[Question #1554] Risk of STD contraction from fellatio

44 months ago
My unhappily married , mother of 2 friend just had a  onetime drunken encounter with her coworker at her company's holiday party on Friday night. This encounter escalated to fellatio only, which she said lasted no more than 20 seconds without ejaculation. The very next morning, she woke up with a severe sore throat and as you can imagine, she is panicking. I've assured her HIV is a nonconcern, but she fears bacterial infections like syphilis or gonorrhea.  She is afraid to talk to he Doctor bc she shares one with her husband. Can you comment on the odds of infection after a limited encounter such as this? Also, she was able to get her PCP to call in a Z pack for "strep" and took 1 gram as a single dose. Will this help?  She fears for herself and  infecting her husband. Should she get tested and for which STDs?
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Welcome to the Forum. While I appreciate your concern for your friend, it is quite difficult to offer advice indirectly, not to mention that the majority of times that clients are asking about "friends" they are actually just too embarrassed to acknowledge their own situation.  Irrespective:

Fellatio is a low risk event with little risk of an STI including HIV.  Unless there is more to the story than is acknowledged here, it is statistically unlikely that the co-worker had HIV or, for that matter, any other STI.  Even if he did, the biological efficiency of fellatio is such that the majority of exposures to infected partners is quite low.  The risk of HIV, again, if he were infected is less than one infection per 10,000 exposures (i.e. 1 100th of 1%).  the other STI most likely to acquire such an exposure is gonorrhea which is likewise quite low. 

Also as an FYI, STIs of the throat acquired through fellatio are almost always asymptomatic and STD symptoms virtually never occur in the 1rst 24 hours after exposure so it is more likely that your friend's concerns were more a reaction to what is now considered an unwise decision than true infection. Azithromycin would cure some but not all gonorrhea if it were present.

My advice is for your friend to not worry further.  There is really no reason for testing of any sort at this part.  I would suggest you talk with your co-worker to clear the air as if this is not done the work situation could become difficult.   

I hope this is helpful.  EWH

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44 months ago
Dr Hook,  Thank you for replying so quickly. I realize the friend angle sounds cliche, but I assure you, I was only trying to give her some reassurance outside of Google because as I said, she was panicked /crying to me over the phone and could not be consoled.   I screenshotted this reply and shared with her. She has a couple follow-up questions. 1) If she decides to get tested, would a urine test show an Oral gonorrhea infection or does she need a throat culture ? 
  2) Is the risk also low for syphilis in this scenario? Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

I'm sorry, if your friend has questions she will need to address them herself. If she can Google, she can post.  I do not mean to be harsh but she needs to ask her own questions.  Final answers.

1.  Gonorrhea is a local infection.  Gonorrhea acquired through fellatio requires a throat swab for diagnosis and would not be detected in urine if there was no genital contact.

2.  Very low.

This thread will be close later today.  EWH

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