[Question #3530] sti from oral sex

37 months ago

Hello Doctors,  about 5 weeks I had brief unprotected oral (received and performed) and protected (condom was used all the time and had no noticeable breakage) vaginal sex with a  very high end western european escort. A few days ago, 4 weeks after the incident, I started having pain while urinating and noticed some scant whitish discharge. I also had some stains in my underwear for a day.  Nevertheless the symptoms kind of have been on and off for the past days (some times I see white substance inside my urethra, others I don’t).  I understand the main risks for oral sex are gonorrhea, herpes and ngu. FYI About 5 years ago I had an of ngu in which no pathogens where found but inflammation and discharge was present (WBC in urine and obvious discharge).  Also, for context, where I am from no urine tests are available for gonorrhea or chlamydia, and there a few doctors/labs familiar with std screening and treatment (today I went to get tested and tests cost about 200usd per std and took 20 days to give results!).  I always use condoms for vaginal sex and oral sex and this if the first time I received oral sex without a condom from someone who is not a regular girlfriend. I have taken the time to read most threads, yet I am still confused. Questions:

·       Given the incubation period of about a month I understand this is unlikely to be gonorrhea. Should I get treated for this anyway? Should I be tested with a culture (only test available)?

·       I understand chlamydia is very rarely transmitted orally, nevertheless should I be treated/tested (if I can) for this as well?

·       If it is not chlamydia or gonorrhea is it due to normal bacteria in mouth? Should I be treated for this? How? is this harmful for me? For any other sexual partner I could have?

·       Am  I at risk for any other pathogen such as Mycoplasma o ureaplasma?

·       Numerically, what was my risk for contracting oral gonorrhea from performing oral sex on the escort? What was  my risk for any other std?

·       If I was unlucky to get a throat infection could I have passed it to another woman via cunnilingus? How likely is this?

·       Finally, how worried should I be? How should I proceed?  When can I have sex again?

Thank you.

Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Welcome to our Forum.  The interaction you describe was very low risk for STI and your symptoms free interval since that time makes STIs still more unlikely.  You are in need of evaluation by trained clinician who can evaluate the entire spectrum of non-STI and STI related possible causes of your symptoms.   Direct responses to your specific questions below:

Given the incubation period of about a month I understand this is unlikely to be gonorrhea. Should I get treated for this anyway? Should I be tested with a culture (only test available)?
If evaluation is truly not available in a timely fashion, there is little downside to therapy with ceftriaxone (250 mg) and 1 gram of azithromycin.  This treatment would be curative for gonorrhea and chlamydia which it is very, very unlikely that you have.

I understand chlamydia is very rarely transmitted orally, nevertheless should I be treated/tested (if I can) for this as well?
See above.

If it is not chlamydia or gonorrhea is it due to normal bacteria in mouth? Should I be treated for this? How? is this harmful for me? For any other sexual partner I could have?
Non-chlamydial NGU from oral sex is caused by mouth organisms introduced in to the urethra during sex.  This sort of non-chlamydial NGU is not clearly and 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 NGU associated with oral sex.  When treated, oral sex-related NGU typically resolves quickly. 

Am  I at risk for any other pathogen such as Mycoplasma o ureaplasma?
Ureaplasma is not a proven cause of NGU and neither mycoplasma or ureaplasmas are transmitted through receipt of oral sex. 

Numerically, what was my risk for contracting oral gonorrhea from performing oral sex on the escort? What was  my risk for any other std?
There are no sound scientific data to answer the question.  My own estimate of your risk of having acquired gonorrhea from the encounter you describe is that your risk is a small fraction of 1%.

If I was unlucky to get a throat infection could I have passed it to another woman via cunnilingus? How likely is this?
Very unlikely.  Cunnilingus is the lowest risk penetrative sex for STI transmission.

Finally, how worried should I be? How should I proceed?  When can I have sex again?
From what you have described about your encounter, your condom use, the interval since your exposure and the intermittent nature of your symptoms, I doubt that this is an STI and would be worried about prostate infection or some other process.  I really think the best thing you could do is figure out a way to be thoroughly examined by an experienced clinician. 

Sorry I cannot help more.  EWH








---
37 months ago
Hi Dr Hook, thanks for your reply. I understand there is only so much you can do online. Today I actually visited an urologist who claims to be especialized in stds.  Yet, the appointment was truly frustrating. The doctor examined me and told me I had chlamydia for sure, that he could tell from the type of slight discharge that he saw when he told me to squezee my urethra. He then told I had to take 10 days of cipro twice per day and 500mg of azytrhomicin for 3 days but only after I finished the Cipro. Also he told me that chlamydia was very infectious and that even sharing a bathroom or a towel would put others in jeopardy. I tried to tell the doctor that from my research chalmydia was rarely transmitted via oral sex and that the antibiotics seemed strange. He got mad and told me to stop looking things online.  He also was trying to sell me an ultrasound treatmet for about 500 usd that he said would clean my prostate and allow me to have sex sooner (this sounds like BS to me). 
Since I was very unimpressed with the doctor I decided to try to get tested again and got chlamydia antigen direct testing and frotis/culture of the discharge. These are the only available tests here, I will get the chlamydia test back today and the culture in 3 days. 
Questions:
  • do you agree with the course of drugs recommended or should I just take the 1gr of azithromycin? should I take any of the cipro?
  • about the possible contagion to others via sharing toilets and towels, is this true? do I need to have any type of precautions in order not to infect anybody? I have a young baby at home, can I hug him, kiss him etc? 
  • when you mention ngu due to oral sex and that in the UK it is not even treated does this mean doctors just allow it to clear by itself without any medication? If I want treatment for this the 1g of azithromycin is appropriate? I also notice that the standard treatment for chlamydia/ngu is either azithromycin or doxy, is any of the two better or am I good with any of the two?
  • Seeing that it's not easy to get good care any recommendations as to how to proceed? 
  • you say I should be worried about prostate infection or other process? What other things cause urethritis type symptoms? Is an urologist the appropriate doctor to examine this? I could try another...
I apologize if the questions seem redundant but due to circumstances I am not able to do the logical steps that I think I could do in other places (ie visit an std clinic/center). 

