[Question #3330] Oral Sex / NGU

38 months ago
Bisexual male here.  I’ve done a lot of reading on this site, which has provided some comfort that my risk is low, but wanted to get your thoughts on my exposure.

On Wednesday, January 31st, I had an encounter with another male who I met online.  We’ve chatted for weeks, and finally decided to meet.  The encounter included receipt of unprotected oral sex and brief condom protected anal sex.  I am certain the condom remained intact for the entire event.

In the last couple of days, I’ve developed what feels like minor burning in the urethra.  I can say with certainty, however, that there has been zero discharge.  Also, the burning sensation doesn’t occur while actively urninating, which seems odd to me if there was infection.

I’m confident HIV is not a risk given the condom protection and the fact that HIV has never been transmitted from mouth to penis.  I’m also confident chlamydia is not a concern given I’ve read on here that it just doesn’t live in the throat and transmit to penis.

So my questions are:

1.  How does non-chlamydial NGU typically present?

2.  If this were gonorhea, based on my reading here, there would certainly be discharge, correct?

3.  Is NGU transmittable to a female partner?


Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Welcome to our Forum.  Coincidentally I happened to check the site at just about the time your question came up so you are receiving a reply a bit more quickly than is typical.  Thanks as well for your commitment to safe, condom protected sex and for taking the time to review other posts on this site.  Your summaries are correct- the exposure you describe is associated with a small risk for urethritis (urethral irritation) which could be due to gonorrhea, chlamydia (very, very rarely), or non-chlamydial NGU. In answer to your specific questions:

1.  The most common symptoms or urethritis are penile discharge and/or burning on urethritis. the discharge is not always present and can be slight in amount.  Over 90% of persons with gonorrhea would have obvious discharge while discharge may be absent in more than half of persons with chlamydial or non-chlamydial NGU.  The burning on urination may be quite mild but when present is more prominent with urination than when one is not urinating.  Assessing the presence or absence of burning can be challenging because as one focuses on the possibility of symptoms many persons become aware normal sensations which are normally overlooked.

2.  Correct, see above.

3.  Non-chlamydial NGU is not clearly an STI in the traditional sense, is not readily transmitted to sex partners like other STIs, and in not associated with complications.  In the United Kingdom, many specialists do not treat the sex partners of NGU associated with oral sex. 

So, to summarize, your symptoms could be a reflection of non-chlamydial NGU.  The only way to really know for sure is to seek evaluation by an experienced clinician.  The optimal evaluation would include a penile swab take from your penis looking for the presence of white blood cells.  Testing urine collected at the beginning of voiding can sometimes be used instead of a swab but is slightly less sensitive.  If you do have NGU it is easily treated.

I hope these comments are helpful.  EWH

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38 months ago
Thank you, Dr. Hook.  Very helpful.

Couple of follow-ups:

1.  Untreated, will NGU resolve naturally?  If so, how long does that take?

2.  You indicate in your response that there is a “small risk” for urethritis after receipt of oral sex.  I’ve noticed statistics are often cited in responses on this forum.  Do such statistics exist for this situation to put into context what a small risk might mean?
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
1.  there are no studies to determine how long NGU might last without treatment (it would be unethical to study this).  we know that gonorrhea and chlamydia do resolve progressively over time but we also know that these infections can persist for months.  It is even harder to say how long non-chlamydial NGU might persist.

2.  Another good question for which there are no data.  To determine this you would need to take a large number of persons and have them receive oral sex and then calculate how many of this acquired urethritis.  OTOH a lot of people receive oral sex and most do not wind up with urethritis.

EWH
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