[Question #12698] Risk?

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6 months ago
Hello Drs, 8 weeks ago performed unprotected oral on male.  At 1 week sore throat which has not gone away (and extreme tiredness for 24+ hours). Went to doctor for routine throat swab for viral/bacterial infections, all negative - didn't request STI test as thought oral was low risk. 3 weeks post exposure had sex with wife. 1 week later she complained of (1) getting up in night to urinate (NEVER does this usually) (2) extreme fatigue (3) cloudy urine (4) missed period. Have not had sex since. Am booked for STI test but anxious that have oral STI and passed on during cunninlingus. 
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6 months ago
My specific questions: 
a. Are her symptoms are indicative of chlamydia (or gonorreha) infection? b. Possible for oral chlamydia to last > 8wks (I see gonorreha is self limited, but not sure about chlamydia)? c. Possible to get BOTH at same time? Which is more likely to be transmitted if so (or both!)? c. Coincidentally had yearly blood work done last week  - would an active infection impact my WBC count?
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H. Hunter Handsfield, MD
6 months ago
Welcome to the forum. Thank you for your confidence in our servcies.

Oral sex is safe sex -- not entirely free of STI/HIV risk, but much more safer than unprotected vaginal or anal sex. Your symptoms are not suggestive of HIV or any STI; almost certainly you had a minor viral infection unrleated to the oral sex event 8 weeks ago. Your wife's symptoms also do not fit well with any STI, including HIV. In addition, even when oral STIs are present, they rarely are transmitted by cunnilingus. Going to your specific questions:

a) No, your wife's symptoms are not suspicious for chlamydia or gonorrhea.

b) Oral chlamydia is rare and indeed is "self limited"; typically it is cleared by the immune system within a couple of weeks, much more rapidly than gonorrhea is. There has never been a well documented case of oral chlamydia transmitted by cunnilingus to a female partner.

c) Yes it is possible to have oral gonorrhea and chlamydia simultaneously, but both usually would be gone by 8 weeks. Gonorrhea is more transmissible than chlamydia, but both very rare (if ever) from oral to vaginal.

d) No STI has any effect on routine blood count results. Whether your WBC was normal, high or low will mean nothing in regard to any STI.

For the reasons already implied, you can expect negative results for your planned STI testing. I would suggest you only have a throat swab for oral gonrrhea and chlamydia and blood tests for HIV and syphilis; no reason for any other STI testing. Your tests all will be negative. 

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

HHH, MD
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5 months ago
Thank you Dr Handsfield, very reassuring. I am booked for testing tomorrow and will obviously not have results for a few days thereafter. In the meantime my wife has been complaining of a very sore lower back (which is unusual). I have read this may be a symptom of Chlamydia/gonorreha.

Is that correct? If this were a symptom is it likely to occur in absence of other more prominent symptoms such as discharge etc. and would back pain likely occur so early in a possible infection.

I realise the risk is low and you have advised not to worry. However this additional sudden onset of back pain has me very worried.
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H. Hunter Handsfield, MD
5 months ago
Chlamydia does not cause lower back pain; I've never heard of such a thing and never saw a patient with it; and certainly back pain cannot be an early or the only symptom. Either you found an unscientific and unreliable source or you misunderstood what you found. Your wife's back problem has nothing to do with your sexual adventure several weeks ago.

You have one more follow-up comment left in this thread. Let's not have any further discussion until you have your test result; I'll be happy to make one last comment at that time. Stay mellow in the meantime; your test results will be negative.
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5 months ago
Hello Dr Handsfield,
Well, as you predicted all tests were negative, thank you for helping me to remain calm.
I just wanted to ask you finally whether you think my wife should also be tested? As in, there is a possibility that I had an oral infection, infected her, but my infection has since cleared. Noting that we still have not had sex since our last encounter.
 Am I being overly paranoid here? 
Thank you.
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H. Hunter Handsfield, MD
5 months ago
There is no need for your wife to be tested. I wouldn't call it paranoid, but you're being overly cautious.

That completes the two follow=-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.
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