydia show symptoms? if asymptomatic how likely would we be able to clear the infection if both of us have it? Would we somehow continuously infect each other until STD testing caught? 

also if we have had sex 6 times in the past two months would a genital infection most likely be transmitted? I know that you have stated before that STDs are not always transmitted. 
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H. Hunter Handsfield, MD
25 months ago
It is pretty much impossible you had oral chlamydia, and even if you did, you almost certainly did not transmit it to your partner. As discussed above, there have been very few confirmed cases of proved transmission of chlamydia oral to penis (if any).

Correct that urethral gonorrhea almost always causes obvious symptoms and chlamydia often does not.

The tone of your questions suggests far more concern than warranted. Try not to over think the situation. There is no significant chance at all that either you or your partner currently has either gonorrhea or chlamydia at any anatomic site. However, if this advice doesn't settle the issue, you and your partner could be retested with urine (or vaginal swab for you) and for pharyngeal infection. Anxious persons sometimes are more reassured by negative test results than by the scientific facts and professional advice, no matter how expert. (We don't take it personally!) However, there is no point in further "what if" or "could I be the exception" questions. I am certain nothing you could think of has any possibility of changing my evaluation and advice.

I do hope you're able to move on without giving this another thought!
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25 months ago
Thanks so much! I appreciate the replies, I have no further follow up questions. Enjoy your week 
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H. Hunter Handsfield, MD
25 months ago
Thanks for the thanks; that's why we're here. Best wishes.---