[Question #4583] Oral exposure risks

28 months ago
Hi Doctors,

I'm a gay male who had an encounter with a csw around a month ago, during which I performed unprotected oral sex on him for maybe 5-10 minutes all together.  He did not ejaculate during the oral sex.  I normally don't engage in unprotected oral sex outside of monogamous relationships, but I slipped up on my own rules here.  As I typically do with all partners, I did ask whether he had HIV or other STDs, and whether he was tested regularly, and he indicated that he is very safe, has been tested (the regularity was left unsaid), and had no STDs.  I know that's not conclusive, but I thought it was worth mentioning.  

What are the risks, if any, of this encounter, and what kind of testing should I pursue with my doctor?  The information on the internet is a bit difficult to parse on the risks here.  In my searches I think I saw answers from the doctors on this site and its predecessor, where the expert sometimes stated that performing oral sex is no risk, and sometimes stated there is some risk, albeit small.  There's a similar split in clarity across the rest of the internet.  I'm mainly asking for clarity on the risk because I'm on the cusp of a relationship that may become exclusive, and I'd like to make sure that I don't transfer anything.

Thanks for your help.
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Welcome to the Forum.  I'll be glad to comment and will start by encouraging you to renew your commitment to condom protected sex with partners whose status you are not confident of.  Statistically, and enhanced by your partner's statement that he was "safe", it is more likely than not that he did not have HIV,  If he was however, there is a demonstrable difference in HIV risk between performance and receipt of oral sex on infected partners.  We do occasional persons who have acquired HIV from performance of oral sex on an infected partner (whether or not ejaculation makes a difference is unknown, most experts assume it does but that the infection can still be transmitted without ejaculation) and the estimated likelihood of infection is 1 infection per 10,000 exposures to infected partners.  In contrast we have never seen and there are no proven reports of persons acquiring HIV from receipt of oral sex.  Thus for both performance and receipt of of oral sex, the HIV risk is low but slightly higher for those who perform fellatio.

Other STIs can also be acquired through performance of oral sex if your partner had one of them.  In particular, gonorrhea occurs regularly following performance of oral sex on infected partners and may be asymptomatic in the throat. Chlamydia is much rarer but does occur regularly.  Both of these infection can be tested for easily with a throat swab.  Finally, unless your partner had visible lesions on his penis, the risk for syphilis and herpes is very low and probably not something to worry about.

I hope these comments are helpful.  EWH
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28 months ago
Hi Dr., thanks for the response.  One quick follow up:  do you recommend HIV testing here, and if so do you recommend I abstain until I’ve been tested?  Thanks.
28 months ago
To clarify, I don’t typically insist on condoms for oral sex, either being performed on me or me performing on someone else,  in monogamous relationships.  I’m very close to being able to classify a current relationship as exclusive.  Im particularly concerned about HIV given its inability to be cured.  Should I get tested for HIV in short order, and if so should I at least abstain from receiving oral sex (him performing on me) in the interim?  Thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
To be honest, even if your partner had HIV which appears unlikely that change of becoming infected (1 in 10,000 max) is so low that I probably would not get tested. At the same time, testing is easy and always is a personal decision.  I must also say that in general, as folks consider making a pledge of exclusivity, I think entering the relationship knowing that both members are free of all STIs is a great place to be. In such situations, we suggest testing at all sites of potential exposure for gonorrhea and chlamydia as well as blood tests for syphilis and HIV.  This would be something that both partners might pursue together and can be don inexpensively at public health clinics.

In terms of risk for HIV to your partner related to his performance of oral sex on you, I really see little need for abstinence.  

EWH
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