[Question #5483] STI Risk

23 months ago
Hi,

I'm pretty familiar with the forum -- thanks for the work that you do. My specific question is about the risks associated with unprotected receptive heterosexual fellatio, specifically, those STIs that are incurable (Herpes, HPV, and please feel free to address any others that I might be missing) as I am aware that HIV risk in this scenario is essentially non-existent. 

Based on previous instances in which I've been tested for this, I noticed that the battery of tests did not include Herpes, HPV, or HIV. In your estimation, does this activity warrant specific testing for these STIs if no symptoms are present? 

I recently engaged in unprotected receptive fellatio and am also in a relationship with another individual. Although I'm not panicking about the situation, I would certainly welcome your professional opinion as to whether I can safely resume normal (unprotected) sexual relations with my significant other without having to go through the process of getting tested. 

Please let me know if you require any additional information and thanks for your assistance.


Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
 Welcome to our forum. Thanks for your thanks and thanks as well for your confidence in our service. I'll do my best to address your questions. 

 While there has been a relatively large amount of media coverage in recent months, by and large oral test  sexually transmitted infections are relatively uncommon and acquisition of STI's through receipt of oral sex is likewise a relatively rare event.   Most persons do not have oral STI's and when they do, compared to infections at the genital track or rectum the efficiency of transmission of these infections to others is lower.  

 Bacterial STI's first. Gonorrhea is the most common pharyngeal infection and the STI most often acquired through receipt of oral sex.   Chlamydia is rarely present in the pharynx and even more rarely transmitted from oral sex.  Trichomoniasis while not a bacterial STI is also virtually never acquired through oral sex.   After gonorrhea the  treatable STI most often acquired as a result of fellatio is non-chlamydial nongonococcal urethritis. This syndrome appears to occur as the result of introduction of mouth organisms into the urethra through fellatio and does not represent a source of complications or a source of infection for sexual partners.   Both gonorrhea and non-chlamydia NGU acquired through receipt of oral sex are typically symptomatic and readily treated.

 The main viral STIs related to oral sex are herpes and HPV ( there are no cases of HIV which have ever been proven to be acquired through receipt of oral sex. ) Herpes type two is almost never acquired through receipt of oral sex and is not a concern.   HSV-1  can be acquired as genital herpes through receipt of fellatio however this is relatively uncommon for several reasons. First over 60% of adults already have HSV-1 and thus are not vulnerable to reinfection. Secondly the efficiency of transfer by HSV-1 infected people who do not have obvious  lesions is inefficient and appears to occur less than 1 in 1000 episodes of oral sex with infected partners.   HPV is the subject of considerable interest and ongoing research. At present what is clear is that HPV is less common in the pharynx than in the genital tract and as in the genital tract typically is asymptomatic and resolves without therapy.   A very small proportion of oral HPV persists and with cofactors such as tobacco use increases risk for oral cancer. This is a very rare outcome and is typically look for as part of routine dental examinations. Otherwise except for getting the HPV vaccine  there is a little could do about this tiny risk. 

 Overall therefore the risk of acquiring any STI from receipt of oral sex is low. If you are concerned, the best way to assure one is not infected  through receipt of oral sex is to  is to consistently and correctly utilize condoms. Because oral STI's are typically asymptomatic,  for persons who practice oral sex routine screening for oral gonorrhea may be wise and for persons receiving oral sex from high risk or  multiple partners, routine general screening is likewise a good sexual health practice if one feels that they may be at risk. 

 I hope this information is helpful to you. EWH 
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23 months ago
Thanks for the detailed information. I did, however, ask a specific question in my original post about the necessity (or lack thereof) for testing pursuant to an incident (which I am copying/pasting below). Could you also provide your input on this? Thanks again.

I recently engaged in unprotected receptive fellatio and am also in a relationship with another individual. Although I'm not panicking about the situation, I would certainly welcome your professional opinion as to whether I can safely resume normal (unprotected) sexual relations with my significant other without having to go through the process of getting tested. 


Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Sorry for missing the specific question.  I'm not sure what recent means.  If you are without symptoms after 7 days following the event, the change that you are infected is very, very low.  At the same time, the only way to be completely sure is to seek testing which is easy to do and easily and confidentially available.  EWH---
23 months ago
Apologies, "recently" was about 10 days ago, and yes, I am completely asymptomatic. I understand that the only way to be 100% sure is to be tested, however I have noted that in many similar instances, you and others on the forum have indicated that testing is not required due to the extremely low probability of exposure/infection from this activity. Given this context, my question is whether you think there is a medical/clinical need for testing before resuming normal sexual relations with my partner or whether the relative unlikelihood of acquiring a viral infection renders testing unnecessary. As mentioned, I'm specifically more concerned with herpes than a bacterial infection at this point. As this is my last message, I'm hopeful that I've been clear up to this point in terms of details. Thanks again for offering your perspective on this. 
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Thanks for the additional detail. I would not be worried if 10 days had passed since the exposure.  The probability of infection is vanishingly low.  

As you know, we provide up to three responses to each clients' questions. This is my 3rd response.  Thus this thread will be closed shortly without further responses.  EWH
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