[Question #1725] insertive oral with CSW in the USA

97 months ago

About 1 year to about 3 years ago, I had multiple encounters withe CSWs in the USA, perhaps about 5-10 different encounters. These situations included insertive oral, me being the insertive, and the women performing on me unprotected oral sex. I hope this makes sense? I have never had any symptoms of any STI. Aside from HIV testing, i have never had any testing done.

Is there any need to do so at this point?

97 months ago

For some reason, i cannot see your response?

H. Hunter Handsfield, MD

97 months ago

Welcome to the forum. Thanks for your question.

The bottom line is that these were all low risk encounters. (Congratulations for having entirely safe sex -- but keep those condoms handy in case you get tempted in future encounters to have vaginal or anal sex.)

Oral sex can be considered safe sex: not completely free of STD risk, but low risk for all and virtually zero risk for some. Most of your risk was from receiving oral sex, but oral to penile transmission occurs rarely if at all for chlamydia, HIV, HSV2, HPV, and viral hepatitis. Those exposures carried small risks for gonorrhea, genital herpes due to HSV1, syphilis, and nongonococcal urethritis (NGU). Absence of symptoms is strong evidence against all of these, although not proof you were not infected.

Cunnilingus (oral-vaginal contact) is even lower risk. You probably could have acquired oral gonorrhea, HPV, syphilis, or oral herpes due to HSV2, but the chance was low and absence of symptoms also is reassuring.

Should you be tested for STDs? Strictly from a risk standpoint, there is no need, especially in the absence of symptoms like penile discharge, painful urination, or sores or warts of the genital area or mouth. However, many people in your situation will be more reassured by negative lab tests than by expert advice based on probabilities and statistics. If you decide to be tested, have a urine test for gonorrhea and chlamydia, a throat swab for gonorrhea, and a syphilis blood test. I would definitely expect all of them to be negative.

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

HHH, MD

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97 months ago

Thank you for the reply.

I have been in a committed relationship this whole time, and not quite sure why now this is eating away at me. I live in a major city with a well known STD clinic. I called them, and they said absent of any symptoms and given the time that has elapsed, they would not provide the free test, but did tell me how i can pay to get ones.

Does this mean they consider me STD free based on these exposures? Or that my risk is so low it is not worthy of their resourceS?

Also, i fear if i had something i could have passed it along to my wife?

Again I hope what I am asking is making sense?

To be clear, i did not perform Oral on the women; just them performing on me.

Would you get tested if somehow you were in my shoes?

THank you!

H. Hunter Handsfield, MD

97 months ago

I agree with the clinic, that exposures that long ago, with no symptoms now, make testing optional and unlikely to be positive. Even if you had acquired gonorrhea or chlamydia, by now your immune system would have cleared them up. The clinic probably does consider you to be STD free. Of course this isn't a guarantee; the chance you have (or had) an STD isn't zero, but it's low enough to be in the lightning strike ballpark. If I put this in personal terms, if somehow I were in your situation I would not feel a need for testing and would not be worried about my wife's health.

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97 months ago

Thank you, that helps a ton. I will try my best to not allow guilt to trump medical reality, and try to move on from this psychologically. I mean, if you and the clinic both think i should move on, that is enough for me (hopefully).

I do have one more question, science wise. You mentioned with C and G, that my system would have likely cleared it up by now. Does that mean that these 2 STI's , if assymptomatic, will eventually within a few years be 'cleared up' by the body?

Thank you

H. Hunter Handsfield, MD

97 months ago

In the pre-antibiotic era, before any effective treatment was available, gonorrhea in men typically resolved in a few weeks, rarely longer than 3 months probably never more than a year. Most chlamydial infections probably are cleared within 3-6 months. For both infections, it tends to take longer in women than men, but over 90% of infections are gone within a year. Whether the infection starts out symptomatic or asymptomatic isn't known to make a difference one way or the other.

Cure by the immune system is the rule for most infectons. Before antibiotics, the large majority of people with serious bacterial infections like pneumococcal pneumonia, strep throat, or staph skin infections survived. Several percent died, which is a horribly high mortality rate by modern standards, and many survivors had ongoing problems due to irreversible organ damage. But the infections themselves resolved and most people got entirely well, even if it took weeks or a few months. There are plenty of exceptions, such as tuberculosis and syphilis, which last indefinitely if not treated. Gonorrhea and chlamydia are more like pneumococcal, staph and strep infections in this regard, rather than TB or syphilis.

That completes the two follow-up comments and replies included routinely with each question, and so ends this thread. Thanks for the thanks for our services; I'm glad to have helped. Best wishes and stay safe.

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