[Question #13231] Oral MSM encounter

1 months ago

Hello Doctor,

I am from Canada. I recently had an extramarital encounter with a man (I am also a man). He performed unprotected oral sex on me. No other sexual contact was made. I immediately regretted the encounter, and have since been dealing with anxiety which is at an all time high regarding spreading an STI to my regular partner (a woman). Googling information is not helping. This encounter happened about 3 days ago. I have no symptoms so far.

I'm planning on getting tested for gonorrhea and chlamydia at the 1 week mark.

I understand there is essentially zero risk for HIV for this encounter, so I'm not worried about that.

My question is as follows:

Will the gonorrhea and chlamydia tests be conclusive after 1 week, and should I be getting for any other STIs as soon as possible, like syphilis, assuming I show no symptoms? Is there any other testing you'd recommend as medically necessary?

Once I'm tested for gonorrhea and chlamydia, assuming it is negative, is it safe to resume sexual activity with my regular partner, or should I wait to test for syphilis and/or other STIs. If you found yourself in this scenario, how would you proceed?

Thank you for your expertise.

1 months ago

Hello, I should also let you know I asked about my encounters STI status and he stated he was tested about 2 months ago (including a mouth swab) and everything was negative. He also stated he doesnt do random hookups very often. I'm not sure how relevant this is since it is possible he could have caught something between our encounter and when he was last tested.

Edward W. Hook M.D.

1 months ago

Welcome to our Forum. Thanks for your questions. I'll be glad to comment. Of all forms of penetrative sex, oral encounters are among the lowest risk. In addition, you did well to ask your casual partner of his STI history- most people tell the truth and his replies suggest that his risks are not particularly high. You are correct that your primary STI risk is for gonorrhea, both penile and oral and when you test I would encourage both a urine test and an oral swab. If you were going to develop penile gonorrhea, there is a more than 90% chance you would develop symptoms (discharge) within 3-4 days of the encounter. Oral gonorrhea on the other hand is frequently asymptomatic and an oral swab is the only way to reliably rule out infection. Either way, results will be conclusive any time more than 3-4 days after the encounter.

Your risk of acquiring syphilis is quite low unless he had a visible penile or oral lesion and even then, most single encounters do not lead to infection. As you point out, there is no known risk of acquiring HIV from receipt of oral sex and in the unlikely circumstance that your partner has untreated HIV, your risk from performing oral sex on him is estimated as less than 1 in 10,000.

Once your gonorrhea (and chlamydia) tests are negative, I would not worry about resuming unprotected sex with your regular partner.

I hope this information is helpful. EWH

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1 months ago

Thank you for your prompt response, doctor. May I ask the purpose of an oral swab on me? I did not perform oral sex on him. The only sexual contact was him performing oral on me (his mouth on my penis).

In the unlikely chance of a syphilis infection, is it likely I will show symptoms, or is it likely I will be asymptotic? Basically in your professional opinion, would you recommend a syphilis test as a result of this encounter? Or can I put this safely out of my mind, assuming no symptoms of course. if testing is recommended, when should I get that test done? I did not see any leisons on his mouth, but I was quiet dark.

I just want to clarify that testing 3-4 days after the encouter will be a definitive result for both gonorrhea and chlamydia, correct?

Lastly, I'm a ball of anxiety (though I've been actively working through it with a mental health professional this past year). In your professional opinion, would I be considered more or less in the clear, and should expect a negative result for all STIs, and the tests are simply a precaution and not necessarily required? I understand this encounter is considered very low risk, but I'm just looking for a bit of reassurance on how low a risk.

Finally, thank you for confirming I can resume regular activity with my regular partner after a clear gonorrhea and chlamydia test. Just to clarify, my partner is a woman and we have unprotected vaginal and oral sex? Does that change anything? Again, it is my understanding, based on previous replies in this forum, that the chances of catching syphilis from receiving oral is a percentage of a percentage, correct?

Edward W. Hook M.D.

1 months ago

I'm sorry, I misread your question and thought that you had both received and performed oral sex on your partner. If you did not perform oral sex on him there is no need for an oral swab.

The majority of persons who acquire syphilis develop a lesion (the chancre) at the sate of inoculation, typically within about 3 weeks following the encounter. I do not feel strongly that you need syphilis testing. If you choose to test, results will be definitive 6 weeks following your encounter.

Yes, 3-4 day gonorrhea and chlamydia results will be definitive.

Your risk is low and testing is always a personal decision. Many of our clients appreciate the additional confidence that a negative test provides.

I agree with your final confirmatory comments

One reply remaining. eWH

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1 months ago

Thank you doctor, you are a rockstar!

Just to back track, regarding gonorrhea and chlamydia, since there is no risk of me acquiring it in the mouth throat, would it be medically necessary to test if no symptoms appear? I already have an appointment booked, this is just more to ease my anxious mind. I understand testing is a personal decision, but id like to know your if you'd refer me for testing for gonorreah and chlamydia based on this encounter?

For final confirmation/to summarize:

Gonorrhea/Chlamydia - possible, but unlikely.

Syphilis - highly unlikely, testing not necessary unless lesions appear, correct?

HIV - not an issue

Lastly, based on all this information, did you have any other recommendations for testing for any STIs not mentioned or STIs I may not be aware of?

Thanks again

1 months ago

I'm so sorry, one last addition to my previous reply. Should I be worried about herpes at all?

Thank you again

Edward W. Hook M.D.

1 months ago

This is rather repetitive. Final Responses

I do not feel strongly that you need testing but you yourself say you are anxious. Testing may help this.

Gonorrhea/Chlamydia - possible, but unlikely.

Correct

Syphilis - highly unlikely, testing not necessary unless lesions appear, correct?

Correct

HIV - not an issue

Correct

Lastly, based on all this information, did you have any other recommendations for testing for any STIs not mentioned or STIs I may not be aware of?

End of thread. EWH

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1 months ago

Thank you Dr. Hook for confirming you do not feel any STI testing is required (unless I show symptoms)

I will proceed with a gonorrhea and chlamydia test for my peace of mind, despite your opinion that it is not necessary unless symptom appear

I will not schedule any additional STI testing (Syphilis, HIV) unless symptoms appear

Thank you for your expertise on the matter, and your patience. I hope you have a fantastic day!