[Question #6261] new cunnilingus and felatio risks

15 months ago

Hello,I'm a male who has had several sexual encounters with 5 different women in the past 6 months.  I’m Symptom-less. I plan on getting a full testing next week (including the HIV RNA) This test will occur 11 days after the latest sexual encounter which I will describe next.

All 5 women were sex workers and I used a condom during vaginal sex every time. However, I've had unprotected oral sex with each of them (both cunnilingus and fellatio). My most recent encounter was 3 days ago. I've had sex with her before 2 months prior. However, on this most recent encounter she said that she was on her last day of her period so don't be surprised if there is a little blood on the condom during sex.  She has told me that she always keeps up on her STD testing and visits her clinic almost monthly, and is free of any STDs.  I performed cunnilingus on her before we had PIV sex and I didn't see or taste any blood.  She had an orgasm during the cunnilingus and I inserted my finger inside her vagina. I noticed a very small amount of blood on my finger.  We proceeded with vaginal sex with a condom but had to stop short because there was a larger amount of blood on the condom a few minutes in. I understand there is a lower risk of STDs during oral sex compared to unprotected vaginal sex however, my main questions are: 1. is the STD risk heightened while she is menstruating, especially regarding HIV?  2. what is the risk of passing on anything to my wife during this time of uncertainty?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Welcome back to the forum, after more than two years.

These questions are pretty much the same as your previous ones, and the answers haven't changed. As we discussed, oral sex -- both fellatio and cunnilingus, both giving and receiving -- is low risk for all STDs and virtually zero for some. Cunnilingus is particularly low risk; the highest risk compoenent of the exposures described is you receiving oral sex (fellatio). For that, absence of symptoms -- i.e. apparently no urethral discharge, uncomfortable urination, or penile sores -- is strong evidence you weren't infected.

Whether or not a woman has an orgasm makes no known difference in risk of either transmitting or acquring STDs, whether by vaginal sex, cunnilingus, or any other sexual practice. Blood exposure is not believed to elevate risk:  the main consideraiton here usually is HIV, but the amount of HIV in blood is no higher than in genital fluids, and unprotected sex during menstruation does not transmit HIV or other STDs more often than without blood exposure.

So the chance you have any STD from these events is very low. But it isn't zero. For reassurance, you could consider having urine and throat swab tests for gonorrhea and chlamydia, and perhaps even syphilis and HIV blood tests. But I stress that this is strictly for the reassurance you will gain from the negative results, not because I believe there is a signfiicant chance of a positive result.

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

HHH, MD
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15 months ago
I appreciate the quick response and I have 1 follow up please.  What is the current testing waiting periods after possible exposure for common STDs?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Swab or urine testing for gonorrhea/chlamydia is valid any time more than 4-5 days after the last exposure. Six weeks for HIV and syphilis blood tests.---
15 months ago
Thanks Doctor, but last question:  What about my risk for HSV1 or HSV2.?  I did kiss several of these girls and I've always tested negative for both viruses so I'm hoping that trend continues
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Nobody should ever be tested for HSV unless the risks are a lot higher than this, and/or the symptoms more typical. The HSV blood tests are not super reliable -- no where near as accurate as HIV and syphilis tests, for example. That said, having had negative results in the past, you're free to do it if you wish. If so, you could have an initial blood test in about 6 weeks (when most but not all new infections would produce positive results) and, assuming that's negative, a final, semi-conclusive test at 4 months. I say "semi" conclusive because some HSV infections never cause positive blood tests, especially HSV1 (up to one third remain negatrive). 

That completes the two follow-up exchanges included with each question and so ends this thread. I'm going to suggest that you've now asked questions 3 times about oral sex risks. I think you'll agree the replies have been similar each time, and repeated questions on the same topic are discouraged. But I do hope this discussion has been helpful.
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