[Question #5024] STD Testing/Risk

26 months ago
Hello, 

I have had several encounters consisting of unprotected fellatio (receiving) over the past few years. Twice, I experienced a burning sensation during urination and consulted a doctor -- in each instance, they took a urine sample and tested for several STDs, but never for HIV or herpes (presumably because of the low risk). Both instances were also all negative, and the doctor explained that it was a non-specific urinary infection and prescribed antibiotics, which cleared the symptoms. The last of these consultations was over a year ago. 

Also, the last encounter of unprotected oral sex was probably several months ago, and I have not experienced any discomfort. My question now is whether I should get tested for any of the STDs that I was previously not tested for (HIV, HPV, HSV, etc.). Is there a risk that I could have contracted something and not noticed it and/or not be tested for it?

Thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome tot he forum. Thanks for your question.

Fellatio can be viewed as safe sex, especially for the insertive (penile) partner. It's not entirely free of STD risk, but the risk of all STDs is far lower than for vaginal or anal sex, and it's zero risk (for all practical purposes) for some. Your two episodes of urinary burning could have been nonconococcal urethrits (NGU) or even gonorrhea, but probably not:  burning alone, without discharge, is uncommon as an STD symptom. Even if they were NGU, probably many (most?) sucn infections from oral sex are due to enitrely normal oral bacteria and not STDs in the usual sense. Or maybe just a little physical irritation if one or more fellatio episodes were vigorous and perhaps a bit traumatic.

But that's all speculation. The question now is whether you currently have an undiagnosed STD from one of your many fellatio events. Almost certainly you do not. That said, all people who are sexually active outside mutually monogamous relationships should be tested for HIV and syphilis from time to time, perhaps every year or two. Also, you don't mention the sex of your fellatio partners -- the risk of HIV and syphils is higher (but still low) if any of them were men. In any case, just as a common sense recommendation, I would suggest you have HIV and syphilis blood tests. You can expect negative results.

I really don't recommend any other testing. Your exposures are virtually zero risk for chlamydia (rare in the oral cavity and even more rarely transmitted by oral sex), and although gonorrhea is possible, it virtually always causes prominent urethritis, with painful urination and discharge of overt pus. But if you want a complete STD evaluation, you could include a urine gonorrhea/chlamydia test. The risks of herpes (due to HSV2) and viral hepatitis were far to low to warrant testing. You may have heard of trichomonas and Mycoplasma genitalium, increasingly included in routine STD testing. However, these too never infect the oral cavity and cannot be acquired by fellatio.

Finally, HPV:  No testing is ever recommended in asymptomatic men. You probably have it (or have had it) -- 90% of all humans get genital HPV at one time or another and 20-50% have active infection at any point in time. But nothing can be done for infections without visible warts or other lesions. And the risk is low (but not zero) from oral sex.

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

HHH, MD
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26 months ago
Thank you for the detailed response. A few follow-up points below:

1) All encounters were heterosexual 
2) You mentioned that you would recommend getting tested for HIV as well as Syphilis. I've read previously on this board that there has not yet been a definitive case of acquiring HIV through receptive fellatio -- if that is the case, why would you recommend an HIV test in this instance (since my last testing, there have been no encounters involving unprotected sex outside of receptive fellatio). 
3) As for syphilis, is my understanding that this a treatable/curable disease accurate?
4) Lastly, just confirming again that there is no need for a herpes test?

Thanks again for your time and assistance. 

 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
1) OK. Even lower risk. The likelihood any particular female has HIV is extremely low, despite what you might assume from media attention.

2) I think you didn't carefully read or understand my advice. Every person should be tested at least once for HIV, to assure no infection despite no obvious risks (per CDC recommendations, which I helped write:  https://www.ncbi.nlm.nih.gov/pubmed/16988643). But not because oral sex is risky. It is not. However, you are nervous about it -- otherwise why did you even come to this forum? Tesing is the most conlusive route to reassurance.

3) Yes. Syphilis was almost the very first infection to be successfully treated with penicillin. If damaging complciations (blindness, dementia, paralysis, etc) have occurred, they cannot be reversed. But the infection is easily cured.

4) True, no need for herpes testing. Among other things, the more we learn about the available HIV tests, the more we learn how unreliable they are. Don't waste your money or your emotional energy.
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26 months ago
Hi Doctor,

Last follow-up -- listing your response first below:

I think you didn't carefully read or understand my advice. Every person should be tested at least once for HIV, to assure no infection despite no obvious risks (per CDC recommendations, which I helped write:  https://www.ncbi.nlm.nih.gov/pubmed/16988643). But not because oral sex is risky. It is not. However, you are nervous about it -- otherwise why did you even come to this forum? Tesing is the most conlusive route to reassurance.

I have been tested for HIV previously. Since that negative result, the only "at-risk" behavior that I have engaged in has been what I previously described (unprotected, heterosexual, receptive fellatio on multiple instances). Although I am concerned with the risk associated with these episodes, I am more than satisfied to draw the conclusion and put my mind to rest that an HIV test is not required because HIV has never been documented to have ever been passed in this manner. Apologies if this sounds like splitting hairs -- I'd rather not go through the process of being tested if there's really no reason to, unless of course what I've previously described would warrant it (it sounds to me as though it doesn't but would like to confirm that with you).  And duly noted re: your other point on syphilis. Thanks again for the assistance. 

  


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Your choice entirely whether you are retested. Your current risks are essentaily zero. If you don't need the additional reassurance from negative testing, don't do it.

I hope the discussion has been helpful. Best wishes and stay safe.
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