[Question #3515] Risky oral sex

36 months ago

I am a male, on March 4th, I received unprotected oral sex from another man.  I ejaculated into his throat. In this environment, he was performing these acts with multiple men (in a row, not group).   I am unware of his STD status. On March 24th, I had unprotected sex with my wife (pull out, saliva as lubrication).  After ejaculating, I noticed a slight burning sensation. It faded away. Over the next few days, I then started to feel a burning/tingle sensation after urination.  Of course, I am much more attuned to penile sensations. Since the 24th, I have had sporadic burning/tingling sensations at the tip.  Sometimes it comes and goes, sometimes it stays. Sometimes it would be a cold sensation.  I have no other STD symptoms. I never experienced burning/tingling during urination, always after. Because of the nature of the 3/4 encounter, and the unprotected sex with my wife, I go to the county STD clinic on 3/28.  The do the normal STD tests.  Urine dip to see about a UTI.  The doctor said that based on the symptom it might be chlamydia. She said it was probably not gonorrhea because there is no discharge.  So, she went ahead and gave me the single dose of Azithromycin. I was told that due to the holiday (today 3/30), the results would not be available until 4/6.  That upsets me, so on 3/29, I go to a private lab and get a chlamydia and gonorrhea test, 17 hours after taking the antibiotic, the results will be available in a few days. I have a hard time reconciling the 3/4 encounter with this being an incredible coincidence.  1) Does this symptom present as an STD infection? 2) Does the behavior of the male in the 3/4 encounter up the risk of transmission of oral sex? I am sure all his male partners go for unprotected oral, and I am sure he swallows ejaculations. 3) If I were infected how what is the probability of transmission with my wife in that single encounter? 4) Will an antibiotic effect a chlamydia and gonorrhea test 17 hours after administration? 5) I understand that many people can be asymptomatic and experience different symptoms.  In the case of gonorrhea, what is the likelihood of my symptom but with no discharge?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Welcome to the forum. Thanks for your question. You can relax:  all is well; almost certainly you have no STD.

Oral sex is safe sex. It isn't completely free of STD risk, but the risk of all STDs is low and it's virtually zero for some. Whether or not you ejaculated into his mouth makes no difference in your risk. One of the zero risk ones is chlamydia, so I disagree with the clinic doctor who was concerned about it and I would not have given you azithromycin. As you suspected yourself, at least did initially. your symptoms are very typical for anxiety magnifying trival symptoms or normal body sensations that you otherwise would ignore or not eve notice. They are NOT typical for any STD. In addition, your symptoms started much too long after the exposure:  if you had been infected at that time, any symptoms would have begun within a few days and for sure within 2 weeks. Twenty days is too long.

So I am confident you acquired no infection from that event and that your wife is not at risk at all. To your specific questions:

1) See above. Your symptoms do not suggest any STD.

2) Obviously your partner in this event is at high risk, especially if we assume he has other sorts of contact with other men (e.g. anal sex) with other men. But whether he swallows, and performing oral on several men in rapid sequence, make no difference. So yes, there's a good chance he has or could get any of several STDs. However, oral to penile transmission of all STDs is actually quite uncommon. Gonorrhea is one of the possibilities, but you can expect that test to be negative. If you had caught gonorrhea, you would have had pus dripping from your penis within 5 days of the event.

3) There would have been high risk of transmission to your wife IF you were infected, but almost certainly you were not.

4) The gonorrhea/chlamydia test will be completely reliable within 24 hr of treatment with azithromycin -- in fact, probably would be reliable for at least 3-4 days after treatment.

5) Under 1% (1 in a hundred) urethral gonorrhea infections are asymptomatic. And even if your partner had oral gonorrhea, the chance it was transmitted to you probably was no higher than 10%. Therefore, the chance you have gonorrhea, without symptoms, is under 1 chance in a thousand. That's high enough to warrant testing, but you definitely can expect your gonorrhea test results to be negative.

I hope this information is helpful. Let me know if anything isn't clear. I'd be happy to comment further if you'd like to post your gonorrhea/chlamydia test results when available. In the meantime, stay mellow. Almost certainly you aren't infected and all is well.

HHH, MD

---
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Thanks for th excellent question, which gives me an opportunity for a blog-like comment that may be useful in future replies as well.

I'm not completely sure why chlamydia is so often said to be acquired by oral sex and there's never been any research on this point. I think it's mostly naivete and simple misunderstanidng of the available data, certainly not an attempt to influence behavior, whether in regard to condom use or any other kind of safe sex. (That never works anyway.)

Part of the problem, I'm pretty sure, is that there are so many parallels between gonorrhea and chlamydia that people assume that whatever applies to one also is valid for the other. But oral infection is a clear exception. There are at least two strong research studies (I am a co-author on one of them and wrote an accompanying editorial on the other) showing that among men with NGU whose only potential exposure was insertive oral sex (i.e. receiving BJs), chlamydia almost never is the cause. Asymptomatic urethral chlamydia also is virtually absent in men who have received recent oral but not had vaginal or anal sex.

At the same time, we have always known that chlamydia occasionally can be identified in the throat. and recent studies using improved diagnostics (DNA testing) show it's more common than previously believed. But it's still far less common than genital or rectal chlamydia, and a lot less common than oral gonorrhea. And even with the better tests, to my knowledge there still have been no reported cases of chlamydia that could only have been acquired by oral sex. That doesnt prove it can't happen (if it's in the throat, why not?) but it's strong evidence that it is rare. For all these reasons, CDC rcurrently ecommends against any routine oral testing for chlamydia. It's just not common enough or important enough to be worth the effort. That could change as new data emerge -- but that's the current state of our understanding.is

---
36 months ago
This might be redundant, or unnecessary, but do your thoughts apply to NGU as well?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Not at all. NGU is a fairly commonly acquired by oral exposure. But your symptoms don't suggest NGU, which usually causes discharge, not pain, as the main symptom. Second, NGU from oral sex probably is often caused by entirely normal oral bacteria and probably not harmful to partners. Finally, azithromycin is the main treatment for it -- so if that were the problem, you've already been treated.

Your original quesiton included disbelief that your symptoms would be just a coincidence with the sexual exposure. I agree. But that doesn't mean an infection as the cause. As I said, your symptoms are much more typical of genitally focused anxiety than they are of infection; and clearly you ARE anxious about this event. So definitely NOT a coincidence, but almost equally certainly not due to any infection from the event.

That concludes the two follow up comment and replies included with each question and so ends this thread. I hope the discussion has been helpful and that you can go forward without worry or anxiety -- especially after you receive your test results, which I am confident will be negative.

Best wishes and stay safe.
---