[Question #1783] STI from insertive oral sex

81 months ago
Dear Doctors, 

I have an enquiry re STI transmission from oral sex. I am male mid 50 now living in Asia. I recently went to a massage parlour in Indonesia where I received unprotected oral sex (not to ejaculation) from a female and she also fingered/fisted my anus. And I fingered her vagina. There was no anal or vaginal intercourse

Now approximately 3 weeks lately, I feel a slight urethral irritation.  No visible discharge or pain, just a minor irritated feeling after urinating.  I aslo have the occasional but not daily  very small white mark on my underwater. No smell or heavy patches.

My questions are: 
1. could I have possibly received an NGU or chlamydia.? My reading of your previous replies indicates that if I had gonorrhea then it would likely be obvious in a week after the oral sex. I also note that you have a stated to others that  chlamydia from insertive oral sex rarely occurs.  Could I have some form of NGU or am I more likely just penis 'focused' hence  the weird feelings because of guilt. 
2. Do I need to test for anything?
3. Am I putting my wife at risk by having sex with her?

I am not concerned about HIV from oral nor the anal fingering/fisting based on your previous advice but am worried about the possible penile std.

Thank you for your time and patience.

Yours sadly, the Repeat Offfender.
Edward W. Hook M.D.
81 months ago

Welcome to the Forum. I'll be happy to comment.  The exposures you describe were low risk and only your receipt of oral sex places you at any risk for STI and what risk there is is small. You are correct to not be concerned about HIV.  As you point out, the STIs you are most at risk for at gonorrhea and non-chlamydial NGU.  If you had gotten gonorrhea there is at least a 95% chance you would have developed obvious urethral discharge and burning on urination.  The slight irritation that you describe could be NGU although the onset is a bit late and the absence of visible discharge likewise reduces the possibility that this is NGU although the slight staining that you notice on your underwear does suggest there may be a slight discharge.  At this point, the single best test for sorting this our would be to seek a urethral gram stain in which penile secretions are obtained with a small swab and looked at under the microscope.  The test is best performed when the specimen is collected at a time at least an hour after you have last urinated as urination tends to "flush out" the white blood cells if present.   If there are increased numbers of white blood cells present, this is compatible with NGU and probably warrants treatment. 

thus, to specifically address your questions:

1. See above.  chlamydia is VERY rare after oral sex, non-chlamydial NGU however is not all that uncommon. The late onset of your symptoms makes it less likely that you have NGU however.  I would add that your suggestion that your guilt and perhaps anxiety over your exposure may also place you in a state of heightened awareness in which what you are noticing are normal sensations .  A urethral Gram stain performed at an STD or sexual health clinic would help to sort this out. 

2.  See above.  A urethral gram stain would be the best test.  Urine testing for gonorrhea and chlamydia is reasonable but I anticipate the results would be negative.

3.  Even if you have non-chlamydial NGU you are probably not putting your wife at risk.  In the UK many specialists do not even suggest treating partners of men who have non-chlamydial NGU.

I hope these comments are helpful.  Please feel free to follow-up if any of this is unclear.  EWH

81 months ago
Dear Dr Hook, thank you for your prompt reply. I appreciate your time and expertise.  I have no more questions. Thank you
Edward W. Hook M.D.
81 months ago
Thanks for your thanks.  I'm pleased I could help.  EWH