[Question #5587] MSM Oral sex risk assesment

74 months ago

Hi,

first of all, thanks for your hard work. I have been following you since MedHelp and always find your opinions to be really helpful and valuable.

I'm writing because approximately 36 hrs ago I had a brief MSM encounter where unprotected oral was the only activity.

Giving was super quick (5 min or less), as, partner had some "performance issues" so I know for a fact there was no ejaculation, and precum was minimal (only felt it once and spitted it out).

Receiving was also short, but not that long, and majority of encounter was just mutual masturbation.

When asked about STIs he claimed to be negative on all, but hadn't tested within 4 months, also had not slept with anyone during that time though.

It might be me just feeling really guilty as I have a stable relationship, but I have been panicking since, my two main concerns being HIV and syphilis.

1) Is there any feasible risk for HIV transmission? I have been even thinking on getting PEP. Should I even be worried at all about HIV?

2) I closely look at his penis, and nothing stood out to me, no sores, bumps or uncommon secretions. Got a mouthwash after done. Assuming no sores there, would that be a good indicator for reducing potential syphilis risk?

3) What about me receiving (me being the insertive partner)? Is syphilis commonly transmitted to the receiving oral sex partner?

4) Should I be this scared, or is it safe to move on?

H. Hunter Handsfield, MD

74 months ago

Welcome back to the forum. Thanks for your continuing confidence in our services.

Oral sex can be viewed as safe sex -- it's not completely free of risk, but the chance of all STDs is very low in comparison with unprotected vaginal or anal sex and zero for all practical purposes for some, including HIV. There has never been a proved case of HIV trransmitted oral to penis, and only rare cases penis to throat. And since people rarely lie about HIV status when asked directly, it sounds like there is little chance your partner has an active transmissible STD., especially by oral sex.

Those comments partly answer your speciific questions, but to assure clarity:

1) Nope, no feasible risk of HIV. I would strongly recommend against PEP. You don't even need HIV testing, unless you decide to do it strctly for reassurance.

2) There are no data on whether syphilis risk might be reduced by mouthwash. That your partner had no visible penile soreds or rash probably is more important (and reassuring).

3) Oral to penile syphlis transmission can occur, but not readily. Given the low chance your partner had syphilis plus the nature of the exposure, syphilis testing is optional.

4) It is safe to move on. That said, I understand that sometimes negative tests are more reassuring than professional opinon, no matter how expert. If you're going to lose sleep worrying about this, you could have a urine gonorrhea/chlamydia test and a throat swab for gonorrhea in a few days, and syphilis and HIV blood tests 6 weeks after the event. Alternatively, you could speak with your partner and perhaps both go for mutual testing for G, C, syphilis, and HIV. For all you know, he may be as nervous abour risks from you as you are from him. If both negative at this time, you'll both know you're home free.

Thanks for your kind opening words. I hope my comments are as helpful as you expected. Let me know if anything isn't clear.

HHH, MD

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74 months ago

Thank you very much Dr Handsfield,

So, just for reassurance:

* No need for PEP at all (today would be 3 days) as the risk is really low.

* So low "medically" I don't even need to test. I can do it later for reassurance or as part of regular screening.

* Do not worry about HIV from this exposure at all. As an additional question, i know receiving oral is super safe HIV wise, will giving with no ejaculation be less risk than with it? If true, even with semen involved, can it still be regarded safe for HIV? That is, no need to think on writing here, taking PEP or losing sleep every time oral happens.

* Syphilis risk is also low, given no visible sores or rash, and mouth to penis transmission is possible but uncommon. I might want to test later, is this for reassurance as well or due to there being a significantly enough risk to need it?

*From what I have read from you, all other possible infections (C, G, Syphilis) would most likely be symptomatic. Given the low risk and this fact, would testing be needed from a risk perspective later if no symptoms appear?

Thanks for your words.

I will definitely try to not lose sleep on this, your response for sure helped me not running yesterday to ER.

H. Hunter Handsfield, MD

74 months ago

Points 1 and 2, you correctly understand my evaluation. No. 3: there are no data on risk of oral sex in relation to ejaculation or semen exposure. With or without ejaculation, oral sex is very safe in regard to HIV. No. 4, I agree: very low risk of syphilis, but maybe not quite zero; consider testing at 6 weeks. Last bullet: lack of symptoms is very reassuring in tregard to gonorrhea. Oral sex is little or no risk for chlmaydia, very rarecly acquired by oral sex -- but if acquired, only half of all cases cause noticeable symptoms. If you remain concerned, bet tested. Same for syphils: usually symptoms, but not always: get tested.---