[Question #2575] More clarity on risk of oral sex

96 months ago

If there is any possibility I would like for Dr Handsfield to ask the following 2 theoretical questions. I am very impressed by his expertise and answers in this forum.As a matter of life style and responsibility to my partners I would like to understand the real risk of getting infected with Gonoorhea from oral sex more accurate and precise than I can find on any website and also not in your forum.While I understand that there cant be any valid concrete numbers I would like to ask your best guesstimate based on your vast experiences over decades.

a)How much less likely in percent is it to acquire Gonoorhea from receiving oral sex from a female in difference to having vaginal or anal sex ? Is the risk still 50 % or is it more in the region of 10 % of the higher risk being vaginal and anal sex ? In other words if I would have vaginal/anal sex with 10 000 different female infected partners how many times could I expect to contract Gonoorhea in this way. In difference how many times could I expect to get infected with Gonoorhea from receiving oral sex from 10 000 different female partners who are infected with oral gonoorhea?

b) I understand that the bacteria lives mainly in the back of the throat and not really in the mouth and on the tongue and that therefore the risk of getting infected with Gonoorhea must be much lower if the oral sex is only performed by licking the penis and/or just by entering with the head of the penis into the mouth but not deeper. How much less risk in percentage would you guess is this technique in difference to deep throating.

c) I also understand that not every exposure to an infected person leads to an infection. What is your guess how many times on average I would actually need to have sexual contact with the infected person on average before I could get infected yourself?

Thank you for an honest response.

Edward W. Hook M.D.

96 months ago

Welcome to the Forum. As you probably know but are trying to work around, clients on this site are not permitted to request who responds to their questions. All questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all other questions. As it happened, today I happened to pick up your question. As an FYI, having worked closely for more than 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary. I will be addressing this question.

Before I answer your specific questions, I need to point out that any conversation about the risk for acquiring gonorrhea starts with the issue of whether or not your partner has gonorrhea at a site to which you are exposed. In at risk persons, while any site or combination or sites can be infected, genital and rectal infections are substantially more common (typically twice as common)than oral infections. Then, the efficiency of transmission at that site may vary as well.

Addressing your specific questions:

There are studies which have evaluated the risk of a man acquiring gonorrhea through vaginal sex with a gonorrhea infected partners but no similar data for oral or rectal exposures. We know that a man genitally exposed to a female partner has about a 20% chance of infection each time he has sex with that partner. Rectal exposure probably has about a similar level of risk. For receipt of oral sex, the risk is lower but how much lower is hard to say but possibly as much as half as likely. Obviously variables such as the duration and parts of the oral cavity to which the penis is exposed may affect this but how and how much is unknown.

Once again, you are asking for guesses as there are no studies to provide an answer to your question. Clearly, because the bacteria are not present on the tongue or lips, kissing or licking the penis during oral sex is likely a very low risk exposure, Whether that means the chance of infection is 1% or less or 5% or less is unknown but certainly risk would not be higher if those were the only sorts of exposures one had.

See above. for genital exposure through vaginal sex with an infected female partner, the average risk per exposure is 20%. Obviously some persons exposed in this way would get infected on their first exposure, others on their 2nd or 3rd and so forth. Risk for rectal infections is about the same. For receipt of oral sex from a partner with oral gonorrhea, I would estimate that the risk for infection is 5% or less (i.e. 1 in 20).

I hope these responses are helpful to you. EWH

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96 months ago

Thank you so much. That was very helpful .May I please add this question : In respect of the new super bug of the antobiotica resistant Gonoorhea which appears mainly in Spain , France and Japan I would like to know how considerable is the risk in percentage compared to the normal treatable G. In other words how many percent of Gonoorhea are untreatable by antobiotics and what does a person actually do if G. can not be treated and you have a lot of pain urinating ?

Does the untreatable Gonoorhea also spreads through if someone got infected from a person with Oral Gonoorhea?

As a last question : How effective is 2 mg of Zithromax in treatment of Gonoorhea in comparison to the other treatments. I am asking as this drug has the least side effects. Thank you.

Edward W. Hook M.D.

96 months ago

I'm pleased my answers were helpful. At present the so-called "supebug strains of gonorrhea are very rare, even in places like Japan, the United Kingdom and Europe these strains are less than 1% of all gonorrhea. The great concern however is that, along with other forms of antibiotic resistant gonorrhea (such as those which are only resistant to one or two types, but not all antibiotics) are increasing and that even these bacteria are progressively acquiring more and more resistance. In turn, this process makes it more difficult to know how to best treat patients with gonorrhea when one does not have the results of testing for antibiotic resistance. At present, all gonorrhea can be treated with available antibiotics although on some occasions treatment on more than one occasion is needed. To make sure they are cured, scientists are increasingly recommending that patients treated for gonorrhea have follow-up testing to be sure that the treatment was successful - these are called "test of cure" tests.

About 60% of men with gonorrhea will have discomfort on urination.

Persons can acquire antibiotic resistant gonorrhea from persons with oral infections.

At present 2.0 grams of azithromycin, taken all at once, will cure most (over 97%) of gonorrhea but there are fears that this number may be declining because azithromycin resistance, like other forms of antibiotic resistance, appears to be increasing. EWH. .

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96 months ago

Dear Doctor Hook,

Thank you again and these should be my last follow up questions :

Does vaginal or anal Gonorrhea travel also to the mouth or is oral Gonoorhea acquired by giving oral sex only and getting infected in this way ?

Or does it mean who has vaginal Gonoorhea automatically has also oral Gonoorhea ?

You are writing that receiving oral sex is half as likely to acquire G than with vaginal /anal contact. Does this mean out of 100 cases of getting infected by Gonoorhea you estimate

for Vaginal exposure to contribute to 40 infections,Anal to 40 infections and Oral to 20 ? I am not sure how to understand your response.

And as last summary of my questions I assume that the risk of contracting Chlamydia for the oral exposure we have discussed over the course of these 3 sets of questions is even lower than for G.

For being the receiving partner of rimming the risk seems to be as close to ZERO as it possible can be as kissing and licking the anus would not spread any G. bacteria ( which are int he back of the throat of the giving person ) to the receiving partner.

Thank you again for your professional answers.

Edward W. Hook M.D.

96 months ago

As you may know, the Forum permit up to 3 responses per question, after which the thread is closed without further responses. I will address your follow-up questions below, then later today the thread will be closed.

1. Gonorrhea is transmitted only by direct contact. Thus cervical or rectal gonorrhea in women does not travel to the throat and throat infections do not occur without direct sexual contact. Persons who have gonorrhea at one site do not automatically have it at other sites.

2. Transmission should be considered on a site-by site basis. Thus if 100 men are DIRECTLY exposed to cervical or rectal gonorrhea, we would expect about 20% of them to get gonorrhea. On the other hand, based on my response above, if 100 men received oral sex from gonorrhea from a woman with gonorrhea in her throat, only 10 of those men would be infected.

3. Chlamydia is less common in the throat than gonorrhea, thus the risk of getting chlamydia from receiving oral sex is lower than the risk of getting gonorrhea, There are no scientific data to be able to comment on the biological efficiency of chlamydia transmission and what proportion of persons with chlamydia at one or another site will become infected.

4. Rimming, like kissing is close to zero risk for acquiring gonorrhea and chlamydia

I hope my responses have been helpful to you. EWH ..

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