[Question #1529] unprotected Analingus with sex worker 4 days ago - what are the risks

83 months ago
As the question states, what are my risks.  

I am getting contradictory information about how easy it is to pass stds from genitals to mouth.  Something similar was asked here and the dr claimed that transmitting stds from analingus to mouth we very low risk yet all information online is telling me that Gonorrhoea and Chlamydia, herpes and syphilis is high probability.

My wife just confirmed pregnancy so i am very anxious.  I will abstain from sex until I can take a test on week 4 (unable to take a test earlier) but what are the chances of passing her anything through kissing or touching?  I dont really want to tell my wife what I did, but if I need to in order to keep her safe I will do.  I just need some realistic advice. 

Herpes from what i read is not necessarily dangerous, but it seems likely given a sex worker probably has it but transmitting from genitals to mouth how common is this?  Syphilis is what I am most afraid about.  Is this very common and what are the chances of getting this transmitted and more to the point, how can I detect it?

Just to clarify, I did not do anything else other than analingus, a part from hand relief. 

Edward W. Hook M.D.
83 months ago

Welcome to our Forum.  Your questions are good ones but unfortunately also questions for which there are few answers.  I can tell you as well that after more than 35 years in the field, seeing patients, reading scientific journal, attending meetings and discussing our work with colleagues, I have never heard of a case of STI which was definitely acquired through analingus.  While it probably occurs rarely, it is not common enough to come to regular attention.   Looking for answers on the internet is a mistake- statements made there are all too often taken out of context, misinterpreted or just plain wrong, all of are misleading.   I'll try to help.

STIs are transmitted through direct contact.  While it is certainly theoretically possible, there is little evidence in the scientific literature that STIs are commonly transmitted from the anus to the mouth through analingus (on cunnilingus for that matter).  The tongue appears less susceptible to infection than other sites and the physical act of inserting one's tongue into a person's anus rarely permits the depth or duration insertion to lead to infection. 

In terms of herpes, for genital contact, if one is having sex with an infected person and that person does not have known lesions (i.e. presumably you would have seen them if they were present), we estimate that the risk for infection is substantially less than 1 infection per 1000 sex acts. 

As far as syphilis is concerned, syphilis is still a rather uncommon infection compared to other STIs and once again, had a lesion been present, chances are you would have noted it.  Syphilis of the tongue is vanishingly rare and when it is present, I have never heard or seen evidence that it might have been acquired through analingus as opposed to direct contact with an infected penis. 

As far as detection of possible infection is concerned, you could have a throat swab performed for gonorrhea and chlamydia and after 4 weeks you could have a blood test for syphilis.  I would not worry about herpes unless there are visible lesions and if this is the case, you should have the lesions tested for both herpes and syphilis.  We strongly recommend against blood tests for herpes as the risk of getting a falsely positive test in situations such as yours is actually higher than your risk for actually discovering that you were infected.

Finally, if you were infected in the throat or tongue, there is virtually no risk of transmitted any STI through kissing or touching. 

I hope these answers and perspective are helpful.  EWH

83 months ago
Your answer was very informative.  But I have just a couple more questions:

Because I was very drunk I did not take note of any lesions which is why I am worried.  So back to herpes,  oral herpes is said to be type 1 with genital herpes type 2 so even if I did come into contact with a herpes sore how is it possible to transfer to the mouth if the type is different? 

My second question is about timing what is the earliest and average time you have seen herpes or Syphilis sores show up and how quickly will herpes sores show after typical facial sensations.   I don't know if my nerves are creating sensations that feel like an outbreak or herpes is going to happen? 

One more thing,  if I do get a visible lesion of Syphilis do you think I will definitely know something is wrong as a lot of information suggests it would look like something else and harmless -  are they always of a particular size? 

In summary,  your information seems like my risk of anything  other than a possible herpes contraction is possible -  meaning low risk.  Is that correct? 
83 months ago
.... Apologies there was one question I totally forgot more for information around gonorrhea and clamydia. 

If these are location based stds and testing requires a swab from affected area e.g throat or Penis then is it possible to transmit these these through sex if you have infection in the throat? 

Edward W. Hook M.D.
83 months ago

Responding in the order of your questions/comments:

Being drunk does not make you blind and lesions are not particularly subtle.  Had their been lesions, you would have seen them.

Regarding HSV, you would not get HSV-1 from analingus.  While HSV-1 can be transmitted to the anus, transmission from the anus or genitals is extraordinarily rare and should not concern you.  This related to the biology of the two viruses. 

HSV lesions could occur within 4-5 days and almost always by 10 days.   Lesion formation would follow tingling sensations by just a day or two.  Most tingling sensations however are more of a sign an anxiety and hyperawareness than related to the onset of HSV.   For syphilis, the average time to lesion formation is about 21 days.  Again, I think you are worrying far too much about either of these possibilities.  If you developed a syphilis lesion it would typically be a half inch wide or bigger. 

Infections in the throat can transmit infection but less "efficiently" than genital lesions.

In summary, I really think you are more worried about this than you need to be.  Please realize that because you asked fact-based questions, I provided the data but that my assessment is that your likelihood of developing ANY of these manifestations is close to, if not, zero.  I hope my replies will allow you to move on without concern- you should.  EWH

83 months ago
Thank you Dr Edward.