[Question #12270] Unprotected Cunnilingus STI Risk

9 months ago

Hello Doctors,

I recently visited an AMP and received unprotected fellatio and performed unprotected cunnilingus. My only concerns are around gonorrhea.

I’m aware that the risk is low, but I plan to have a urine test to confirm (via stdcheck.com). My main question is around oral gonorrhea risk. I performed cunnilingus for 2-4 minutes. I know it’s difficult to quantify the risk of contracting, but if I did have oral gonorrhea:

1. What is the risk of me then transmitting to my wife via oral sex?

2. Do you think I should get an oral swab?

3. Is it more difficult to transmit by performing cunnilingus than receiving fellatio?

4. Is it more difficult to contract oral gonorrhea by performing cunnilingus or receiving cunnilingus?

Thank you for all you do.

Edward W. Hook M.D.

9 months ago

Welcome back to the Forum. I'll be glad to comment. Both receiving fellatio and performing cunnilingus are low risk activities with performing cunnilingus being lower risk for gonorrhea acquistion that receipt of fellatio. While no sort of encounter results in transmission 100% of the time (in fact most exposures to infected partners do not result in infection), oral sex is the lowest risk of penetrative sexual activity. When you add that to the fact that most people, even most commercial sex workers do not have STIs, STIs and gonorrhea in particular are relatively rare. With respect to your specific questions:

1. What is the risk of me then transmitting to my wife via oral sex?

As mentioned above, your risk of infection is low and in the unlikely circumstance that you have oral gonorrhea, the risk of transmission to your wife through cunnilingus as also quite low. The reason for this has in part to do with anatomy. If you had oral gonorrhea, the infection would be at the back of your throat and as a result, there would be little gonorrhea in your saliva. Further, to infect your wife, the bacterial would need to be introduced deep into the vagina in order to infect the uterine cervix. Cunnilingus is unlikely to do this.

2. Do you think I should get an oral swab?

An oral swab test would likely prove that you do not have oral gonorrhea which might be reassuring. If you are getting tested, why not get the oral swab as well as the urine test.

3. Is it more difficult to transmit by performing cunnilingus than receiving fellatio?

Yes, for the anatomical reasons outlined above.

4. Is it more difficult to contract oral gonorrhea by performing cunnilingus or receiving cunnilingus?

There are no scientific studies to inform this reply but both would be very, very rare and, I suspect, it would be more difficult to transmitt gonorrhea by receiving cunnilingus than by performing it

I hope this information is helpful. EWH

---

9 months ago

Thanks, Doctor.

Is it safe to say that you wouldn’t bother testing, if you were in my shoes?

I’m trying to not inform my PCP of this issue and would prefer an anonymous option. Unfortunately, stdcheck only offers a urine test, not throat swab. So if you think I shouldn’t bother testing, I’d be interested to know.

Lastly, I feel a bit of a sore throat 2 days after exposure. Is this just my anxiety getting the best of me or could this be a symptom? I believe you mentioned on a different thread that oral gonorrhea typically presents no symptoms.

Thanks again for all your guidance.

Edward W. Hook M.D.

9 months ago

I do not feel strongly that testing is needed.

Testing can be carried out inexpensively and with a high degree of confidentiality of you choose to pursue testing. If you anticipate continued anxiety, this may be a good option.

Most oral gonorrhea is asymptomatic although a minority of persons with oral gonorrhea do have sore throats.

EWH

---