[Question #112] What are my risks of STIs from unprotected oral sex

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104 months ago
This is my situation:

I am 55+ year old Heterosexual male
I have had a partner for many years who I occasionally still have sex with
So I have been seeing escorts from time to time. Ones in a category that I would expect take care of themselves.
I do not want to give my partner an sti, including the kinds of HVP that cause genital warts or that show up on a Pap smear or would create any other health problems ("dangerous HVP")
With our sexual history, is she got HPV there would be only one examination for it and that is that I got it from someone else and gave it to her
I had a GARDASIL  vaccine about two months ago and will have the second one soon
        I had unprotected oral sex about 4 times before having the vaccine

I stumbled upon a website that consolidated HUNDREDS of question and answers from addressed by Dr. Hansfield and Hook about STDS and unprotected oral sex... I read MANY of them.
My take away is that both Drs said on MANY occasions that "oral sex is safe sex".  I understand that there is some risk but my take is that it is still a small risk. 

1.Does this "small" risk  change materially because I am having sex with escorts about once a month?
2.  HPV.   Are the "dangerous" HPV strains commonly transferred by oral sex? One post from Dr. Hansfield says rarely.
                 If so, what  are my risks of having acquired one of the dangerous HPV strains from the 4 times I had oral sex prior to the vaccine?
       A.  Does the ONE vaccine I have had protect me from future exposures to ALL TYPES of the HPV viruses that show up in a Pap Smear and those that cause warts as a Porto Rico study claims?  To those that may cause health problems?
       B.  If not will ALL those  dangerous HPV be prevented after the second shot?  How long until it is effective?
          C.  Does a Pap Smear positive show that it was definitively  caused by HPV or can there be other explain actions.
             D.  Are there symptoms or detection of the non dangerous strains?
3.  From reading those Medhelp post this is my understanding and remaining questions:

       A.  HIV.  No known risk.
       B.  Chlamydia.  Very rare
       C.  NGU.  Can come from sex but also from many other sources.
        D.  Trich.  Is not passed orally?  Can it be explained by non sexual activity?
        E.  Siphilis.  Fellatio ...not unless there is an obvious sore one the mouth.  Cunnalingus...(no obvious sore would be present0 so it IS transferable???  But in any case my understanding siphillis is a very rare STI amount heterosexuals  and is thus low risk.  Is this correct???
             F.  Gonorrhea.  It is transferable with fellatio.  Is it with cunnalingus? but again it  is a rare STI so is not a big risk.
             G.  HSV 1.  I have already and don't have oral sex when I have a rare outbreak.
              H.  HSV 2.  Rare with oral sex both ways.  Is that correct?   My take was that it is a very rare transmission--correct? Not fellatio unless an obvious sore on mouth of giver.  Cunnalingus??
               I.  Hepatitis B and C.  Little if any risk.  I have had the B vaccine.

I think that covers it.

I feel like I am taking advantage of the site with such a comprehensive question. I would be happy to pay more or make a contribution.
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Edward W. Hook M.D.
104 months ago

Your question is very broad and more extensive than is appropriate for this forum.  It is not really one question but many. I will provide brief answers but I will not get to all of your questions. 

1.  Oral sex is relatively safe no matter what sort of partner you are having sex with.  That some of your partners are CSWs does not increase your risk much.

2. A single injection of the HPV vaccine offers some but not complete protection.  Following the 2nd injection protection is essentially complete.  The HPV vaccine will protect against the types of HPV present in the vaccine and these are the types that cause nearly all genital warts and most pre-cancerous lesions.

Abnormal PAP smears can have many causes and if your partner had an abnormal Pap smear it would not necessarily mean she was infected or that the infection came from you.  It can take many years after infection for abnormal PAP smears to appear.

Most HPV infections are asymptomatic.

3.  I presume these questions are about risk from oral sex. If so, your summary is essentially correct.  Gonorrhea can be acquired through cunnilingus on an infected partner.  Trich does not appear to be acquired from oral sex. 

Please limit further questions to single questions and do not write a list of questions as you did above.  EWH