[Question #5363] Unprotected Oral Sex

21 months ago
Hi doctor(s),

I recently engaged in unprotected oral sex (both giving and receiving) with a woman who is not a stranger to me. We then had protected vaginal sex.  Afterwards we discussed STIs. I have no reason to believe she is the type to knowingly harbour any infections or engage in overtly risky behaviour, but either way she was not concerned as we used protection which she took proactive steps to ensure was used (not that I was opposed). 

The upshot is that it seems that many consider oral sex as being relatively safe. This is interesting as the consensus on many medical websites is not clear, and assigns varying levels of risk to the activity; from low to extreme!

In your opinion, what is the risk to me from this exposure and would you recommend testing on the basis of this encounter (ie would I put anyone else at risk if I were to engage in long term unprotected vaginal sex without testing)? In other words is testing warranted? 

I was recently tested and all results were negative.   
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to our Forum.  I'll be glad to comment.  Your partner sounds as though she (and you) are in the habit of practicing safe sex and that goes a long way towards reducing risk for any STI.  Most persons do not have STIs and when they do, the oro-pharynx is infected less commonly than genital sites.  There is no risk for HIV from receipt of oral sex and the risk of acquiring it from cunnilingus is likewise virtually zero.  I have never seen of heard of anyone who acquired HIV from performing cunnilingus on a partner or from receipt of oral sex.

As for other bacterial STIs, again, oral sex only relatively rarely leads to infection.  When it does, the most common problems are either gonorrhea or non-gonococcal urethritis NGU) caused by mouth organisms introduced in to the urethra during sex.  Both infections are typically symptomatic.  This sort of non-chlamydial NGU is not clearly and STI in the traditional sense, is not readily transmitted to sex partners like other STIs, and in not associated with complications.  In the United Kingdom, many specialists do not treat NGU associated with oral sex.  Both gonorrhea and NGU are most often symptomatic.  Hence I see no reason for concern or for testing related to the exposure you described.  

I hope this comment is helpful.  EWH
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21 months ago
Dr Hook.

Thanks for the quick and detailed response.

Some follow up info:

- the woman in question is not my regular partner.
- when I asked about risks to another person should I subsequently engage in unprotected vaginal sex from here on, I meant in a general sense - and with someone else.

I don’t believe the above significantly changes your response, however? 

 I also had two follow up questions (if that’s allowed!) 

- how long would it take for symptoms of a bacterial STI to appear?

- do you have any opinions as to why most advice in the public domain is relatively conservative as to the risks of unprotected oral sex? 

Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
 Thank you for the follow up information.

Regarding your new questions:
1.  When sharing information about past STI & AIDS and STI risk with a new partner relevant questions include have you had STIs in the past, have you been tested for STI's and if so when.  If positive the answers to these questions may lead to further questions to help you process your risk and need further testing. 
2.  When symptomatic, the onset of symptoms for most STI's is somewhere between three and 10 days following exposure. Syphilis, which is rare, typically takes a bit longer, 21 days on average for general lesions to appear.
3.   I hesitate to guess why so much of the media information on Oral STI is sensationalized. It makes it a better story perhaps 

EWH
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21 months ago
Dr Hook,

As my final follow up - and I suppose to summarise your original response: having been last tested only before the encounter I originally described in my title post, and if I were to engage in unprotected sex with a different partner in future and after this encounter, my risk to that partner would essentially be negligible enough so as to forego testing. Is that a fair summary?

7 days later and I exhibit no symptoms. 


Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Correct.  I would not be worried.  EWH---