[Question #12808] Oral sex
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5 months ago
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Hi Doctor. I am quite anxious about STDs, and unfortunately, despite this fear, I made a mistake two days ago. It was an MSM type of relationship, and the person was a well-groomed individual in their 20s. Before our meeting, I explained my STD concerns, and he assured me that I could trust him. He is someone who engages in anal intercourse occasionally and had an HIV test about a month ago, which came back negative. I was in the insertive position, he performed oral sex on me, and we kissed. I believe the risk is very low, and to ease my mind, I will still get tested for HIV, Hepatitis B, C, syphilis on the 45th day, and a urine NAAT test for chlamydia/gonorrhea. Do you think this is reasonable? I currently have no symptoms.
Additionally, I have a significant concern that I want to ask you about:
When I returned home after the encounter, I went to the bathroom and had defecated. After finishing, I washed my rectum with the bidet faucet(bidet spray). However, some water also got on my penis, and reflexively, after drying my penis with a toilet paper, I folded the same toilet paper slightly and wiped my rectum with it. When I realized this, I immediately washed my rectum again with water. Now I am worried that if I contracted gonorrhea/chlamydia in the urinary tract, I might have infected my rectum as well. I am concerned about transferring the infection to my rectum with the tissue. When I asked AI about this, it said it could theoretically be possible, and I started to worry.
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Edward W. Hook M.D.
5 months ago
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Welcome back to our Forum. I agree with you that this was a low risk encounter. Congratulations on asking your partner about his testing- it provides important information and will help to keep you safe. His recent negative test makes it unlikely that he has HIV. Even more importantly, there are no proven cases of HIV acquired from receipt of oral sex or kissing- you are not going to be the first. The risk for other STIs is also low. If you wish to test for the most common STIs, gonorrhea and chlamydia, you can get a urine test any time more than 3-5 days after your encounter and will get reliable, conclusive results. Testing for HIV, syphilis and hepatitis as you suggest will need to wait until 45 days have passed but are unlikely.
Using the toilet paper to dry your penis and then wiping your rectum is a no risk activity. No STIs are transmitted through transfer on toilet paper or your hands. Not even theoretically.
Please don't worry. EWH
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4 months ago
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Thank you so much for your response, Doctor. I have a few more questions:
1) I forgot to mention that I have hemorrhoids. If urine comes into contact with that area, is there a risk of transmission? When I shower, I touch both my penis and rectum; does this pose a risk? There shouldn't be any risk with water or shampoo, right? Can I be sure?
2) If I dry myself with the same towel, there shouldn't be a risk of transmission, correct?
3) Besides what I've mentioned, should other STIs be tested after sexual intercourse? For example, Mycoplasma genitalium and Ureaplasma are not routinely checked. Why does the CDC not recommend testing for these?
4) I will have another urine test on the 45th day. If it comes back negative, does that mean there is no infection in the rectum, or could a negative result indicate that the immune system has cleared the urethra? Could it bypass an infection in the rectum?
5) I've seen doctors online stating that gonorrhea/chlamydia can be transmitted from the penis to the rectum, which has worried me. Is this true?
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4 months ago
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I didn't see a rule about this in the forum, but I want to ask a few questions that worry me about a sexual encounter from two years ago. Can I ask these in the last follow-up section?
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Edward W. Hook M.D.
4 months ago
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Straight to your follow-ups:
1. The presence of hemorrhoids makes no difference. No STIs, including HIV are transmitted in urine or by touching in the manner you describe.
2. Using a used towel is not a risk
3. There is no need for testing because there is no evidence that it is a risk.
4.Your 45 day urine test will show the same results that earlier tests showed. The will be negative again.
5. Of course gonorrhea and chlamydia can be transmitted by DIRECT, UNPROTECTED, PENETRATIVE sexual contact between the penis and the rectum
We answer specific questions on the Forum. You should not ask questions about other, unrelated encounters.
You have one follow-up remaining, You are worrying needlessly. EWH
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4 months ago
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Thank you for the valuable information you provided, sir. If you allow me, here are my final questions:
1) I think I wrote incorrectly. I haven't had a urine test yet. I will have it on the 45th day along with the other tests. Since I have no symptoms, is my chance of being infected low?
2) As I understand it, I cannot transmit chlamydia and gonorrhea to other parts of my body on my own. This includes situations like from my mouth to my penis or vice versa, all of them true?
3) I should only test the areas where I had intercourse, is this correct?
4) There is no need to test for bacteria like Mycoplasma genitalium, Ureaplasma, and Trichomonas. I only need to follow the CDC's routine screening recommendations, right?
5) Is it sufficient to perform each of the tests I will have after the 45th day just once? The lab I will go to is very good.
6) Is a throat test necessary due to kissing?
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4 months ago
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I apologize, I have one last question: Are Mycoplasma genitalium, Ureaplasma, and Trichomonas harmless bacteria that can go away on their own from the body?
Thanks again for your service.
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Edward W. Hook M.D.
4 months ago
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Final responses. Thanks for the clarification on the urine test. In response to your follow-ups:
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1) I think I wrote incorrectly. I haven't had a urine test yet. I will have it on the 45th day along with the other tests. Since I have no symptoms, is my chance of being infected low?
There is little chance that you have infection of any sort. Whatever tests you have will almost certainly be negative.
2) As I understand it, I cannot transmit chlamydia and gonorrhea to other parts of my body on my own. This includes situations like from my mouth to my penis or vice versa, all of them true?
This is correct
3) I should only test the areas where I had intercourse, is this correct?
Correct. Only sites of direct exposure need to be tested for gonorrhea or chlamydia. Blood tests are required for diagnosis of infections such as syphilis or HIV, neither if which you are at all likely to have.
4) There is no need to test for bacteria like Mycoplasma genitalium, Ureaplasma, and Trichomonas. I only need to follow the CDC's routine screening recommendations, right?
Correct. As I have said earlier, there is really no need for testing at all and there is certainly no need to test for M. genitalium, Ureaplasma or trichomonas.
5) Is it sufficient to perform each of the tests I will have after the 45th day just once? The lab I will go to is very good.
Yes
6) Is a throat test necessary due to kissing?
No
As I mentioned above, this will be my final reply and the thread will now be closed. Please don't worry. EWH