[Question #5416] STIs from unprotected oral sex

74 months ago

Hello Doctors,On May 13th I regrettably went to see an escort from an agency. I received unprotected oral sex as well as protected vaginal sex with a condom. I have been filled with anxiety ever since. I currently have no painful urination or drip from my penis. I do have a light stinging/discomfort at the tip of my penis. Actually, I cannot really tell if this sensation is coming from the head of my penis or my foreskin. The sensation seems to come and go and it does not hurt to the touch. Otherwise my penis looks normal. I have taken much time to read previous questions about this situation and I already know what the standard answer is. Reading these past answers did help with my anxiety but alas I decided to go to a local sexual health clinic here in Ontario, Canada to get a Gonorrhea/Chlamydia urine test just so I can have a definitive answer and move on. Today, (May 24th)I went to the clinic for the test and unfortunately instead of my anxiety lowering from the visit it got worse! I explained what happened to the person that saw me and he inspected my penis. He made me try to squeeze out any liquid from my penis and nothing came out. He then slightly spread the opening to my urethra to take a look. He seemed satisfied that my urethra was normal. He then told me that he is ruling out Gonorrhea because of no symptoms and that if it was anything it would be either chlamydia or NSU. I tried to confirm with him that Chlamydia is rare from oral but he insisted that it is a real possibility and that "in his 15 years at the clinic he has seen more cases of Chlamydia than Gonorrhea". Anyway, I took the test and expect the results in 7-10 days but left there with a lot more anxiety. Please let me know what you think of this. Can I really have been infected with Chlamydia? What are my overall chances that I caught something? Its going to be an excruciating 7-10 days for me.

H. Hunter Handsfield, MD

74 months ago

Welcome to the forum. Thanks for your question.

My first thought is that since you have seen a sexual health clinic expert, that's where you should go for details of your clinical management. In person evaluation is more reliable than anything a distant expert can add based only on your description.

That said, it is apparent you are very seriously overreacting to a low risk situation. Unprotected oral sex is generally quite safe, with low risk of all STDs and virtually zero risk for some. Second, condoms work. Third, at any point in time, the large majority of escorts and other commercial sex workers do not have active STDs. Fourth, even if infected, and even with no protection at all, most exposures do not result in transmission of inection.

Your symptoms are most consistent with anxiety, elevating your awareness of minor, meaningless symptoms or entirely normal body sensations that otherwise you would ignore or not even notice. From what you say, I am confident you have no urethritis of any kind (no chlamydia, NGU/NSU, gonorrhea, or anything else). The "overall chances that [you] caught something" are under one chance in several thousand. Your tests will be negative. Do your best to mellow out and stop worrying!

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

HHH, MD

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74 months ago

Thank you for your answer.

Can you expand further about contracting chlamydia from oral sex? Why is there a slight risk of gonorrhea from oral and very low risk for chlamydia?

Why did the person I see tell me there is a real risk from chlamydia?

Do you think it is safe for me to resume sex with my regular partner?

H. Hunter Handsfield, MD

74 months ago

Good question. Science has not fully explained the differences, but the main thing is that gonorrhea bacteria easily and frequently infect the throat, but chlamydia does not. All in all, oral chlamydia is about 1% as common as oral chlamydia. Since chlamydia uncommonly is in the throat, it is rarely transmitted by oral sex. However, many physicians, including STD experts, do not fully understand these detials, partly because the research on oral chlamydia is quite new and still evolving. Until 3 years ago, I would have replied that chlamydia never infects the oral cavity. Research now shows it happens, but quite uncommonly -- but some people just assume that everything gonorrhea does, so does chlamydia, which isn't true.---

74 months ago

Hello Doctor,

I got my results today and I am relieved to say they came back negative for both chlamydia and gonorrhea. I thought my results would be reassuring to anyone that would read this also in a similar situation.

As my last question do I at all need to worry about Syphilis? I have had no other symptoms 2-1/2 weeks after.

I am thankful for all of the work you, Dr Hook, and other professionals have done for this field of medicine.

Take care.

H. Hunter Handsfield, MD

74 months ago

Syphilis is rare in female sex workers in the US and most industrialized countries and absence of a sore (chancre) within 3 weeks at sites of direct exposure is further evidence against syphilis. If you prefer the reassurance of a negative blood test, you can do that any time 6 weeks or more after exposure.

Thanks for the thanks. I hope the discussion has been helpful.

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