[Question #2004] STI Concerns from cunnlingus

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83 months ago

I am male in the UK and in a happy marriage and stupidly strayed with a female CSW of European origin (I think Spanish but may have been Eastern European) on Thursday of last week in a drunken moment of madness. The facts:

-          - No vaginal penetration or receiving of oral whatsoever took place

-        - I performed unprotected cunnilingus and analingus on the girl including inserting my tongue inside her vagina and anus for lengthy and prolonged periods of time

-         - She touched herself and inserted her fingers inside her vagina and then immediately rubbed and massaged the tip of my penis (directly on and around the opening          to my urethra) for prolonged periods on several occasions. I also fingered her and masterbated mysellf immediately after thus her fluid came into contact with my penis and my urethral opening again as I remember touching it on several occastions

  I am obviously very scared as to what I might put my wife at risk of from this crazy mistake;

 Questions:

1.       1. I understand my risk of catching ghonorreah  from cuninlingus is exceedingly low. Is it low enough not to warrant oral testing?

2.       2. I’m concerned about mycoplasma genitalium and ureaplasma urealyctum from cunnilingus. A reputable private clinic in London called Freedom Health offer throat swabs for these bacteria, would you advise that I’m tested for these?

3.       3. Is there any risk from the girl touching herself and immediately then massaging the tip of my uncovered penis? Similarly, from me getting her secretions on my exposed penis tip

4.      4.  Should I be tested for Hep A due to analingus or is this too harmless a condition to worry about? I am concerned that this could be passed to my wife from my hands not being properly washed etc and then me preparing food or something along those lines

5. 

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H. Hunter Handsfield, MD
83 months ago
Welcome to the forum. Thanks for your question.

Cunnilingus and analingus (anal-oral) are inherently low risk for all STDs. Not zero risk by any means, but probably virtually zero from some infections (e.g. HIV) and very low for all other STDs. The greatest health risk from an exposure like yours is for a non-STD intestinal infection from analingus:  if your partner happened to have viral gastroenteritis, for example, almost certainlky you're in for the same thing in the next few days; or if she has other intestinal/enteric infections. There is zero risk of HIV for all practical purposes:  there has never been a case known to have been acquired by cunnilingus or analingus. To your specific questions:

1) Gonorrhea is rarely transmitted by cunnilingus, and statistically it is unlikely your partner had it. I would say there is under 1 chance in a thousand you acquired it. Is that high enough for testing? Probably not, in part because transmission of oral gonorrhea is difficult -- i.e. you would not significantly put your regular partner at risk either by kissing or cunnilingus. And oral gonorrhea rarely causes symptoms and clears up on its own in a few weeks or months, without treatment. But if you remain nervous about it, you could visit a clinic for throat culture for gonorrhea. (Urine testing doesn't detect non-genital infections.)

2) Definitely no worries about M. genitalium or Ureaplasma. They are not known to infect the oral cavity.

3) In theory, direct contact of your meatus (penile opening) with wet vaginal secretions could transmit gonorrhea or chlamydia, and theoretically other STDs. However, this risk undoubtedly is very low. Even the busiest STD clinics see essentially no patients with penile STDs who did not have unprotected vaginal, anal, or oral sex. Hand-genital transmission is extremely rare, even when genital fluids are used for lubrication. However, nobody can say the risk is zero. If you attend a clinic for a throat swab for gonorrhea culture, you might also request a urine gonorrhea/chlamydia test just to be on the maximally safe side. But I definitely predict negative results.

4) Hepatitis A is one of those enteric infections that could easily be acquired by analingus. However, there is no hep A carrier state:  the only people who can transmit it are those with active hepatitis. The chance your partner had hep A, but still felt and looked healthy, is almost zero. I wouldn't worry about this at all.

If somehow I were in your situation, I would not be tested for anything and would continue my normal sex life with my wife, without worry. I would understand the risk isn't zero, but it's low enough to take the very small chance. But I'm not you and you'll have to make your own decision about testing.

I hope this has been helpful. Let me know if anything isn't clear.

HHH, MD



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83 months ago
Thank you for your responses Doctor. A few follow ups for further understanding if I may:

1. Re. intestinal/enteric infections - i assume nothing i should actively seek testing from my GP for without symptoms and nothing potentially serious to worry about?

2. Re. throat swab - will this be accurate at 2 weeks which is the earliest i can get to the clinic and would any infection  still be there / won't have cleared on it's own by then? Also, i'm assuming if negative the result will be conclusive with no repeat necessary?

3. When you say ureaplasma urealyctum and m. genitalium aren't known to infect the oral cavity, is this based on data from research or based on assumption due to low risk of ghonnoreah and chlamydia from oral transmission?

4. Re. ureaplasma urealyctum and hominis - are these to be ignored even if picked up on a full STI screen urine test? I've done some reading on the medhelp site and Dr Hook says that even if UU is treated and it clears it often re-appears, does this mean that it grows back spontaneously or that it needs to be caught back from someone else? You've mentioned in the past that some parts of Europe take UU more seriously, Spain for example, why the discrepancy with the US / UK?

5. Re. Hep A - I'm a bit confused as everything i've read on official sites (NHS in the UK for example) says that it can often be carried with no symptoms and people may not know they have it but still be contagious. I was also incredibly drunk and wouldn't have noticed if this girl was looking off-colour / unwell. Am I right in thinking that even on the theoretical chance that i did catch Hep A there would be no serious health risk to my wife? Again, some sites say there are no serious complications and others say it can on rare occasions be fatal due to liver failure?

