[Question #1823] Recent oral encounter

42 months ago
Hello. I very much appreciate this service and I am hoping that it may put my mind at ease. I am a male and 4 days ago I received unprotected oral sex from a worker at an expensive asian massage parlor for about 1-2 minutes. I am currently in a committed long term relationship and I am having extreme guilt and anxiety due to this encounter.

I am having absolutely no symptoms except for extreme anxiety. I saw a doctor at an urgent care facility today and they told me that I was only within the window to be tested for gonorrhea and chlamydia and even still I am at the very early stages of the testable window. My main concern is that I will not be able to cease sexual activity with my significant other due to the fact that it would very much arise suspicion.

My questions are:

1. What are the chances that I actually received an STI from this encounter? 

2. How much risk am I putting my significant other in to be continuing unprotected intercourse with them? 

3. I am hoping to receive back negative chlamydia and gonorrhea results in the next 3 days. How conclusive do you expect these results to be? 

4. It was recommended that I get a full panel STD testing done at 2 weeks post exposure. If these come back negative is it safe to say that I do not have any STDs?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome. Thanks for your kind remark about the forum and your confidence in our services.

STD and HIV risk from oral sex is one of the most common kinds of question we receive. Our consistent advice is that oral sex is sufficiently low risk that it is considered safe sex, especially considering transmission from the oral to the genital partner. It's not entirely without risk, but the chance of any infection is low for all STDs and virtually zero for many of them. The risk for any single exposure is always low, both because oral STDs are uncommon compared with genital or anal, and when present, they are not efficiently transmitted -- that is, even exposure from an infected partner usually doesn't transmit infection. The three STDs most common in your situation -- and I stress that all these are actually quite uncommon -- are nongonococcal urthritis (NGU), which often is believed to often result from normal oral bacteria, i.e. not true STD bacteria or viruses, and probably is pretty much harmless; gonorrhea; and herpes due to HSV type 1, the cause of recurrent oral herpes (cold sores). Syphilis is possible, but in the US is currently uncommon among heterosexuals, including sex workers; it's primarily a problem these days in men who have sex with men. Finally, you'll notice I've said nothing about chlamydia, HIV, and viral hepatitis, and HPV. Chlamydia rare infects the throat and is almost never transmitted by oral sex; HIV probably even lower risk, with no proved cases, ever, anywhere in the world, transmitted mouth to penis; and viral hepatitis also very low risk. HPV maybe slight risk, but it's a universal infection anyway and almost always without symptoms or harm, so nothing to lose sleep about.

To your specific questions:

1) As a rough estimate, there's probably under 1 chance in a thousand you were infected with anything. Absence of symptoms by 4 days is itself strong evidence against gonorrhea; and if you go another week without symptoms, that alone will rule out most cases of NGU and herpes. 

2) While nobody can guarantee you were't infected with one of these STDs, the chance is very low. If somehow I were in your situation, I would continue unprotected sex with my wife without hesitation and without worry.

3) At 3-4 days, the gonorrhea result will be conclusive. Chlamydia perhaps not quite; it might take up to 5 days for testing to become positive. But as noted above, there is no significant chance of chlamydia anyway. (If positive for chlamydia, it would be necessary to assume your wife was the source.)

4) Assuming this means blood tests, 2 weeks is too soon. Conclusive HIV testing requires 4 weeks (for the antigen-antibody, i.e. "duo" test) and syphilis 6 weeks. But I see no need to test for these anyway. And I would not test for anything else commonly offered in "comprehensive" STD lab panels. However, if you want the reassurance of negative testing, have just the HIV and syphilis tests at 4 and 6 weeks, respectively.

Going back to how I would manage myself in this situation, or a close friend or family member, I would be satisfied with the negative gonorrhea (and chlamydia) results at 3-4 days, and no further testing, assuming no new symptoms n the next 1-2 weeks.

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

HHH, MD

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