[Question #4726] Sex and irritation

28 months ago
I have been on a trip to Japan and speak pretty good Japanese. On Sunday I met a woman here and we had sex two times and oral sex the next night. We also met last night and had oral sex. I noticed a few small stains on the bed the day after we had sex. It could have been from menstral blood or even from dark makeup, but I saw no blood on the condom when I tested it and noticed no blood when giving her oral although the lights were dimmed.  She had no visible sores, but I am afraid that maybe she had some kind of sore inside her vagina that I didn’t notice or that it was menstrual blood. My questions are:

1. Would this situation put me at risk for anything from giving her unprotected oral or from the condom slipping a bit on my shaft (which it did, but it still covered 1/2-2/3 of the shaft and all of the head).

2. My bigger concern is that today the tip of my penis is a bit irritated. There is no discharge and no sore or redness. It is just around the tip of my penis and it feels like irritation and sometimes an urge to pee a little. The pee is clear and just regular pee from what I can see. I think it might just be irritation from the oral sex last night combined with all the sex earlier in the week. But I am a bit scared. I plan to see her again tonight but if its irritation can abstain. If it is something else I am terrified. 

Thank you and I apologize for the lengthy post. 
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Welcome to our Forum.  I'll try to help.  In general, sex is all about friction, right?  More sex, more friction thus in persons who hare having relatively frequent sex (a relative term) with irritation resulting.  From the sound of things this may be happening.  Oral sex can sometimes lead to irritation if the teeth are in contact with the genital skin as well.  In addition, for some persons, irritation can result from contact with lubricants on the condom or used by one's partner and a modest proportion of persons actually develop an allergy to the latex of condoms which most often presents itself as irritation and/or local redness in areas covered by the condom.   With this background, on to your specific questions:

1. Would this situation put me at risk for anything from giving her unprotected oral or from the condom slipping a bit on my shaft (which it did, but it still covered 1/2-2/3 of the shaft and all of the head).
Local irritation implies inflammation and even microscopic irritations can make risk for acquisition of STIs somewhat higher.  OTOH, if your partner does not have STIs, and you continue to use condoms, the risk for any STI is really quite small and probably not a major concern.

2. My bigger concern is that today the tip of my penis is a bit irritated. There is no discharge and no sore or redness. It is just around the tip of my penis and it feels like irritation and sometimes an urge to pee a little. The pee is clear and just regular pee from what I can see. I think it might just be irritation from the oral sex last night combined with all the sex earlier in the week. But I am a bit scared. I plan to see her again tonight but if its irritation can abstain. If it is something else I am terrified.
The urge to pee is most likely a manifestation of the irritation that you are aware of already.  If over the course of the day your penis feels better, then irritation is most probably what you are dealing with.  If it gets worse or an obvious penile discharge develops, there is more to be concerned about  (please do NOT start repeatedly checking yourself for a discharge- this will only increase your irritation and if a pathological discharge is present, it will be obvious).


Presuming there are no other issues in play here, my sense is that the activities you describe were very low risk and if you are together again, your own degree of irritation is likely a better guide to your activity than any specific concerns about STIs.

I hope these comments are helpful.  EWH
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28 months ago
Dr. Hook,

       Thank you so much for the detailed answer! You mentioned that if she had no sti and I used a condom there would be little risk. I definitely used a condom, but I do not know her sti status. I didn’t see any visible sores or anything, but I did meet her at a bar and as I mentioned in my initial post I gave her oral and realized afterwards that she may have had slight menstrual blood because there was a small stain on the bed. Does oral with slight menstrual blood put me at risk for hiv or any other std? 

Also, there was a small bit of what I think is called frottage where she rubbed her vagina on the lower shaft (not near the head) before I put the condom on. I looked at your other excellent answers and it looks like absent visible sores that this is not a major concern. Is that a correct understanding? 

One other minor thing I forgot to mention is that I just a finished a zpak a few days ago. Would that be of any help if she gave me oral and there was some irritation (she had no visible sores on her mouth) at that time?

