[Question #1228] Specific STD Risks From Unprotected Oral Sex

47 months ago
ok, I will try to be as detailed as possible so I do not need any follow-up question. Maybe these questions have been asked over and over again and I'm really sorry but i have not yet found any satisfying answer on the internet. Today I had sex with a sex worker. We had french kisses and she also gave me a blowjob (unprotected oral sex). I did not touch her vagina at all and we did not have any kind of vaginal/anal sex. Basically, the only actions we had were french kisses and unprotected oral sex. Keep in mind I am the receiver (she gave me oral) and not the giver.

What's the chance for me to get STDs?  I want to know my risk for each STD, especially:
1. gonorrhea
2. herpes (HSV1 & HSV2)
3. syphilis
4. chlamydia

if you can, please answer one by one...because I want to learn about each of them. the reason why I don't mention the rest of STDs like HPV or HIV is simply because I read somewhere else that these four above STDs are the most common STDs for oral sex (with chlamydia being the least common among these four). I believe my chance to get HPV is almost zero and HIV is zero as long as there's no blood coming out of her mouth (and yes, there was no blood or wound at all). Is it true?

I also would like to know what's my chance to get asymptomatic infection for gonorrhea and herpes and syphilis and chlamydia? I think I read somewhere that it's uncommon (about 5%) for a man to have asymptomatic infection for gonorrhea. That means if I do not get any gonorrhea symptom, I shouldn't think too much about it. What do you think? I dont know if that 5% number is true or not, that's why I'm here. I also have the same question for the above STDs (herpes, syphilis, and chlamydia).
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Welcome to the Forum.  I will try to help although I cannot provide you precise information on your personal risk since the prevalence of the infections you ask about varies from location to location and among population subgroups (and CSW subgroups) at those locations.  Overall, your risk for acquiring any STI from French kissing is effectively zero and from receipt of unprotected oral sex is considerably less than 1%.  I would also add that the reason that you will not find a satisfying answer through internet searches is because the information on the internet is unfiltered and often incorrect.  Internet searches for questions such as yours are typically confusing and frustrating.  We recommend against this practice.  On to the 4 infections you ask about

Gonorrhea:  Risk from French kissing is zero, no matter how long, how deep and whether or not your partner or you have mouth sores, gum or dental disease, or blood in the mouth- still zero risk.  Most people do not have gonorrhea.  When people do, less than 10% of infected people have gonorrhea in the mouth.  There are no firm scientific estimates of how often oral gonorrhea can be transmitted through oral sex but it is certainly less than half the rate by which gonorrhea is transmitted through vaginal sex (which is 20%).  If you had gotten gonorrhea, over 95% of persons with infection develop symptoms.  If you do not have symptoms at 7 days, you should not worry and do not need testing.

Chlamydia.  Chlamydia is similar to gonorrhea in may ways but far rarer in terms of receipt of oral sex.  Risk from French kissing is zero, no matter how long, how deep and whether or not your partner or you have mouth sores, gum or dental disease, or blood in the mouth- still zero risk.  Most people do not have chlamydia.  When people do, less than 1-2% of infected people have chlamydia in the mouth.  There are no firm scientific estimates of how often oral chlamydia can be transmitted through oral sex but it is certainly less than half the rate by which chlamydia is transmitted through vaginal sex (which is 20%).  If you had gotten chlamydia, about 40% of persons with infection develop symptoms.  Given the rarity of the problem, I recommend that you should not worry and do not need testing.

Syphilis.  Syphilis is much rarer than gonorrhea or chlamydia and is transmitted through DIRECT contact with sores.  If your partner did not have a sore on or in her mouth (and since you were French kissing, you would know), you are not at risk for syphilis.  If you were to acquire syphilis from receipt of oral sex, you would develop a painless sore on your penis within three weeks of your exposure.  No sore, no need for testing.

Herpes.  Oral HSV-2 is very, very rare and therefore there is no meaningful reason for concern about getting HSV-2 from the exposures you describe.  As for HSV-1, you probably already have it, whether you know it or not (90% of persons with HSV-1 do not know they have it) and if you have it, you will not get HSV-1 again from a partner, even if that partner has the infection.  If the partner is infected and you are not, if she did not have lesions, your risk for infection is less than 1 infection in 1000 exposures.  If you were infected, you would most likely develop penile lesions within 12-14 days of exposure.  If no lesions we strongly recommend against HSV blood tests.  If lesions are present, we recommend PRC testing for HSV.

Hope this helps.  EWH

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47 months ago
ok thanks for the very detailed answer. just curious, is it true that it's almost impossible to get HPV through oral and not possible to get HIV through oral (same question as before, as receiver)? thank you once again.
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

There are no cases in which someone has acquired HIV from receipt of oral sex by an infected partner.  There seem to be a (very) few instances in which persons performing fellatio on an infected man may have acquired HIV.

As for HPV, oral HPV infections do occur although at about half the rate that are seen for genital infections and very rarely are associated with oral or laryngeal cancer but these events are incredibly rare from a statistical perspective and of no practical consequence so there is no good way to diagnose oral HPV, much less treat it.  Most oral HPV infections are of no consequence and resolve on their own without therapy.  There are even fewer data on acquisition of HPV from receipt of oral sex.  It is likely to be a rare event.  EWH

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47 months ago
ok i guess this is my last follow-up question. this is not that related to the previous ones but i'm still slightly paranoid. Basically, i acquired HPV and genital warts about 5 years ago. I think i never had any new genital wart for more than a year so I assume it has cleared on its own. However, I do believe it's harmless to get vaccinated with gardasyl or similar HPV vaccine.  I also want to get the vaccine to prevent future infections. It's not very expensive where I live so I have plan to get the vaccine.

My question is this: Why do people typically recommend HPV vaccine for those who have not yet been infected? I mean, why is it considered ineffective for those who have acquired the virus like myself? even in my situation, it can still help, right? As far as I know, vaccine works by "upgrading" our antibody system so it can fight the virus when we finally get infected. In my case, even though I already have the virus, I assume the vaccine can still help fight the old infection. After all, it's still good to fight future infection in case I get another strain of HPV one day.. what do you think?
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

As  you know, clients may receive up to a total of three replies related to a question.  This question is on a different topic but I will provide a brief answer.. This is my third reply to your questions. This there will not be further relies to this thread and the thread will be closed later this evening.  If you have further questions you will need to start a new question.

I see no reason (other than the expense) for you not to take the HPV vaccine as it will be highly effective for preventing infection by HPV strains which you have not yet had.  For this reason, if possible, I would suggest you try to get the nonavalent vaccine which prevents 9 different types of HPV infection. The vaccine has few side effects.  The only reason that the vaccine is not routinely recommended for persons over  the age of 26 is as a cost saving measure since by age 26 most people will already be infected with one of more HPV strains and in North America the vaccine costs $400-500 dollars.. 

The vaccine is a preventative vaccine which prevents infection in those who were not yet infected and is most affective in preventing infections by HPV virus types that people have not already acquired.  there are no definitive data to prove that the vaccine "boosts" immune response to existing or prior infections .  if has no known effect on established infections (i.e. it is not a therapeutic vaccine).

I hope these comments are helpful. Take care.  EWH

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