I am a 37 year old male with a 39 year old female partner. I have, on occasion, visited with CSWs. Vaginal intercourse has always been protected however I have sometimes received unprotected fellatio. I have never had any symptoms of stuff. My partner, about a year and a half ago, started having more severe period pains. I was tested at that time and was negative. Since then, I have received unprotected oral 2 or 3 times. In Sept or Oct of last year my partner started having heavy bleeding with her periods. She's been to her doctor and had pelvic exams and ultrasounds. They found 2 - 5cm cysts on her ovaries. Since one of the cysts remained after a few months they performed laparoscopy today. The doctor removed her right ovary and tube due to significant adhesions being found. He gave her no antibiotics and told her to follow up in 6 weeks. I am very frightened that the adhesions might be related to PID caused by my being infected by unprotected oral and transmitting to her. I am wondering if you could share your thoughts. Could PID have been missed on ultrasound and pelvic exam? Would PID be so apparent on laparoscopy that antibiotics would be prescribed right away?

Welcome to the forum. Thanks for your question.---

Thank you so much for your response, Dr. Handsfield.

1) Yes. If her doctor had suspected an active PID infection, s/he would have prescribed antibiotics for sure.---

Is Chlamydia very unlikely with unprotected oral sex? It is my understanding that it is commonly asymptomatic. In my online "research" I read that in a recent study, 4% of csw in England were found to have chlamydia of the throat. This sounds like a high number.

Yes, very unlikely from oral sex. Chlamydia indeed is often asymptomatic, although most infected men develop symptoms, especially urethral discahrge. Also, chlamydia is rarely if ever transmitted by oral sex. It used to be "common knowledge" that chlamydia rarely if ever infected the throat. With newer diagnostic methods, i.e. DNA detection, in the past several years we have learned it's somewhat more common than previously believed. However, 4% of CSWs still is a low number, not a high one, a lot less common than genital infection. And it still appears chlamydia doesn't take well to the oral cavity and when present appears to be in small numbers, perhaps too little to allow easy transmission. Other research has shown no statistical association of receiving oral sex with penile chlamydial infection in men.---

Thanks again. I just have one piece of information that had slipped my mind and wanted to see if it affects my risk assessment. Last January and then again last May I had incidences of testicular swelling. It was localized to my right testicle, painless and not tender to touch though it felt a bit heavy and the testicle was quite a bit bigger than the other one. Both times it went away on its own without treatment within a few days. Could this have been epididymitis from receipt of unprotected oral? I never had any other symptoms. I'm just worried that during this time I might have been infected and transmitted this to my partner.

Epididymitis does not come and go, and is always painful, often excrutiating. (We only half joke that we sometimes can diagnose men with epididymitis cases before even speaking with them, by the way they walk into the exam room.) Anyway, the only known STD causes of epididymitis are gonorrhea and chlamydia, and we know you never had symptoms or testing to suggest you had either of them.---