I had an unprotected oral encounter (receive)with a CSW around 5 months ago, an older Thai lady I believe. I have read the forum back to front and understand this is a low risk encounter and probably shouldn’t be worried but I wanted some clarification. I had unprotected sex twice with my partner after this encounter and she had a vaginal swab for unrelated issues but this would have picked up an STI. After this I’ve since had unprotected sex twice with her and I’m concerned. She has heavy periods and complains of tummy pain, she has had a cholecystectomy around 2/3 months ago but complains of tummy pain. My concern is if this is PID potentially rather than relating to the surgery? I apologise as this may seem anxiety driven but I can’t bring myself to get it out my head. 1/2

Your partner's symptoms are nonspecific:  in medical terms, that word means the symptoms can point to a large number of conditions and usually are not suspicious for any particular problem. Stated another way in your wife's case, there must be a hundred medical conditions that go along with "tummy pain", among which PID is among the uncommon ones. Something related to her recent gall bladder surgery is far more likely -- that is, I am confirming your own suspicion. (Probably her discomfort has nothing to do with her cholecystectomy either, although of course she should check with that doctor if the pain continues, becomes severe, or is accompanied by fever.)

That no STI showed up on your wife's vaginal swab test may not mean anything. Unless an STI was suspected by her doctor, probably STI tests (primarily gonorrhea and chlamydia) were not done. However, you describe very safe sexual exposures -- and presumably you had no symptoms (like penile discharge or painful urintion) in the next 1-2 weeks after the sexual exposures that concern you. Yes, chlamydia can be asymptomatic in males, but is rarely acquired by oral sex anyway.

If you continue to google STI symptoms, you will continue to find statements that seem to confirm your worries. I suggest you stop such searching entirely. If you must do it, at least stick with professionally organized sites (like public health, academic medicine, etc) or professionally moderated ones (like this forum) -- and stay away from from sites run by and for people with the problem you fear or at risk of it (like Reddit, for example). Also beware of AI resources like Google AI and ChatGPT:  they generally analyze the frequencies of online comments and fears, without regard to scientific evidence or credibility.

All is well. Neither you not your wife need be tested for any STI.

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

HHH, MD

I appreciate the in depth response. I think it’s probably a guilt driven thought process rather than using actual logic. I know from your comments on other questions you explain how gonorrhea is more likely but you would get penile discharge and burning within 3-5 days so that isn’t a concern as 5 months have passed and nothing to this day. With Chlamydia, just how rare is it from oral and how unlikely to of caught it from an encounter like this? I live in the UK and even the NHS website seem to confirm oral sex is still a viable way to contract this. I want to put this thought process to bed so one last question. Would you say this is completely an irrational fear to have based on your knowledge. Would you safely resume unprotected sex with your partner?

You raise an interesting and important question about oral chlamydia. Here comes one of my occasional blog-like replies that might be useful in response to future questions, or of scientific interest to some readers.

There is scientific controversy and uncertainty about oral chlamydia. Before the use of nucleic acid amplification testing (NAAT) -- i.e. when culture (growing chlamnydia in the lab) was the only test -- oral chlamydia was almost never found, and urethral infections after oral sex almost always were chlamydia negative. (I did some of these studies myself.) But NAAT has a potential problem in sometimes being too sensitive, detecting RNA or DNA from dead organisms; or the traces of an exposure that didn't take hold and cause actual infection. Over half of chamydia NAAT positives soon are negative when retested before treatment; and even after a few years of study, there has yet to be a well documented, scientifically proved case of urethral chlamydia when the only possible exposure was receiving a BJ.

However, chlamydia is ubiquitous and can be long lasting:  some people who believe oral sex was their exposure actually were infected previously. There's usually no way to know the exact source of infection. In addition, oral gonorrhea IS a big deal, and gonorrhea NAAT automatically includes chlamydia as well. So even though oral chlamydia testing is not advised by CDC and other expert agencies, it's done very frequently anyway along with gonorrhea -- and sometimes comes up positive. The meaning of positive results in this situation is generally unknown. To be safe, it is advised such persons be treated as if they have an active chlamydial infection, and that their partners might be at risk and should be treated -- but probably it usually isn't truly necessary.

Given these uncertainties, and a desire to err in the direction of conservative safety, many health agencies like NHS, CDC, and others now advise that chlamydia may be acquired by oral sex. But trust me on this:  the scientific uncertainties just outlined are far closer to the truth.

I am very confident none of this is relevant to your sexual exposure and your partner's abdominal pain. And the answer to your closing question is this:  If somehow I were in your situation, I definitely would be continuing unprotected sex with my wife. I never would have stopped, at least not after 1-2 weeks with no symptoms had passed after my outside sexual exposure.

 What symptoms would a chlamydia infection in the throat cause if she had it in her throat? 

Chlamydial urethral discharge is continuous cloudy mucus.

You're overthinking everything. Ignore any and all future symptoms. You never had chlamydia and neither has your partner.