Thank you very much and as to what you suggested yesterday I want to thank you and let you know that when we met again last night we just had oral because I felt the condom might irritate and today the irritation seems a bit better; although I still have the occasional urge to pee (the pee is clear and no discharge that I can see and I am following your advice not to irritate it more by constantly checking). That is excellent advice as I remember being scared one other time about something unrelated to sex and I kept constantly checking which just made my skin more irritated.
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Thanks for the follow-up and additional information. several further comments and clarifications.
1.  If she had no STIs, there is no risk.  OTOH  if she does have any STI, any sex acts that are condom protected are no or at least very little risk for STI acquisition when compared to an totally unprotected exposure..
2..  The possible presence of blood is irrelevant.  There is a very common misperception that blood contact is associated with higher risk than contact with genital secretions.  Actually, for blood born infections, the amounts of bacteria/virus present in genital secretions and blood are similar,.  Thus possible contact with blood does not change this risk calculations.
3.  Frottage is a no risk event for virtually all STIs.
4.  Oral sex carries with it a theoretical but very tiny risk for STI acquisition such as pharyngeal gonorrhea if your partner has it but that risk is again, quite small.
5.  That you recently finished a Z-pack may somewhat slightly reduce your risk for acquisition of bacterial STIs since some bacterial STIs are sometimes sensitive to the azithromycin and the amount of azithromycin present in blood for a number of days (5-8) after completion of the medication,  
6.  Finally, that the irritation has improved is a good sign and makes it more likely than not that it was not due to an STI.

IIt sounds like things are going well.  If there are further questions, the forum does permit one further follow-up question before the thread will be closed.     EWH
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28 months ago
Dr. Hook,

      Thank you so much for your answer, and I apologize for the delay in using my final follow up. I have two quick related follow up questions and also wanted to let you know that the irritation seems better and while the pee urge is still there on occassion, it is also better and there is no discharge at all. Just regular pee.  My questions relate to the risk of acquiring oral gonnorhea from giving intensive cunnilingus, which I know is quite low to begin with based on your last answer.

1. Since she had no visible sores I gather the primary concern from intensive cunnilingus even is she had a bit of menstrual blood I didn’t notice is oral gonnorhea. My concern is that my back lower left wisdom tooth is a bit impacted so I floss quite a bit around it and the neighboring molar and realized that the day before cunnilingus it was quite irritated or maybe even cut  back there from flossing. Would that increase my risk of oral gonnorhea and if she had menstrual blood would it create an hiv risk?

2. As to oral gonnorhea the timing of my zpak was that I began it on Saturday, Dec. 15 for a sinus infection and took the last pill on December 19. The first cunnilingus  was Friday night December 14 and then again on Wed. Dec. 19 and Thursday Dec. 20. The most recent cunnilingus was December 25. I know a zpak is for sinus infections (as I take about one a year when a sinus infection gets too bad to clear on its own), but would the 8 day window you mentioned be from the first or the last pill and would it potentially help prevent oral infection?

3. How likely would it be to spread orak gonnorhea to a partner if I somehow got it from these incidents?

Thank you again for the amazing work you do. I am a researcher in a non medical field, and I wish we had more people like you who are not only immensely knowledgeable, but also willing to use that knowledge on a daily basis to help others. 
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Thanks for your thanks.  Straight to your follow-up questions.

1. There are no data to suggest that either the irritation associated with flossing nor an impacted wisdom tooth, nor other gum or dental problems would change the risk for acquisition of oral gonorrhea.  If anything, given that flossing is good for oral hygiene and reduces risk for dental disease that the practice would be beneficial rather than troublesome but this is conjecture on my part.

2.  Yes, given the timing of your Z-pak the azithromycin present would likely reduce your risk for acquisition of gonorrhea or other bacterial infections.

3.  Just as oral sex is a biologically inefficient  practice in terms of risk for acquisition of infection, it is also an inefficient practice for STI transmission.  given your history and the topics we have discussed, I would not be worried about either the likelihood of infection or any risk of transmitting infection to others.

I hope these comments are helpful.  As your note acknowledges this and as this is my 3rd response as part of this thread, it will be closed later today without further responses.  Take care. EWH
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