[Question #1057] Risk of std transmission oral sex

50 months ago
I recently went to a high end massage parlor American and recived for a few mins at best unprotected oral from her. I am pretty nervous about the circumstances. I recived a prescription for 250g of azithromycin to be taken once a day for 7 days. I started taking it within 24hrs of receiving oral sex.

My question is am I at risk really at all for any std or sti? And by taking the azithromycin as prescribed am I all but worrying for no reason?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Welcome to the forum. Thanks for your question.

Oral sex is safe sex:  not entirely risk free, but with a far lower chance of STD than unprotected vaginal or anal sex. For mouth to penis transmission, some STDs are extremely low risk, close to zero (HIV, chlamydia, HSV2, HPV, viral hepatitis); and others are more common but still unlikely for any single exposure (gonorrhea, herpes due to HSV1, syphilis, nongonococcal urethritis).

I would have recommended against antibiotic treatment; but if done, azithromycin is not a very good choice. Also, you're on the wrong dose for STD treatment or prevention:  a single dose of 1 gram (four 250 mg pills) is the only recommended treatment for any STD. However, even this is reliable mostly for chlamydia, for which you were not at risk, and not reliable against any of the others. That said, 250 mg daily for a week probably would prevent chlamydia and perhaps NGU and gonorrhea (and maybe syphilis) -- but this dose has never been studied for this purpose, so we can't be certain about its effectiveness.

In summary:  there was little or no risk from this event, and the antibiotic really not necessary. However, now that you have started it, probably it makes sense to complete the treatment; or take 4 pills at once and discard the rest.

I hope this has helped. Let me know if anything isn't clear. Best wishes--  HHH, MD

---
50 months ago
So I am in the clear and. Should not worry I have taken the 4th pill this am with 3 left. Am I in the clear pretty much here and shouldn't worry at all? Also is it ok to have relations with my significant other now or should i wait
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
Nobody can guarantee you are "in the clear". As I said, oral sex is low risk for STDs, but not zero risk. At a personal level, if somehow I were in your situation, before having sex with my wife I would for about a week to make sure no symptoms (discharge, sores) had appeared. At that point, with no symptoms, I would not be tested for anything and would resume sex at home without worry.

But if you need maximum confidence you couldn't give her anything, you would need a urine gonorrhea/chlamydia test (which could be done at any time); syphilis and HIV blood tests in 4-6 weeks; and an HSV1 blood test now and again at 3-4 months. And you could never be 100% certain about HPV, although that probably doesn't matter since everyone gets genital HPV anyway.

---
50 months ago
Only thing I am experiencing now is frequent urination. No pain, no discharge. Could this be from the azithromycin? Or is it from mostly from the aniexty I am having. I also take adderall and drink a bunch of coffee as diet soda. Is this urination anything to worry about?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
50 months ago
No STD causes frequent urination. By contrast, it is a very frequent symptom of genitally focused anxiety; and also could indeed be influenced by your coffee and perhaps soda intake. So the answer is no, this isn't anything to worry about and does not change my opinions or advice above.

That completes the two follow-up comments and replies included with each question, and so ends this thread. Take care and stay safe.

---