[Question #3735] Unprotected oral sex risk

33 months ago
Hi, i had Condom protected sex and unprotected oral with a girl whose status i am not aware of. What kind of STI transmission should i be worried about.? HIV? Should i consider testing? Please advise. Not aware of any sores the girl might have had. This incident happened less than 24hrs ago. Help. Freaking out, reading about possibilities
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Welcome back to the forum, but sorry you found it necessary. I think I can help.

First, you say nothing at all about your partner except that you are "not aware" of her STI status. But beyond that, all kinds of clues are available from things like where and how you met, whether she is a sex worker and, if so, an escort (expensive, by appointment) or a brothel worker or street walker. If not commercial, a bar pick-up is inherently riskier than, say, someone introduced by friends. Drug user? By injection? If you have any information along these lines, I could better judge her risk.

Second, even among the riskiest partners, any any point in time most do not have transmissible STIs. It can be hazzardous to "read about possibilities", especially on the internet, in which the discussion almost always assumes higher risk than really exists. (Most such sites fail to say what I just did, that most "risky" partners are not infected.)

Third, when one partner is infected with most STIs, transmission usually doesn't occur with a single episode of sex. (Something else most websites neglect to mention.) That's not to say it can't happen:  of course it can. But if a woman has gonorrhea, for example, the chance her partner will catch it during any single episode of unprotected vaginal sex is about 20%, i.e. 1 chance in 5. Pretty high, but nowhere near 100%. For herpes, it's more lke 1 chance in a thousand. HIV, 1 chance in 2,500. These figures are IF the woman is KNOWN to be infected; and without condoms.

And finally, condoms work, with marked reduction in whatever risk there was from the vaginal sex. And oral sex is safe sex, even unprotected, with a much lower risk of all STIs and virtually zero risk for some, including HIV, chlamydia, HPV, and HSV2.

What to do now? First, don't panic; understand the truth of all I have already said and that the odds are very strongly on your side. Second, if infected, most STIs can be effectively curred or otherwise managed; the chance of a seriously bad outcome is very, very low. Third, be on the lookout for symptoms. If within the next 7-10 days you don't get penile discharge, uncomfortable urination, or penile blisters or sores, it will be solid evidence (not proof, just evidence) that you didn't catch anything. Finally, get tested, if only to reduce your anxieties:  the negative test results probably will be more reassuring than anything I can say. Specifically, after 4-5 days you have an accurate urine test for gonorrhea and chlamydia; and at 6 weeks, blood tests for HIV and syphilis.

I hope these comments start to ease your fears, as intended. Let me know if anything isn't clear -- and as implied above, feel free to tell me more about your partner and perhaps I'll have more to say about the chance she has any active STI.

HHH, MD
---
33 months ago
Hi doctor, thank you for responding to my query in a very comprehensive manner. I really do appreciate it. My partner in question is of Chinese origin, mid 40s, divorced mother. I met her on a dating app. My panic kicked in as she mentioned she had unprotected sex a year ago with someone she trusted, but never was tested. She had been dating but insists that she has not been with anyone but me in the last 6 months. On asking her to take a test she seemed apprehensive, and has not agreed to take one yet. Non drug user but a light weight with alcohol (which opens other possibilities). Our romp was a result of the same. 

She is healthy looking. Sex has always been short and protected. The oral was the only direct contact with genitals.
 I am positive for Hsv1, and my last screen about 7 months ago was negative for everything covered. Haven't been with any other woman but the girl in question. I will definitely get tested at the times mentioned, but was hoping i could eliminate any chance by having her test and know her status.

The seriously bad outcome... Hiv has me worried. I know i was the receiver, and that Probabilities are in the range of 1 of 20000 as per cdc guidelines. And I've been seeing it repeatedly said, that no proven case of mouth to penis transmission known to occur... But does that truly mean it does not ever happen or simply that a cause and effect has not been established? 

I'm on the lookout for the symptoms.. And will be watching close. Fingers crossed. 
Your note was comforting... Thank you.  Any further insight is truly appreciated. 
33 months ago
Ps:i am an uncircumcised male. 
33 months ago
Ps: we have been intimate only 2 times
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Thanks for the clarifications and glad to hear that my comments have given you some reassurance.

A partner like you describe almost certainly does not have HIV and is very unlikely to have any other STD either. I don't see any need for testing at all. There are all sorts of reasons someone might not wish to be tested, and that is nothing in that response that implies a higher risk.

It is impossible to know that there has never been a documented cases of oral to penile HIV transmission. If a person has had both unprotected vaginal and oral exposure to an infected partner, how can you know which activity was responsible. However, we do know that there are few or no cases in which oral sex was the only possible transmission route. In your particular exposure, you also had vaginal sex, and condoms are not 100% effective:  99% is a good estimate. In other words, if she in fact has HIV, your risk of catching it is higher from the protected vaginal than from the unprotected oral. But both are zero for practical purposes.  And have you thought through the implications of CDC's estimate of 1 in 20,000 for oral to penile transmission?  That's equivalent to receiving BJs by infected partners once daily for 55 years before transmission might be likely. Even this is only if the partner is infected. If we guesstimate perhaps 1 chance in a thousand your partner is infected, your risk from the oral event could be estimated to be 1/1000 x 1/20,000 = 1/20,000,000. That's one in 20 million. Surely you will agree that's zero for all practical purposes.

Being uncircumcised in theory double the risk of HIV if sexually exposed. But so what? Would 1 chance in 10 million make you any more concerned than 1 in 20m?

So feel free to be tested if you wish. Or speak again (very sensitively) with your partner about the possibility of both of you being tested together. (For sure do not suggest that only she needs testing just because you were tested 6 months ago. In this situation, it should be an agreement for both of you to be tested, not one or the other. She would be justified in viewing you as a risk more than the other way around.)

---
32 months ago
Hi doctor. Per your advice i got tested and was negative on standard sti panel after 6 days. Also tested negative on a hiv pcr rna Quant test at 11 days. I intend to further test at 4/ 6 weeks using the 4th gen duo test. I do know that any negative test is good news, but would you be kind enough to provide your expert opinion on the negative rna pcr quantitative test, and should it be a source for additional reassurance? Any insights would be appreciated. Thank you for your supportive thoughts and comments thus far. 
32 months ago
Also, To add non symptomatic at 13 days. 
32 months ago
Also, the standard panel at 6 days included a duo 4th gen test. Tested negative. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
The RNA test is probably around 90% reliable at 11 days. Remember the chance you were exposed or infected with HIV is zero anyway. (The 6 day duo test was irrelevant, a waste of money. It could not have been positive even if you had been infected.)

That concludes this thread. Do your best to move on without worry. If you go ahead as planned with a later duo test, you can be sure it will remain negative. 
---