[Question #12966] Receiving cunnilingus and risk for Gonorrhea and Chlamydia
3 months ago
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Dear Dr. Handsfield and Dr. Hook,
I’m a 22-year-old female from Germany. 16 months ago, I received cunnilingus twice (1–2 minutes each) from a monogamous partner, but his STI status was unknown. I’ve had no symptoms since and no other exposures.
Still, knowing GC/CT can be asymptomatic, I tested via urine NAAT at a reputable clinic. I was told to include the first drops of urine, which I did—but I mistakenly voided about 200ml in total, thinking the more the better (no one told me I had to urinate only ~30ml). I transferred a small sample (as instructed) into the tube and handed it (without mixing the larger volume). The results came back negative, but how to rely on this when I made such grave mistakes and it is maybe a false negative.
Staff reassured me 3 times that the large volume doesn’t affect accuracy and don't recommend testing only because of that. Despite this, I’m still anxious. Online info (CDC/forums) made me feel like I certainly had something, and I worry about future infertility.
My ex had max 2 sexual partners in the past, and his last encounter was over a year before our relationship, yet I can't rely on that info. Was my GC/CT risk virtually negligible from receiving oral? Are my results fully reliable? Is retesting needed or can I move on from this with full confidence?
I know the risk is very low because of the inefficiency for transmission during cunnilingus, due to anatomy etc. I have read on the SFCC std risk chart that gc and ct aren't a real risk for cunnilingus and tried to convince myself to believe it, but I want your expertise about this matter. I have done a full research to understand about my risk. I hope my worries of infertility are irrational in my situation, because I'm yearning to move on and believe my test results. Is my risk now of having something virtually 0?
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H. Hunter Handsfield, MD
3 months ago
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Welcome to the forum. Thank you for your confidence in our services.
Your own statement is correct: "the risk is very low because of the inefficiency for transmission during cunnilingus, due to anatomy etc"-- is perfect, I could not say it any better. Cunnilingus is a very safe sexual practice with very low risk of all STIs, especially for the vaginal partner both for that reason and because oral STDs are not very common anyway.And the tests you had are highly reliable; the "mistake" in providing a large amount of urine for testing was not a mistake at all and your negative test results are reliable. In other words, the reassurance from from the clinic staff was correct.
"I hope my worries of infertility are irrational in my situation...": maybe not "irrational", but the chance of infertility on account of the two exposures described indeed is better than "virtually zero"; it is truly zero.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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3 months ago
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Dear Dr. Handsfield,
Thank you for your quick and reassuring response! It really helps ease my anxiety about the situation immensely.
I wanted to clarify one small detail: my sample was about 2 ml (as requested). I was concerned because I had voided a larger volume (around 200 ml) before providing the sample.
I realize now that I was overthinking, but your confirmation that this wouldn't affect the accuracy of the test gives me much-needed peace of mind.
In the course of my small "research", I’ve come to understand that the transmission of STIs through cunnilingus is not very efficient, due to anatomical defenses and other factors. Despite this, I felt the need to confirm everything with highly respected experts such as yourself, and I’m very happy to have reached out to you for clarification. It’s a relief to have accurate, professional guidance, rather than relying on less trustworthy sources on the internet.
I appreciate your expertise in confirming that cunnilingus is a very low-risk activity for STIs, especially in my situation, and I'm happy to hear that my concerns about infertility are unwarranted.
Thank you again for your time and for providing such clear guidance and for the efforts you put into helping people in similar situations.
Thank you for your quick and reassuring response! It really helps ease my anxiety about the situation immensely.
I wanted to clarify one small detail: my sample was about 2 ml (as requested). I was concerned because I had voided a larger volume (around 200 ml) before providing the sample.
I realize now that I was overthinking, but your confirmation that this wouldn't affect the accuracy of the test gives me much-needed peace of mind.
In the course of my small "research", I’ve come to understand that the transmission of STIs through cunnilingus is not very efficient, due to anatomical defenses and other factors. Despite this, I felt the need to confirm everything with highly respected experts such as yourself, and I’m very happy to have reached out to you for clarification. It’s a relief to have accurate, professional guidance, rather than relying on less trustworthy sources on the internet.
I appreciate your expertise in confirming that cunnilingus is a very low-risk activity for STIs, especially in my situation, and I'm happy to hear that my concerns about infertility are unwarranted.
