[Question #6196] Oral Sex / Risk

16 months ago
Thank you for this service.  Very informative.  I’ll start by saying I’ve read just about every post on here with a question similar to mine;  nonetheless, I welcome your thoughts.

I’m a married bisexual male.  Married to female.  Live in New England.  Last Tuesday evening, I received unprotected oral sex from a new male partner.  I inquired as to STD status and was told he was clean in all respects.

I can’t say that I’ve had any real “pain” on urination, but I noticed a bit of clear staining in my black underwear yesterday afternoon, and this afternoon.  It’s definitely not yellow, thick, or a lot.  Out of an abundance of caution, I did go give a urine sample for G & C this afternoon.

Just want some general thoughts on these symptoms and your assessment of what the likely culprit might be.

I understand Chlamydia is rare via oral sex, but may happen more often than once thought?

Is 9 to 10 days post potential exposure too late for Gonorrhea symptoms to show up?  

Does Gonorrhea always have thick yellow discharge with obvious pain on urination?

Again, thank you for your thoughts.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Welcome. Thanks for your kind words about the forum and your confidence in our services and especially for reviewing other quesitons similar to yours. I was logged in when your question came up; most users don't get real-time replies!

I'm not sure I understand the timing. Your opening description sounds like you first noticed the possible discharge about 36 hours after the oral sex event, but later you ask about 8-9 days. Can you clarify? If only 36 hours, gonorrhea is almost the only realistic possibility. But at 8-9 days, chlamydia and non-chlamydial, nongonococcal urethritis (NGU) are more likely. Of those two, probably not chlamydia, for the reasons you already understand, i.e. rare after oral sex. (To date there has never been a report of a scientifically documented case of urethral chlamydia following oral sex.) And yes, gonorrhea usually has think yellow discharge (pus, basically) -- although it can start more mildly. However, if it has been 8-9 days, that's too long; it is rare for gonorrhea symptoms to be delayed more than 4-5 days.

So my bet is that your gonorrhea/chlamydia results will be negative. If apparent discharge continues, you should be treated for NGU, which means either a single dose of azithromycin or 7 days of doxycycline. Most experts would favor doxy, especially in patients who are likely to remember to take the drug twice daily for a week (and the overall tone and context suggest you're in the reliable camp!).

I hope these comments are helpful. Please clarify the timing and let me know if anything isn't clear.

HHH, MD
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16 months ago
Thank you for the reply!  Very helpful and reassuring information.

My apologies on the timeline confusion.  No discharge of any kind until yesterday and today (the sexual event was last Tuesday, 10/15).  Again, it’s not really thick, yellow, or a large quantity.  Also, I should point out that I haven’t visibly seen the discharge actually on my penis.  In other words, the only thing I’ve noticed is the small stain in my underwear.  And I didn’t have it first thing in the AM.  Even if I try and gently express discharge from my penis, I cannot (which I realize you advise is never necessary).

Couple additional questions:

If it’s NGU (non-chlamydial), is antibiotic treatment absolutely necessary? 

Does this sort of NGU transmit from penis to vagina via sexual intercourse with my wife?


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
You need to be professionally examined to determine if discharge can be observed, and also to evaluate for white blood cells in your urethra. If WBC are present, for sure you have urethritis (NGU).

Does it need to be treated? Excellent question -- without a clear answer, unfortunately. This is something I have written about professionally (https://www.ncbi.nlm.nih.gov/pubmed/28079750, https://www.ncbi.nlm.nih.gov/pubmed/28079750). Here is a simplified version:

The cause(s) of NGU from oral sex are not known, except that traditional STDs (chlamydia, Mycoplasma genitalium, trichomonas) are not involved -- not surprising, since these are rare or nonexistent in the oral cavity. A widely accepted theory is that normal oral bacteria, or something else associated with the oral cavity, cause an inflammatory reaction as the urethra adjusts to an unaccustomed environment. And no adverse consequences are known in affected men's main sex partners. Therefore, treatment may be unnecessary. However, until more reearch is done, we don't know if not treating is safe either for affected men or their partners. My personal guess is that it indeed would be safe and that partners are not at risk. But until we know for sure, the professional standard is to treat as for any other case of NGU, and that is what I advise my patients.

So back to my comment above:  See a professional and find out if there is objective evidence of urethritis. If there is, you should be treated and should avoid sex with your wife until then. (If you have already had intercourse with her, then standard practice would be to treat her as well.) But if no visible discharge and no elevated WBC, no treatment is needed. That is, I would not recommend treatment forn symptom alone, only if there is clear evidence of urethritis.
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16 months ago
Thanks again Dr H!

As you predicted (guessing this ain’t your first rodeo!), I am happy to report that my tests for Chlamydia and Gonorrhea were non reactive, so I’m obviously relieved about that. 

I will see my doc for examination to determine if treatment for NGU is advised.  I’m just cautious about antibiotic use if not necessary as I don’t want to contribute to the creation of super bugs!  

Just one more question for my own info:  in your experience, if someone contracts non-chlamydial NGU from oral sex, are they more susceptible to contracting it again from additional episodes of oral sex?  Or does it not really work like that?

Thanks again!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
It's good to be cautious about antibiotic use. But if clearly needed, you can be sure the potential health problems of not using an antibiotic outweigh the potential for selection of resistant strains or other environmental impacts. But it's good you know and care about this important issue:  that's pretty rare and very responsible!

There are no studies that directly or indirectly produced data on risk of second episodes of NGU after oral exposure. From a biological perspective, I see no reason for suspicion about it; and I don't recall ever having a patient who acquired NGU more than once after fellatio.

We're at the normal limit of follow-up questions and replies. Let's hold off on further discussion unless or until you have something to report after seeing your doctor. Assuming he's not primarily an STI or infectious diseases specialist, you might consider printing out this thread as a framework for discussion.
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