[Question #6112] Oral recipient to infected partner

18 months ago
Hello Doctor, 

I am hoping to understand transmission risk oral ghonrrhea/chlamydia from saliva to vagina. I also have a question about HSV-1 to genitals. 

First question, 
I recieved  only oral sex from a straight male who tested positive for ghonrrhea. He did not throat swab. It has been 10 days I have new pain/burning with urination and lower pelvic pain. No discharge changes. Could I have contracted oral ghonrrhea to genitals? And does the same rules apply for oral chlamydia to genital? 

And a burning question about HSV-1: my first HSV blood test was positive for HSV-1. This occurred one month after having unprotected oral-vagina sex with a man who I didn’t notice had a cold sore on his lip. I did not notice symptoms, though I also took Acyclovir 3 days after the encounter from fear. I was shocked; I never had a cold sore on my lip before, though both siblings and parent have them. Could I have contracted HSV-1 to genitals from this encounter? Or is it more likely I have oral HSV-1 but I have never had a coldsore? 

Thank you for helping to rest my worried mind


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome to the forum. Thanks for your confidence in our servcies.

Oral gonorrhea is present in only 1-2 percent of heterosexual men with urethral gonorrhea, so if your partner doesn't have sex with men, the chance he had oral gonorrhea was low. And even if he did, oral to genital transmission by cunnilingus is rare. That's not to say it can't occur -- it probably can. Oral chlamydia is even less common than gonorrhea, and probably less transmissible by oral sex. There has never been a proved case of oral to genital chlamydia transmission, in either men or women. Again, that doesn't prove it can't happen, only that it is rare.

But regardless of the seemingly low risk, your symptoms certainly could be caused by either of these STDs. Absence of vaginal discharge doesn't mean much. You need to be examined and tested for both infections ASAP:  if the pelvic pain is severe or if you have fever, do not delay, even if it means a Sunday visit to an urgent care clinic or hospital emergency department. (You probably will be treated for gonorrhea and chlamydia, based on your sexual history. Standard practice is to treat the sex partners of known infected persons, without waiting for test results. That guideline doesn't distinguish between risk levels from different kinds of exposure.)

Among adults in the US, 30% to 50% have positive blood tests for HSV1, mostly from childhood oral herpes which often was not diagnosed at the time. Most such persons have no history of cold sores, i.e. oral herpes. Therefore, your positive HSV1 test result is very likely the result of childhood herpes; or conceivably a genital infection in the past. New genital herpes is fairly unlikely in the absence of obvious genital herpes symptoms, and it usually takes more than a month to develop a positive blood test. There is no way to prove you did not acquire genital HSV1 during your cunnilingus exposure a month earlier, but all things considered, that's a lot less likely than a distant past infection. Either way, I wouldn't worry about it:  genital herpes due to HSV1 recurs infrequently (in more than half of all persons, no recurrent outbreaks at all) and sexual transmission of genital HSV1 to partners is rare. For those reasons, in people with positive HSV1 blood tests, it usually doesn't matter whether the infection was oral or genital, especially if it remains asymptomatic, as it usually does.

For all those reasons, by far the most important issue here is your pelvic an urinary pain. Check it out right away. I'll be interested to hear the findings and your test results. In the meantime, I hope these comments are helpful.

HHH, MD
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