3 months ago
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Apologies for one last clarification, I just realized I hadn’t mentioned that I was the one who transferred the urine into the sample tube (about 2ml) after voiding the full 200ml. I didn’t mix or shake the larger container before pipetting, as I wasn’t instructed to.
I'm not intending to keep bothering!
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H. Hunter Handsfield, MD
3 months ago
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Thanks for the first of these replies -- I'm glad you understood my replies and are more comfortable with the situation. As for the details of how you collected urine, it makes no difference at all. The test is very forgiving, and such details as the amount of urine, time since previous voiding, and mixing or otherwise managing the specimen all make no known difference at all. (When these tests were first studied, certain standard collection methods were specified. Those methods generally have been included in ongoing instructions for specimen collection and management. However, 20 years experience with millions of specimens that obviously were not managed exactly as directed has shown that these details make no significant difference.---
3 months ago
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Thank you again for your thorough and reassuring responses—they’ve been incredibly helpful. If I may, I’d love to better understand why cunnilingus is such an inefficient route for GC/CT transmission, both biologically and epidemiologically. If I may ask one last question.
From my reading, I gather that:
Mucosal preferences matter: GC/CT thrive best in the columnar epithelium of the cervix/urethra, not the stratified squamous epithelium of the vulva/vagina or the oral cavity.
Saliva’s role: Enzymes (like lysozyme) and dilution in saliva may further reduce bacterial viability.
Dose-dependent transmission: The tiny bacterial load in saliva (if present) seems quite unlikely to overcome anatomical barriers during cunnilingus. Bacteria would need to find its way up to the cervix, which seems unrealistic to me, but maybe under extreme conditions this could happen.
I’m asking partly for closure, but also out of scientific curiosity-your expertise on the gap between theory and observed risk would be invaluable. Thanks again for your time and insight!
From my reading, I gather that:
Mucosal preferences matter: GC/CT thrive best in the columnar epithelium of the cervix/urethra, not the stratified squamous epithelium of the vulva/vagina or the oral cavity.
Saliva’s role: Enzymes (like lysozyme) and dilution in saliva may further reduce bacterial viability.
Dose-dependent transmission: The tiny bacterial load in saliva (if present) seems quite unlikely to overcome anatomical barriers during cunnilingus. Bacteria would need to find its way up to the cervix, which seems unrealistic to me, but maybe under extreme conditions this could happen.
Yet, while forums and guidelines often cite "possible risk," I’ve struggled to find documented cases of vaginal GC/CT acquired solely from cunnilingus-unlike fellatio, where infections are well-documented. In your clinical experience, have you ever encountered a confirmed case of vaginal GC/CT transmitted this way? Or is this truly a "theory vs. reality" scenario where anatomy and bacterial behavior make actual transmission implausible?
I’m asking partly for closure, but also out of scientific curiosity-your expertise on the gap between theory and observed risk would be invaluable. Thanks again for your time and insight!
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H. Hunter Handsfield, MD
3 months ago
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Again you correctly summarize the current state of knowledge and our standard advice.
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Here comes one of my occasional blog-like replies that may be useful in response to future questions. Maybe more detail than you want or need, but here goes. Potential risks for HIV were first outlined 30-40 years ago, when the worldwide HIV/AIDS epidemic was new but knowledge was still evolving, i.e. before clinical experience matured and careful research could be designed and conducted. Many of those initially believed routes of infection proved to be rare or non-existent. Human nature being what it is, and some agencies (especially non-scientific ones) having moralistic or political motives, some zero or near-zero risk exposures commonly show up with no qualifications to define actual risks, case numbers, etc. Human fears and anxieties also play roles and it's always best to avoid websites by and for people with a particular health problem or fears of it -- like Reddit, for example -- and stick with professionally run or moderated sources. And there's simply the fact of efficiency: It takes a lot fewer words (e.g. on brief statements or written hand-outs) to just say (for example) that oral sex can transmit HIV, without describe risk in quantitative or statistical detail, or the comparative risks versus other kinds of exposure. A particularly egregious error made by many otherwise responsible agencies is to list "blood exposure" without qualitifcation, leading people to believe that merely touching a spot of dry blood might be risky, when in fact there are almost no blood-transmitted HIV infections other than those from shared injection equipment, despite many people's occasional interaction with other persons' blood.
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.