[Question #13650] giving fellatio and rimming risks

1 months ago

Dear Doctors,
I was trying to piece together answers from your repository but decided it might be easiest to just come straight out and just ask - if I were to visit a trans-female sex worker and gave fellatio and analingus, what are the risks for any STIs, HIV, etc.. Assuming there is some risk, if afterwards I wanted to make 100% sure I was clean and would not infect another person, what tests should I do? For any possible risks, what would be the treatment? Are there risks of any STIs that could result that I might not be able to get rid of? Is one of these acts safe and the other not?

H. Hunter Handsfield, MD

1 months ago

Welcome to the forum. I'm happy to help.

Choose your partners with care, which includes having discussions about STI risks and prevention with a potential partner before you have intimate contact. Avoid contact with those who have HIV and are not on treatment or otherwise at especially high risk. Then use condoms for penetrating sex.

Oral sex, including analingus, is low risk for STIs. For analingus and fellatio your main risks would be for garden variety gastrointestinal infections (from the anal contact) and for gonorrhea, syphilis, etc from fellatio. (Chlamydia doesn't easily infect the oral cavity -- it can happen but is rare). The main two STI's that can persist indefinitely are herpes and HPV infection, but the chance of these is quite low for any single exposure with a partner without obvious symptoms. HIV is a potential risk but very rare from oral exposure of any kind. In general, we do not advise testing after every sexual encounter with a new partner. But after several such contacts, consider blood tests for syphilis and HIV and throat swab testing for gonorrhea and chlamydia.

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

HHH, MD

---

1 months ago

Thank you, doctor. Would digital stimulation of anus (mutual) and receipt of fellatio rather than giving be safer practices?

H. Hunter Handsfield, MD

1 months ago

I'm not sure what you mean by "giving", so I can't comment on the relative safety of the sexual practices on your mind. Fingering and hand-genital contact rarely if ever transmit STIs orHIV.---

1 months ago

Giving meant giving fellatio vs. receiving. I feel as though in the past many such questions on here were answered with "oral sex is safe sex" as though no one should concern themselves with consequences of any oral sex, but in this thread and other recent ones I looked at there seems to be more hesitancy over oral sex safety. Has there been new information, new studies that make your practice here more inclined to warn of oral sex concerns?

H. Hunter Handsfield, MD

1 months ago

Our advice about oral sex and HIV/STI risks hasn't changed significantly for at 10 years or more. It seems likely you're over-interpreting minor differences in wording, which can vary quite a bit depending on the specific question asked, and sometimes the tone and style of the question. A couple of simple principles are that in general fellatio is higher risk than cunnilingus (for both givers and receivers); that the risk varies between various infections (in general gonorrhea the highest risk, HIV the lowest, chlamydia very rare); and both herpes and HPV maybe not quite zero risk, but very low and less common than might be assumed on the basis of their fairly high frequency overall. The main "new studies" of possible signficance are reports from Australia about higher potential for gonorrhea transmission by saliva and kissing than previously understood -- but still very low risk overall.

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

---