[Question #3305] Oral sex in Africa

38 months ago
Hello doctor I am writing because I am worried about a sexual act that occurred on my journey to Kenya I received oral sex from a stranger. It lasted maybe 5 minutes I did not cum in her mouth but I decide to stop and come outside.  I went to see a doctor 5 days later and she checked me and told that I was fine and she said that STD test I came out clean. She also told me that the HIV test would be irrelevant because the chances of sexual STD are low. I went to see a Urologist and he told me that I was fine for clamydia, and gonorhea that I should not worry for single exposure and that my testical pain are due calcium deposits and kidney stones. I am worried because so far I have not received any symptoms but in the back of my mind even after 2 urine test for STD that came out clean I worry. She had braces and worry for cuts I see many articles to be careful for sores and cuts. But when I read other articles it says not to worry for sores and little cuts. Doc I really need some advice  on what to do next my gf is asking for more sex and I am scared. I know it was only one one exposure but the info I read on the net drives me crazy
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your question.

Oral sex is always low risk for STDs, and zero risk for some, and can be considered safe sex, even unprotected. There has never been a proved case of HIV transmission mouth to penis, so I agree that HIV testing isn't necessary. The urine test for gonorrhea and chlamydia is highly reliable, and apparently you have had two of tests. (Actually, the chlamydia part was irrelevant. It also is rarely if ever transmitted mouth to penis.) Absence of urethral discharge, which you don't mention, is also reassuring, and without urethral (penile) discharge and painful urination, no STD is a likely cause of testicular pain (regardless of calcium deposits and kidney stones). Finally, you have had two in-person examinations and reassurance. You don't say how long it has been since the exposure, but if there have been no penile blisters or sores, that's also reassuring.

So my advice is to follow your own doctors' advice:  no further testing is needed and you can safely resume unprotected sex with your girlfriend. If you would like additional reassurance, feel free to have blood tests for syphilis and HIV 6 weeks after the event. If somehow I were in your situation, I would not feel the need -- but some people are more reassured by negative tests than by professional reassurance. Finally, I would also recommend no further online searching about it. Like many anxious persons, it seems you are being drawn to information (most of which may be inaccurate) that inflames your anxieties and missing the reassuring parts.

I hope this information is helpful. Let me know if anything isn't clear. 

HHH, MD

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38 months ago
Thank you for your rapid response doctor, you don't know how much I appreciate it. I do have a couple of questions, I want to take the chance educate myself.  That exposure was 5 months ago, and It was the only one. I just want to know if sores, small cuts, somebody brushing their teeth, having braces, enhances the chances of hiv during oral sex . Because other than you and doctor hook I did not find specific information on this type exposure. This person that I met wanted to have sex after a couple of drinks and good convo for hours. She is extremely well educated, and she seemed attracted to Western men and  Well mannered individual after oral sex I decided to stop it because I was scared to go further even if I had condoms. Guilt came over me and I had to apologise and cut the night short. I went to a clinic 5 days later the nurse and the doctor told me that I was fine. That I was going to waste my money on the urine test since they my genitals and said that everything was clean. I told them that if I was at risk because to my knowledge she was not a prostitute and she had to go work at an office job she hated every morning and she had braces. The nurse and the doc giggled at me and gave me a look of " you are so innocent".  I did the test and she told me just as I predicted you are fine.  I went to a Urologist 2 months ago  and assured me that no STD was in my system, after an ultrasound and urine  test he confirmed that my pain was due to calcium deposits and kidney stones.Well I have been reading your impressive resume Dr. Hunter and now is the time to ask my questions. What could I get resulting in oral sex from someone in Africa and why do you say that it is relatively safe sex. I know that nothing in life is 100% I could die from a car accident or food poisoning from anywhere in the world. You say that most internet sites are not good,What book would you recommend for me to get more educated that I could read on stds. Sorry that my questions are not in order and I just want to get educated as much as possible. Since I am far from being an expert in this matter.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
In theory, sores, vigorous tooth brushing, etc might increase the risk of HIV. However, since there has never been a known case of mouth to penis HIV transmission, any increased risk obviously makes no difference -- there must have been millions if not billions of exposures to HIV in the presence of such lesions, and yet no known infections. As for why I describe oral sex as "relatively safe sex", that is what the data show. Despite the high frequency of oral sex in most young people, the busiest STD clinics uncommonly see infected patients whose only possible exposures were oral sex. It happens for some infections, notably gonorrhea, herpes due to HSV1, nongonococcal urethritis (perhaps often caused by normal oral bacteria), and syphilis. But not very often. In addition, many STD pathogens don't take hold well in the oral cavity, and testing shows far lower frequencies of or STDs than genital or rectal infections; and when infection is present, it is less efficiently transmitted than from vaginal or rectal infection.

For reliable informatoin online, I recommend you limit your searches to websites run by public health agencies, governments, and academic institutions, or that have professional moderators (like this one); and avoid sites run by and for people with HIV or STDs or people at risk of them. Remember that anyone can post anything on line; there are no controls, and often the loudest voices are those with social or political axes to grind (e.g. social or religious conservatives whose main intent is to scare people away from non-marital sex). Two reliable resources about STDs and HIV are the American Sexual Health Assocation, the sponsor of this forum (www.ashasexualhealth.org) and the US Centers for Disease Control and Prevention (CDC) (www.cdc.gov/std or .../hiv). As for books, there aren't many written for lay audiences. However, my own book, Color Atlas and Synopsis of Sexually Transmitted Diseases, 3rd edition 2011, is aimed both at medical and educated lay audiences; it's available at Amazon.com and online as an app. (Full disclosure:  obvioiusly I get royalties, so you'll have to make your own judgment about its objectivity and this recommendation.)
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38 months ago
Thanks Dr.Handsfield I just a couple of  more questions
1. So according to the story I told you I should be fine for hiv, I have no warts, no blisters, no signs of outbreaks.
2. I feel a slight pain in testicules and a slight burn in urinary tract with no pain when peeing but the Urologist told me that if it was not for my sexual act in Kenya I would completely ignore the slight discomfort he says that my brain is causing me anxieties. That is is cause by the stones I have in my kidneys and the calcium deposits in my testicules.
3. I could  have unprotected sex with my gf and that my HIV test would come negative.
4. Even with sores, braces, etc. My chances are still low and considered   1 in 20000 ?
5. And finally most of the videos and article on the internet are designed to scare me and that they exagerate the their facts.

Doctor I did buy another question I might not ask for it anytime soon but I want to keep the option to ask for more questions. Also is there a place where I can make donations from time to time to any organization that you are involved. You have given some relief I am still going to get tested and I am grateful for the work you do. You are a tremendous help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
You're asking me to repeat answers already given, or whose answers are obvious from my comments above.

1) True.
2) I agree with the urologist.
3) Yes you can have unprotected sex with your gf.
4) Your risk is far lower than 1 in 20,000. That's the estimated risk if the oral partner has HIV. You don't know your partner did. If we assume a 1% chance s/he is infected, then your risk calculates as 1 chance in 2 million. Braces or sores make no difference.
5) Not many sites are designed with the goal of scaring people. But as discussed, many give inaccurate risk assessments and overly cautious advice.

Thank you for your offer to make a charitable donation toward STD/HIV prevention. I would recommend the sponsor of this forum, the American Sexual Health Association (www.ashasexualhealth.org).

Finally, thanks for the kind words about our services. I'm glad to have been of help.
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