[Question #3581] Fellatio Risks and Symptoms

36 months ago
Hi, 
I received unprotected oral sex  that lasted a few short minutes, without completion, about 2-1/2 weeks ago. Since I'm in a relationship, I am concerned for my partner and have regret about the experience. I have not had any discharge, and it does not burn when I pee. However, I have been experiencing local irritation/discomfort in the genital region for the last few days. Specifically, it feels like the tip of my penis is irritated, although it's not swollen looking or more red than it usually is. Sometimes it also feels like the entire penis area is burning (for lack of better word) or irritated. It does not hurt when I squeeze the urethra or produce discharge. I submitted a urine test for chlamydia and gonorrhea today and expect results back tomorrow. 

1- What am I at risk of from this experience and did I seek out the proper testing? 

2- What STI would cause symptoms of a generalized burning feeling, and irritation at the penis tip without discharge? The sensations are more pronounced at times, and at times not present. Is it possible to have a urethra infection that is just painful, but does not produce discharge? It also does not hurt during ejaculation. I'm scared I could have passed something on to my partner, but I don't know what. 

3- I'm sure mental focus plays a role, but these sensations are very real. The genital area feels irritated and "full" for lack of a better word. 

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
 Welcome to our forum and thank you for your question. Receipt of fellatio is a monks the lowest risk sorts of penetrative sexual encounter a man can have.  Most person's, even casual sexual partners, do not have STI's. In addition, biologically, transmission from the oral site is far less efficient than transmission following exposure to a female vagina or a rectum.  Following receipt of fellatio the most common STI's are either non-chlamydial NGU OR gonorrhea. Chlamydial infections following receipt of oral sex are very, very rare.   In addition, the syndromes I mentioned above are most often symptomatic. In your case the absence of symptoms search to make it much less likely that you were infected by the exposure that you mention.   If you were tests for gonorrhea and chlamydia are negative you can rule those possibilities out and my advice would be to move forward without further concerns. 

In answer to your specific questions:
1.  Please see above.  You did the right tests.  Non-chlamydial NGU is unlikely and would not be. A risk to your regular sex partners.

2.  The generalized burning you mention is not a typical STI symptom and, as you note above, when we worry and look for symptoms there is a  to notice normal stations which are otherwise overlooked as we live our normal lives.   Further, repeated self examination can also Eitan search sensations. I suspect the symptoms that you're experiencing will resolve without specific therapy. 

3.  Please see above.

 I hope these comments are helpful to you. Take care. EWH
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36 months ago
Thank you for your prompt reply. If it maters, the event in question involved an Asian SW. I am over 40. 

1) In trying to forecast my test results for gonorrhea and chlamydia, would it be safe to assume they would have been symptomatic well before the 2 week mark I passed a few days ago? Would there clearly be discharge, and if there wasn't until now, is it likely that I was indeed not infected with either of these? You say chlamydia is very, very rare. Is that like, say a 1% chance or less? What about a percentage chance of a positive gonorrhea test after 2 weeks with no discharge? 

2) My current symptoms are very concerning. At times while sitting at my desk, and throughout the day, I have very pronounced discomfort. Just today, 17 days past exposure, it was uncomfortable enough to consider seeking treatment, although I don't know what for. I'm having a hard time justifying it to just mental focus. It looks as if NGU presents itself a little later than gonorrhea, however, would there have to be discharge to be diagnosed with that? Can pain and discomfort alone be the only symptom? In your experience, have you been able to diagnose an STD by just those symptoms, considering they come and go in severity? If my tests come back negative tomorrow, what do you advise I do if the discomfort still exists? 

It just feels like something is wrong. I'll leave my final comment after receiving my results. Thank you for any input about my specific symptoms and risk. 


Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
The characteristics of you partner do not change my assessment or advice in any way.  In answer to your follow-up questions:
1.  These or sort of "what if" questions which we find are not very helpful.  As I already said, "In your case the absence of symptoms search to make it much less likely that you were infected by the exposure that you mention."  There are no absolutes in medicine however- over 95% of persons with gonorrhea would have had a visible penile discharge by this time.  Overall, based on the information you provided, I would estimate the overall risk of you having acquired ANY STI, including gonorrhea as being less than 1%.  I anticipate that your tests will prove that you were not infected. 

2.  Part of this question is also repetitive.  Please see my comment above about penile discharge- this statement includes NGU.  Your description of your discomfort seems to vary-  "pain in the "entire penis area"  seems to contradict " it feels like the tip of my penis is irritated" and "genital area feels irritated and "full" for lack of a better word".  Is your discomfort on the skin or inside your penis?  Does anything make it better or worse?  How has the discomfort changed over the 2+ weeks since your encounter of concern.  At this point, this really does not suggest an STI but may be compatible with CPPS (the chronic pelvic pain syndrome) which is well described ion Wikipedia.  At present my advice is: 1.  Stop your repeated self examination, this does not help. 2.. consider seeing a urologist or your primary car physician is the discomfort does not get better.  EWH

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36 months ago
Update: 
My Chlamydia and Gono tests came back negative thankfully, over 2 weeks past exposure. 

Could you please advise on the following symptoms I am feeling since this exposure: 
- I get a burning sensation throughout my penis, perineum, pelvis and inner thighs. There are times it feels like the pelvic bones themselves hurt some. This discomfort can be difficult, and cause me to stand instead of sit, put lotion on skin areas (although no rash at all), and remove underwear for airflow. During these episodes,  I get some penis tip irritation but it never burns when peeing. These feelings are what drove me to get tested. It didn't feel right at all. (I did fail to mention in the original post that I also received analingus for a brief time, and that I already have HSV1 since childhood.) Does that change anything? 

Knowing that my tests above were negative, would you be lead to believe that something else could be wrong, like NGU? Would it be a good idea to seek out a test for WBC's? Would an office even do a swab without discharge? 

Finally, I have read your suggestions about CPPS and the role of anxiety in pain similar to mine. Admittedly, anxiety has been very high for me. If this is indeed a high probability, will it improve somewhat quickly with the reassuring negative test results and the calming of nerves, or do the pelvic nerves take much longer to reach a normal state? Should I be seeing a urologist for the prostate or let it be for a while?

Sorry for being all over the place, I just need to get this past me once and for all and move on. Thank you. 
36 months ago
Edit: To answer your previous question, the irritation described started just after the two week mark, which is why I sought testing. 

There are also times when just my penis tip feels irritated and uncomfortable, without the wave of the general area feeling like it's burning. It's not the entire day, but comes and goes. Are there any other STD's other than the two I tested for that would cause this type of pain? I have no discharge or blisters. Could it be a urethral infection? I've never really experienced this irritation and doubt it's from friction or soap. If it's over-alert nerve endings I'll deal with it. I just need to be sure I'm not passing anything to my partner. 
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Thanks for the additional information and I am glad (but not surprised) to hear that your tests were negative. The symptoms that you describe are really not at all characteristic of any STI, including herpes.  My sincere hope is that with this reassurance and your negative tests, as well as knowing that the events you describe are very low risk for any STI (this comment includes your comment on analingus) you will not worry further about the symptoms you describe.  Should the symptoms concern, please accept my assurance that they are not an STI and work with your regular doctor to identify other causes.

I hope this comment is helpful.  As I suspect you know, following three responses, threads on this forum are closed without further responses.  I hope my comments have been helpful.  Take care.  EWH
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