[Question #4318] Oral sex risk concern

29 months ago
Hi Drs,

I am helping my sister who can not speak English very well to translate her questions. 
Thank you very much for taking your time reading the questions and helping us. 


"About 3 weeks ago I gave unprotected oral sex to a male friend (not clear about his STD/HIV status but he is a doctor in China and does annual health checkups). The unprotected oral sex lasted for few minutes and I swallowed his ejaculation.  I do not recall having open cut or sore in my mouth but I did swallowed the ejaculation. 

Few days after that I had cold like symptoms and a little fever, but it went away in 3-4 days after I took some medication.  I am terrified that I might be getting HIV or other STD/STI if he is positive in any of those.  

Should I be worried about HIV?  Also, we checked other people's questions on this website and it seems that though you don't have to worry too much about Chlamydia, you do have chance of getting oral Gonorrhea and it cannot be detected by the urine test?

Please help me. Thank you"


Thanks again for your time and help.
P





H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Welcome to the forum. Thanks to your sister and you for your confidence in our services.

First, it sounds like your partner is at low risk for HIV and other STDs. Second, even if he has HIV, you are at little or any risk of infection. One calculation of oral sex risk (from the US Centers for Disease Control and Prevention, CDC) is that if the penile partner is infected, performing oral sex on him has 1 chance in 10,000 catching HIV. That's equivalent to performing oral on infected men once daily for 27 years before infection might be likely. Whether or not semen is swallowed make no known difference in risk of HIV. Third, symptoms of HIV infection don't start until at least 7-8 days (usually 10+ days) after exposure; and HIV doesn't cause "cold symptoms", i.e stuffy nose, nasal drip, etc.

Oral gonorrhea almost always is entirely without symptoms. Sometimes sore throat or even severe pharyngitis, similar to strep throat. But these are very rare. Oral chlamydia is possible, but is not known to ever cause symptoms of any kind. Neither chlamydia or gonorrhea causes typical "cold symptoms" (stufffy/runny nose, "sinus" symptoms, etc). 

One approach could be to contact your partner and ask him to be tested for HIV and urine testing for gonorrhea/chlamydia. If negative, you would know you could not be infected. If you cannot do that or he refuses, you can have a throat swab for gonorrhea testing. (Gonorrhea and chlamydia can only be tested at the infected sites. Urine detects only genital infection.) Chlamydia testing of the throat really isn't necessary. To be honest, I don't think HIV testing is needed either. But if you remain nervous about it, feel free to have an antigen-antibody ("combo", "duo" or "4th generation") blood test, which will be conclusive 6 weeks after the exposure. In the meantime, try not to worry. It is extremely unlikely you have any STD at all.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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29 months ago
"Thank you very much Dr. Handsfield and it helps a lot to get a detailed reply from you. Does it mean the reason of doing any testing including HIV  is more about helping me not be nervous, and not that I need to be tested? " 

We also checked other people's questions and saw you replied one of the question #2011 with "Oral sex is safe sex. It's not completely free of STD risk, but all infections are far less frequent from oral than vaginal or anal exposure, and the risk is zero for some. You can consider yourself at low risk for gonorrhea, but really not much else. Any theoretical risk for others, including HIV and syphilis, is extremely low. And this remains the case in presence of oral inflammation, such as gum trauma from cleaning or other procedures. If you think about it, you'll agree that various cuts or sores in the mouth are very common, and hence there have been billions of oral sex exposures in their presence -- and yet even the busiest HIV/AIDS or STD clinics rarely see patients in whom oral sex was the only opportunity for infection. The chances of other things (herpes, syphilis, chlamydia, HPV, etc) really are zero to miniscule......All in all, if somehow I were in your situation (or if I were counseling a family member), I would not recommend testing. Among other things, oral gonorrhea, the single most common (but still rare) possibility, rarely causes symptoms and generally is cleared by the immune system, without treatment, within a few weeks."

Does it mean that I am worrying too much about it and I do not need to do any test?

Thank you so much



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
"Does it mean the reason of doing any testing including HIV  is more about helping me not be nervous, and not that I need to be tested?" Yes, that is exactly right.

"Does it mean that I am worrying too much about it and I do not need to do any test?" Yes. In general, the risk of any infection after a single oral sex exposure is too low to need testing. However, as you suggest, sometimes testing still is a good idea, if a negative test result will be more reassuring than my advice based on scientific probability and statistics.
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