[Question #268] Oral Sex Risk

36 months ago
Hello Doctor, 
Last week, I let my curiosity get the better of me, and I gave oral sex to another man. I do not know much about his history, but he claimed he was disease free. I touched his penis and scrotum with my bare hands to get him erect. Once he was erect, I put a flavored latex condom on his penis and gave him oral sex. At one point, we stopped, and he rolled the condom even further down his penis hoping I would go deeper. After a few minutes, I began to regret my decision and stopped the act. He did not ejaculate at all. I did touch his thighs and buttocks while he was in my mouth. He had a good number razor bumps on his thighs and pubic area.

I would like to know what are the risks (high risk, low risk, zero risk) for the following STDs: 

1) HIV 
2) HPV 
3) HSV-1 & HSV-2 
4) Gonorrhea 
5) Chlamydia

I am married, and I am very upset that I let myself do this and put my family at risk.

Thank you for your answer.
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

Welcome to our Forum.  I'll be pleased to comment.  While, at least from a theoretical perspective virtually and STI can be transmitted by any sort of DIRECT, UNPROTECTED sexual contact, the facts are that most people do not have STIs; that for all sex acts, most contacts with infected partners do not lead to infection; and the among the variety of possible types of exposure, oral sex is among the most inefficient (i.e. least likely to lead to transmission) forms of sexual contact.  In your specific case, the use of a condom throughout the sex act makes this safe sex with no realist risk for acquisition of infection.  I would urge you not to be concerned and really do not see any reason for even getting tested.

With regard to the specific infections you mention:

1.  There are a small handful of persons who may have gotten HIV from performing oral sex on an infected partner.  This number is very, very small and again, with use of a condom, there is no realistic risk for infection.

2.  The likelihood of acquisition of HPV from performing oral sex a single time on an infected person is unknown and likely small.  Even were infection to occur, the risk of serious consequence of infection is miniscule and again, with a condom, there is no reason to worry. 

3.  HSV-1 and -2.  See comments about condoms above

4.  Gonorrhea, oral sex can occasionally lead to acquisition of oral gonorrhea but with a condom, there is no reason to worry.

5.  Chlamydia.  Oral chlamydia is very, very rare even if exposed.  Not a concern

Your family is not at risk. I would not worry and as I said above, there is no medical reason for seeking testing. EWH

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36 months ago
Dr. Hook, 
Thank you for your response. I feel much better. Unfortunately, I came down with a sore throat and ear ache after the incident. While I am sure the two were not related, it definitely added fuel to the fire in my mind of all the terrible things that could have happened. 

I have two follow-up questions if I may. I understand you said to not seek testing, but if I were (for complete peace of mind more than anything) when should that be done? Would four weeks be enough time or is it better to wait six?

Second, I assume from things I have read elsewhere, that masturbation/hand jobs, even if there were small cuts, are not a risk. I guess I don't understand how small cuts would not be a risk. Is it because they are often not deep enough to go through all the layers of skin? Sorry, I am just trying to get a better understanding.  

Thank you again for your response! I hope you have a good weekend.
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

1;   Testing for gonorrhea, chlamydia, syphilis and HIV (using a 4th generation, combined antigen/antibody test) can be done at 4 weeks and be expected to provide entirely reliable results.  there is no need to test for HSV (if you were, without an outbreak, the results would be more likely to mislead you than help by giving either false positive results or informing you that you had acquired HSV long ago and were aware of it).  Similarly there are no good tests for HPV and even if there were, I would not recommend it for you.

2.  The statements regarding masturbation are based on observation and studies involving thousands and thousands of people.  Further STI Pathogens tend to be quite fragile and are not effectively transmitted  from person to person on the hands.  EWH

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36 months ago
Thank you for the reply Dr. Hook.