thanks again,
37 months ago
Hi Dr Hook, were you able to look at my reply and follow up questions? 

thnaks,
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
You need to be patient- the site is not staffed 24/7. We provide up to three responses to each client.  This will be my 2nd response.  In doing so, I should also add that our capacity to respond to long, multifaceted questions is limited.  The more you can focus your questions, the better we can serve you.  On to your follow-up questions.

I'm afraid you are right to be unimpressed with the provider you saw.  Some of the information he told you is incorrect.  OTOH, the medications you have provided would almost certainly cure gonorrhea or chlamydia if present.  On to your questions:

do you agree with the course of drugs recommended or should I just take the 1gr of azithromycin? should I take any of the Cipro?
Yes, these medications will cure gonorrhea, chlamydia and NGU.

about the possible contagion to others via sharing toilets and towels, is this true? do I need to have any type of precautions in order not to infect anybody? I have a young baby at home, can I hug him, kiss him etc?
No, this is absolutely incorrect.  STIs are not transmitted on towels or toilets, not by kissing.  There is no need to take the sort of precautions you mention.

when you mention ngu due to oral sex and that in the UK it is not even treated does this mean doctors just allow it to clear by itself without any medication? If I want treatment for this the 1g of azithromycin is appropriate? I also notice that the standard treatment for chlamydia/ngu is either azithromycin or doxy, is any of the two better or am I good with any of the two?
See comments above.  Much oral sex related NGU does clear without treatment but the treatment you have been prescribed would cure NGU as well. 

you say I should be worried about prostate infection or other process? What other things cause urethritis type symptoms? Is an urologist the appropriate doctor to examine this? I could try another...
I would wait and see what happens with the therapy you have been prescribed.  If it does not, perhaps consider seeing another, better informed urologist would be reasonable.

I hope these further comments are helpful.  I am sorry to hear of your experience with the urologist you saw.  EWH 
---
37 months ago
Hi Doctor Hook, thanks for your reply. I received my tests back: negative for chlamydia but the culture and discharge analysis and urinalisis showed 8-10 wbc, 2-4 cells, 2-4 hematies and presence of Enterococcus faecalis.   Questions:
  • do you think this bacteria caused my symptoms? I read that it can infect the bladder and prostate. 
  • is this bacteria transmitted by oral sex or I got it from somewhere else? how?
  • can I infect somebody else with this bacteria? partner? baby? should I tell them about this bacteria. My baby has been having bronqueolitis, could this be related? 
  • if this bacteria did not cause my symptoms it means i have this bacteria plus ngu? (i evidently did have urethritis)
  • the test says the bacteria is sensible to cipro and this is consistent with my symptoms clearing up almost entirely (still some pain between anus and testicles at night).  should I take any more meds or tests or just stick to current antibiotic treatment?
  • again: any recommendations as to how to proceed? (i got tested against my doctors will who was certain I had chlamydia which is very rarely transmitted by oral sex!)

Sorry for the multiple questions but I find your advice much more trustworthy and professional...

best,
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
thanks for your additional information about test results. Your results prove that this is not an STI but some other process.

On to your specific questions, noting that you have not mentioned what your own doctor has suggested based on these test results;
  • do you think this bacteria caused my symptoms? I read that it can infect the bladder and prostate
  • Yes, this bacterium, which is not an STI, could cause these symptoms by causing a urinary tract infection or prostatitis. 


  • is this bacteria transmitted by oral sex or I got it from somewhere else? how?
  • No, this bacterium is NOT transmitted by oral sex.  It lives on your body normally and from time to time, through bad luck, can cause infections.

  • can I infect somebody else with this bacteria? partner? baby? should I tell them about this bacteria. My baby has been having bronqueolitis, could this be related? 
  • Neither your baby or your partner is at risk for infection from these bacteria.  It is NOT an STI

  • if this bacteria did not cause my symptoms it means i have this bacteria plus ngu? (i evidently did have urethritis)
  • See above.  I STRONGLY recommend that you give up on the STI concerns

  • the test says the bacteria is sensible to cipro and this is consistent with my symptoms clearing up almost entirely (still some pain between anus and testicles at night).  should I take any more meds or tests or just stick to current antibiotic treatment?

  • You need additional treatment.  Cipro may not be the best drug.  I might treat it with amoxicillin for 1-14 days.  You should discuss this with your doctor. 

  • again: any recommendations as to how to proceed? (i got tested against my doctors will who was certain I had chlamydia which is very rarely transmitted by oral sex!)
  • See above. Please consider discussing this with your doctor.  EWH
  • ---
    Edward W. Hook M.D.
    Edward W. Hook M.D.
    37 months ago
    Also, FYI, as this is my3rd response to your questions, as per Forum guidelines, this threa will be closed shortly.  There will be no further responses form me.  EWH
    ---