[Question #6280] Risk from receiving oral sex

16 months ago
After receiving oral sex two months ago I seem to have what appears to be a recurring yeast infection( itching in the Vaginal area) 28 day’s after this exposure I had all the std testing done and all were negative. I also recently had a Pap smear and that was negative for HPV as well. However, is there a potential this could be HPV that is living on the skin?  Would the warts have been visible to the doctor?  Could it be Herpes and it was just too soon to detect at 28 days? As of yesterday the doctor did not notice anything and says it appears to be yeast but I am concerned that it is not going away.  Could I have caught something from the oral sex that hasn’t shown up yet other than in the form of this itching and redness? 
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago

Welcome to our Forum and thanks for you confidence in our service.  I'll do my best to help.  As it happened, I was on the site when your questions arrived and so you are receiving a reply sooner than is typical.  Follow-up replies may take longer.  Additional information may be helpful as well.  For instance was the encounter you describe a single event or recurring and was your partner a regular partner or was the encounter more casual?  If it was a casual or one-time event, is it possible that you are looking more closely for signs and symptoms than you did in the past?  Also, have you tried any treatment for this problem as yet?  If so, what sort of treatment?

As a generalization, oral sex is a biologically inefficient means of STI transmission and the symptoms you describe are non-specific.  It is good that you have ruled out the most common STIs such as gonorrhea and chlamydial infection.  Careful examination by a trained clinician is an important part of evaluating these sorts of symptoms.  The ability to look under the microscope for evidence of a problem called bacterial vaginosis is an important element of the evaluation because BV is the most common sexually associated cause of vaginal symptoms in women. 

I can assure you that your symptoms are not due to HPV.  HPV infections are typically asymptomatic and rarely become detectable until at least two weeks after sexual acquisition.  Similarly, these symptoms are not at all suggestive of herpes. 

I hope this preliminary response is helpful.  I may have more to add after I see your response to the questions above.  EWH

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16 months ago
This was a two time event. Over two months ago and as I mentioned I did have blood and urine testing done to rule out 10 STDs including herpes and at Syphillis and Trich at 28 days past the encounter(however I know it was early for some of those).  I hope that was enough time to rule out most of them that would be a concern here though.  I also was negative for HPV this past week. 
1. I had the hiv rna test done and that was negative. Would that definitely rule out any chance of hiv? 
2. I treated this with the regular yeast infection medications that worked initially but then the symptoms returned. 
3. Would the gynecologists(I have been to two) notice if something looked abnormal other than yeast? 
4. Maybe this is just a stubborn yeast infection or a resistant  strain of yeast? It seems to be worse at night.   It is driving me crazy.  I just want an answer to it. Maybe my stress over it is making it worse!! 
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago

Thank you for the additional information.  Your 28 day test results are highly reliable and effectively rule out the STIs which were tested for, including HIV.  Believe your results.  I'll address your 4 follow-up questions and then conclude with a final suggestion regarding where to go from here:

1. I had the hiv rna test done and that was negative. Would that definitely rule out any chance of hiv? 
These results are accurate and should be believed.  no need for further HIV testing (BTW, I am not aware of any cases of HIV acquired as a result of cunnilingus.  If this was your only exposure, your risk is so low that you probably did not need testing at all).

2. I treated this with the regular yeast infection medications that worked initially but then the symptoms returned. 
I am not sure what you mean by "regular" yeast medications.  Was this an OTC yeast medication?  Some forms of yeast need more aggressive therapy.

3. Would the gynecologists(I have been to two) notice if something looked abnormal other than yeast? 
Usually.

4. Maybe this is just a stubborn yeast infection or a resistant  strain of yeast? It seems to be worse at night.   It is driving me crazy.  I just want an answer to it. Maybe my stress over it is making it worse!!
I think your last comment here is very insightful.  Symptoms become more prominent at night because there in less to distract you from the sensation.  In some instances, the sensations experienced are actually normal sensations that become apparent when one is looking for them. 

Comment:  My sense is that you are regretting the exposures associated with these symptoms.  If this is the case, you may be  in a state of hyper-awareness in which your search for symptoms is leading you to experience normal sensations which you would otherwise overlook as abnormal  OTOH, there may be a problem such as a resistant yeast infection (which could be unrelated to the encounter of concern).  The best way to address both of these possibilities is to return to the GYN whom you feel most comfortable with, express your concerns and work with her/him to sort this out.  Each time you seek care from a new provider, that person needs to start your evaluation again.  There is much to be gained by giving your health care the provider to see you repeatedly over time for a persistent problem.

I hope these comments are helpful.  At this point I think it is most unlikely that you have a classical STI.  Work with a provider to sort this out.  EWH
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