Dear Doctors,

Yesterday I met a female partner from a dating app and we had protected vaginal intercourse. However, she also performed unprotected oral sex (fellatio) on me (approximately one/two minutes, twice). I didn’t really want this, but I couldn’t stop it. 

I am concerned about the risk of sexually transmitted infections, particularly gonorrhea, syphilis, and herpes.

1. Based on this exposure, how would you assess my level of risk? Would you be worried if you were in my situation?

2. Is it possible to estimate the likelihood (even roughly) of transmission in this scenario?

3.  I will check for symptoms in the next week. If an infection were transmitted, are these conditions typically curable or manageable without long-term complications?

4. If I remain asymptomatic, would you recommend anyway routine testing after a certain period (e.g., 6 weeks, or later)?

Thank you for your guidance.

In general, oral sex is low risk for all STIs, substantially less risky than vaginal or anal sex. Although HIV doesn't seem to be your main concern, I'll start by saying that over the 40+ years of the worldwide HIV/AIDS epidemic, there have been few if any scientifically documented cases of HIV transmission oral to penis. OF the others you mention, the main risk of importance is gonorrhea but even that is uncommon in this situation, in part because oral gonorrhea is absent in most sexually active women. Chlamydia is little or no risk. There is potential risk of herpes due to HSV1, but probably this occurs in under one exposure in tens of thousands. Depending on where you are geographically, syphilis also is very unlikely in your partner, and transmissible oral infection especially rare.

Those comments start to cover your numbered questions, but to be explicit:

1. See above; and no I would not be worried if I were in your shoes.

2. All in all I would guess there's well under one chance in a thousand of any STI from this exposure.

3. Being on the watch for symptoms is exactly the right approach. If no penile pus or painful urination within 5 days, you can safely assume you didn't acquire gonorrhea. No discharge or penile blisters/sores within 1-2 weeks will mostly exclude herpes and chlamydia. Same for syphilis if no painless penile sore within 2-3 weeks. All these are curable except herpes, but genital HSV1 infection usually has few consequences; and as discussed above it a very unlikely outcome.

4. If I were in your situation, I would not be tested if none of these symptoms appear. That said, risk alone is not the only potential reason to test:  reassurance alone is a valid reason. If you remain concerned, you could have a valid urine gonorrhea/chlamydia test after 4-5 days and conclusive HIV and syphilis testing at 6 weeks. I would not advise testing for HSV:  the standard tests are not good enough to be reliable in this situation.

Bottom line: Little or no risk, no medical/risk reason for testing and little cause for worry.

HHH, MD