6. Finally, when you say 'theoretically other STDS' can be caught from hand-to-genital can you state which ones so i can take a private clinic test to rule them all out for my peace of mind?

Thanks for your clarification Doctor. 





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H. Hunter Handsfield, MD
83 months ago
1) There are no readily available tests for asymptomatic or recently acquired enteric infections. It's just an issue of waiting on symptoms and getting checked if anything shows up. If nothing shows up within 5-7 days, no worries.

2) A 2 week throat swab would be fine.

3) There are few data actually testing the oral cavity, but we never see genital infections with Ureaplasma or M gen in people whose only exposure was oral sex. 

4) Proper STD screening, including the most "full" panels, don't include Ureaplasma. As you seem to know, there is some controversy about it, but most experts consider it a normal bacteria in the genital tract. It's present in the genital tracts of up to 50% of entirely healthy people. And M gen screening is controversial:  it isn't know whether its presence, without obvious clinidal problems like urethritis etc, requires treatment.

5) True some cases of hep A are asymptomatic, i.e. infected persons can feel and look healthy. However, it's a brief illness (a few weeks) and unlike hep B and C, has no ongoing carrier state. So the statisitcial likelihood any particular healthy person is infected is almost zero. This is to be ignored. In my 40+ years in the STD business, I have never once seen a case of heterosexually acquired hepatitis A (or hep C, for that matter).

6) Stress on theoretically. For practical purposes this never happens. I strongly recommend against testing on the basis of hand-genital contact.

All things considered, you're rather seriously over-analyzing all this. You had safe sex with a partner who is unlikely to have any STD. I suggest you just let it go. That's what I would do if somehow I were in your situation.

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83 months ago
Thanks Doctor. My final questions if I may:

1. My wife and I had sex this morning and afterward there was a very obvious white, slightly foamy discharge around her vagina only after intercourse which sometimes appears (at least once before) – it’s definitely not anything untoward like chlamydia or anything as we have both been tested very recently as we never had been in the past (tested prior to my recent incident obviously).  It is either entirely normal caused by sex or a yeast infection and just goes. My concern is if it is BV I would have had it when i was with the CSW so is there any real risk that I could have spread it to the CSW through touching my penis urethra and pre-ejaculate etc and then fingering the CSW (fingers in her vagina)? My concern is that whilst she was slim she had an extended/bloated belly which may have meant she was pregnant. Should i contact the CSW to tell her as my understanding is that BV is a risk to pregnant women? Or does the near zero risk of hand-genital transmission also relate to BV and for BV to transmit to a partner is an unprotected penis in a vagina required so nothing to worry about anyway?

2. Re. your response to my questions re. MG and UU in the oral cavity and that you never see infections in those you who's only exposure was oral sex. I assume this means in research settings given there is no widely used test in the US for MG and UU?

3. I am going to have a throat swab and urine test simply to put my mind at rest but can't get to the clinic until Monday 1st May - 17 days since my incident. I assume that any infection picked up (appreciate the near zero chance) wouldn't have had time to clear on it's own by this date?

4. Finally, given i put my tongue inside the CSW's vagina when performing cunnilingus, if one of her previous clients had ejaculated inside her, or all of them, I didn't see her until 3am and I have no idea if she insisted on condom use (i imagine she does but every CSW has their price not to i imagine), do you think there's any real chance of my tongue having come into contact with someone elses semen? I know there would be no STD risk but the thought it is playing on my mind. I know that after ejaculating in a woman it 'falls down' so wondered if you think i could have come into contact with it or close to zero for anatomical reasons even with putting tongue in as far as it would go? 

Thanks Doctor  






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H. Hunter Handsfield, MD
83 months ago
1) From your description, your wife's vaginal secretions don't sound abnormal. If she believes she has a new or increased vaginal discharge, she should check it out. The main symptom of BV is not discharge, but odor. If she isn't noticing abnormal odor, especially after unprotected sex, then she probably doesn't have BV. And occasional "bloating" is part of being human, not a symptom that usually means anything important.

2) There has been little research on oral infection with these organisms. But the general consensus of researchers studying them is that oral infection, or transmission by oral or anal exposure, probably doesn't occur. And true, there are no FDA approved tests and no widespread testing for UU or MG in the United States, even though you can find online sources offeriing such tests, but they are nonstandardized and not necessarily reliable. And UU testing makes no sense anyway; half of all tested people would be positive (genital or urine), and it doesn't require treatment.

3) It is possible gonorrhea or chlamydia could clear within 17 days, but unlikely.

4) So you're asking if exposure to a previous partner's infected fluids could result in your being infected, even if infection had not yet taken hold in your partner. I would judge this as exceedingly unlikely, unless she'd had sex with the other guy in the preceding minutes. In any case, there are no data at all on the details of analingus that you describe and how it might affect STD risk. But I doubt it makes any difference.

That completes the two follow-up comments and replies included with each question, and so concludes this thread. My final advice is to not over-think all this. Re-read my initial reply (and the last two as well) and accept the reality that there was little or no STD risk from the events described. Just go on with your life and put this business behind you. 

Best wishes and stay safe.

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