[Question #12438] Oral sex risk

7 months ago

Hey I’ve been panicking the last few days and found this website on reddit. For some context I’ve been in a long term relationship with one person exclusively in which we both confirmed we were clean early on. 4 days ago I saw a hispanic prostitute and got a blowjob without a condom and have sort of been freaking out since about STIs. It was a dumb mistake and I texted her asking if she was clean to which she said yes and then said not to worry because she takes drugs that prevent STIs. How likely an I to get something from this? And can you get HIV from a blowjob? (the internet says its little to no risk, but I just want to be sure). Also since I saw her Ive been noticing an uptick in little red dots all over my body and have had a sore throat.

H. Hunter Handsfield, MD

7 months ago

Welcome to the forum. One of our common themes is to be very careful about STI advice on non professionally run or moderated websites (like Reddit), where anyone can write anything and much information is just plain wrong. But I guess I can't fault them on everything, if there are referrals to our forum!

In any case, your main take-home message from the internet -- that oral sex is close to zero risk for HIV -- is correct. There has never been a scientifically proved case of HIV transmitted oral to penis, and only very rare ones in the opposite direction. Chlamydia is nearly zero risk, and so are HPV and herpes due to HSV type 2. Oral sex transmission of syphilis is fairly common in men having sex with other men, but it's very unlikely in contacts like yours, i.e. a female partner -- even in sex workers.

So what are the main risks? Three of them. The most important is gonorrhea, but probably occurs in under one in hundreds or thousands of exposures like yours -- largely because oral gonorrhea is uncommon in females, including most sex workers. And if you don't have obvious symptoms after 4-5 days (pus dripping from your penis, painful urination) you can be nearly certain you didn't get it. Nongonococcal urethritis (NGU) can occur, perhaps often due to entirely normal oral bacteria; it causes similar symptoms as gonorrhea, but milder and not showing up until a week or two after exposure. Finally, herpes due to HSV type 1, the cause of oral herpes (cold sores) is possible, but also very uncommon after any single exposure.

The other factors in your favor are that you describe a partner who is unlikely to have an active, transmissible STI. Most sex workers are aware of and have an accurate understanding of the likelihood they are infected, and her belief she is "clean" probably is accurate. Taking drugs to prevent STI also is a very effective strategy against HIV and, with the right drugs, syphilis and chlamydia. Preventing gonorrhea is somewhat trickier, but all things considered you are at low risk for everything.

No STI causes "little red dots all over [the] body" and sore throat is almost never due to STI. Even when an oral STI is present, over 90% of the time there is no sore throat or any other symptoms.

If somehow I were in your situation, I would not feel a need for testing and would continue unprotected sex with my wife without worry. However, if you feel you need the additional reassurance of negative test results, you could have a urine test for gonorrhea and chlamydia (valid any time more than 4-5 days after exposure) and blood tests for syphilis and HIV in a few weeks. But even if you choose testing, you really should not be seriously worried as you wait for results. Almost certainly you're fine.

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

HHH, MD

---
---

7 months ago

Ok understood, when should I test for NGU? Just wanted to add that a day after I saw the prostitute I performed oral sex on my partner, did I put her at risk of anything? Also the prostitute spoke no english and must have been from a central/southern American country. Did that in anyway affect my chances of getting something? (not in anyway meant to be bigoted I just know that different demographics and regions are affected differently in regards to things like this).

7 months ago

As it pertains to HIV I read it doesn’t transmit through saliva, does that make kissing and oral sex functionally impossible for transmission? What circumstances would have to occur for it to transmit from oral to penis (or oral to vagina)?

H. Hunter Handsfield, MD

7 months ago

There is no test for NGU. If you don't have symptoms of discharge or discomfort urinating, you idon'thave it.

I have no way to judge the chance your sex work partner had a transmissible STD. For the reasons already describe, your risk was low even if she was infected.

Your exposure was penile. You cannot have an oral STD as a result. And even if you did, STDs are very rarely transmitted by cunnilingus (oral-vaginal contact).

There are no known "circumstances" that would create significant risk for HIV transmission oral to genital.

---

7 months ago

Ok so even if she was bleeding profusely from or had sores and cuts in the mouth it wouldn’t really change anything? (I doubt she did.)Then finally I have been noticing i’m much more itchy these past 4 days and had diarrhea a few times. Could this just be from overthinking anxiety or is it a sign of infection?

7 months ago

I”ve also felt burning sensations on my arms+other parts of the body. Does this signal hiv?

H. Hunter Handsfield, MD

7 months ago

Oh good grief. "Bleeding profusely" and you didn't notice??? I will not participate in irrational speculation about events that didn't happen. And see my comment above that there are no circumstances you can think of that would change my assessment that you were at no significant risk of HIV.

Itchiness (anywhere on the body) is not a symptom of any STI, and neither are diarrhea of "burning sensations" on the arms or elsewhere. And whenever someone suggests their own symptoms are the result of anxiety, usually they are right.

You don't have HIV, but of course you're free to test for it if you like. Believe the negative results when you get them. FYI, in the 21 years of this and our preceding forum, with thousands of questions from persons worried about HIV after a possible exposure, not one has ever reported they ended up testing positive. You will not be the first. If and when it finally happens, surely it will be from a genuine exposure -- and not something that has never been known to happen previously, like receiving oral sex!

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion helps you move on without further worry. If you remain concerned, just go back and carefully re-read this discussion.

---