[Question #1557] unprotected oral sex

45 months ago
Hello, Drs. I am a gay man. Two weeks ago (Dec. 10, 2016), I went on a date with a guy that we have been seeing each other 3 times before. And we took a night boat cruise (very windy and cold that night and we were exposed to the rain for about an hour). After the the cruise, we went back home and got intimacy. I have not been engaged in any sexual activities since I broke up with ex-boyfriend (a year ago), and I tested for negative for full STD panel in August 2016. That night, Dec. 10, 2016, I performed a very brief unprotected oral sex for him (he did not ejaculate into my mouth. For a fact, he did not ejaculate at all at night). And then after that, I showered and brushed my teeth and also used the mouthwash. However, the second day morning (Dec. 11, 2016) after I wake up, my throat started feeling so hurt, and then i started drinking a lot of water. However, the sore throat lasts and then by Thursday (Dec. 15), I feel headache and chill. And then I went to see my family doctor (GP) on Friday morning (Dec. 16). And we found that my right side tonsil was a little bit swollen and there are a couple of white spots on the tonsil. I got so scared, then I asked the GP am I in dangerous (I did not tell her about my sexual expose), and she said she think it was more likely a cold virus (not bacteria infection), but she did not do throat swap. But it has been another week, this past Thursday (Dec. 22), I went to see the GP again and told her on exposure, she said she still think it was more likely a cold than STDs, but she did say that I was in risk of HIV, syphills, and C/G. And she said in order for ease my mind, she will do a full STD panel for me also including a throat C/G check, but meantime she does not prescribe me any medicine. The results will not be available for 10 days, but my throat still hurts now and the tonsil still a little bit swollen. Doctor, please help me, I am so worries now. Am I in risk of HIV, syphilis and C/G? I could not sleep well everyday. 
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to our Forum.  I will be happy to comment.  Your GP sounds well informed and wise- I agree with most of what she has done.  I will comment both on your risks for infection and the symptoms you have experienced.

First your risk.  Your risk for any STI is very low.  You do not know if your partner had an STI and it is likely that he did not.  You have known him for some time now and I hope that you would be comfortable asking him if he has an STI of any sort and whether he would mind getting tested.  Even if he was infected, HIV is very, very rarely transmitted by performing oral sex on an infected partner (less than 1 in 10,000 sex acts, on average, IF he was infected),  Gonorrhea can be acquired through oral sex, very rarely so can herpes or syphilis however all or these are rare.  your doctor did the right tests and I anticipate that they will be negative for infection.  If your partner had syphilis, you would have seen a sore on his penis. 

I would also add the IF your partner had an STI (unlikely), the fact that he did not ejaculate also makes it less likely that you would be infected.

As for your symptoms, your symptoms are much more consistent with a common. "every day" non-STI sore throat than an oral STI.  Your symptoms started too early to be most STIs and when people are infected with gonorrhea in the throat, the infection is typically present without symptoms.  On the other hand it is typical both for non-STI viral and strep throats to cause the sore of white plaques on the tonsils that you described. 

I would suggest the following:

1. I would discuss your symptoms and concerns with your partner.  This is not to blame him but an honest question and shows concern for his health as well as yours.

2.  I would contact your doctor and ask her if she did a test for strep throat- your symptoms are most consistent with strep of a non-STI viral infection.

I hope these comments are helpful.  EWH

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44 months ago
Hello Dr. Hook. Thank you so much for the responses. Here are some updates.

1. I asked my partner. He said he tested all for negative last May (it has been over a year), and he does not have any complaints / does not feel any discomforts at the moment. 
2. Regarding to my test results and the throat tests, I have also been in contact with the GP. First, all the STD tests results came back negative (GP told me that she did HIV antibody and P24 test, syphils test, G/C urine test, G/C thorat test and even the G/C anus test). This test was done 12 days after my exposure (only briefly unprotected oral sex). Do you think the result is conclusive? Also I asked the GP regarding to the stripe thorat test as you mentioned, she said she did it too. The thorat culture came back negative too, which she thought supported her diagnose of the common cold virus. 
3. I know the G/C results seems should be reliable given test at 12 days post exposure. However, this week (15 days after exposure), I started feeling a little bit pain/discomfort/a little bit itching at the penis. But I have been diagnosticed as nonbacterial prostatisis by the urologist since early this year (he told me I have a condition called CPPC). And this discomforts like come and go during the past couple years. Based on this, do you think the feeling I am expericing now is more likely relat ed to this CPPC or I should wait couple weeks and perform another STD test to be conclusive given the test was done at 12 days after exposure and I started have this discomfort feeling coming back at 15 days? 
Thank you very much! 
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

1.  This confirms that your partner is rather low risk.

2.  I agree with your GP. She has done a good job.

3.  The symptoms you describe are more compatible with your anxiety or possibly prostatitis than an STI. I recommend you believe your test results.  I really see no reason for additional testing. 

EWH

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