[Question #6322] Analingus followup

15 months ago
Hi. Again thanks for all the work you do. I engaged in another situation where I received from massage at Korean massage parlor and engaged in analingus, I received from her and and also performed this on her. She also gave me unprotected oral briefly. Says she clean. I know this is a repetitive questions but this time i was a willing participant and have some questions around mainly transmission not previously asked about by me. Ive read alot on medhelp and here on analingus and know is very low risk for all STD, generally no real risk to receiving for STD and more to oral partner for GI issues but what about oral and Rectal gonorrhea, mainly throat as my throat has been scratchy since exposure 11 days ago. Can you get gonorrhea from giving analingus? i checked it was clean and no oder or taste, no tongue penetration? I have no noticeable discharge at penis site but slight itching at anal area but thing that my head, amplifies when i think about it. if she had gonorrhea of the throat, what is the chances i got rectal gonorrhea and not genital gonorrhea, or what if she had rectal gonorrhea and what are the chances of passing that to me when performing . Mainly worried about passing throat gonorrhea to wife.     you mentioned you were going to be talking at a summit on this topic in july, how did that go and any new  info. MY last though twas since she was Asian, and i know the super strain is more prevalent in asia, could that strain pass easier either way? i want to avoid getting testing due to insurance claim, etc. other then a slight ongoing throat irritation since , not other issues.   
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Welcome back to the Forum and thanks for your kind words.  Our goal is to help clients with questions and concerns about risks for STIs. On this occasion, I happened to pick up your question and will be answering.

Analingus, either giving or receiving is a biological inefficient mechanism for STI transmission.  As a generalization, throat infections are relatively uncommon compared to genital infections and the tongue does not typically reach the sites where infection occurs.  For these reasons, infections due to analingus (giving or receiving) are rare.  OTOH, are they unheard of - no.  They are biologically plausible and the only way to be sure that you are not infected is to test at sites of exposure (i.e. for you, rectal and throat infections).  Personally, I would not be worried but only you can decide whether you need the additional assurance that tests will provide. 

FYI, when throat or rectal infections occur, they are most often asymptomatic. thus only testing can be truly definitive.  The irritation in your throat that you have noticed is far more likely to reflect your anxiety than to be due to infection.


Hope this information and perspective is helpful.  EWH


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15 months ago

Thanks for the response. This makes sense, however can you help me better understand how one can acquire Throat or Rectal gonorrhea?

Can it only be passed with interaction with a penis, meaning one would have had to have given oral to a male? Is the same true for rectal gonorrhea, can it only be acquired through anal sex, rather than analingus?

I’ve read response’s from both yourself and Dr. Handsfield  from here and medhelp where you have never seen a case in your career of someone acquiring an STD through performing or receiving analingus, does that still hold true today, especially if gonorrhea can be passed to throat from the analingus?

 

As for my comment in the prior about no issue with my penis to date, whats the late timeframe for gonorrhea onset? Im basically at 12 days? Could it be delayed or no?


Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Gonorrhea is transmitted ONLY by direct contact with an infected source.  The penis is a very efficient means of inoculation and transmission.  Performing fellatio on an infected person can also regularly lead to infection although slightly less efficiently than inoculation of the female cervix through penile-vaginal sex or the rectum through receptive rectal intercourse.  Analingus, either receptive or active is far less efficient and while theoretically possible, very rarely leads to infection.  Neither of us has still even seen infections acquired in this way although it probably happens quite rarely.  Gonorrhea does not infect the tongue- it infects the back of the throat, thus the mechanics of transmitting of acquiring gonorrhea through analingus are a major reason why is it such a rare event.

When a person acquires urethritis (penile infection), symptoms typically occur within a week of exposure.  If 12 days have passed and you have not experienced symptoms, I would not be worried.   EWH

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15 months ago

Thanks for the details.

Based on your feedback and the fact both you and Dr Handsfield have seen tens of thousands of STD cases/situations which none of your patients acquired pharyngeal gonorrhea or rectal gonorrhea by way of analingus is reassuring, I feel confident I was not infected and will not be the first based on a 1 min exposure of licking her anus. I know you said anything is possible but the word “rare” makes me feel like testing is a waste of money and time and I just need to get it out of my head that I was not infected.

 

In the future if I kept this lifestyle in place with a visit a few times a year where I engage in analingus with a CSW/massage, and keep it to those activities only, I should be pretty safe of not acquiring anything? 

 

Just a follow-up to pharyngeal gonorrhea and the throat, you said it takes hold in the throat and I understand oral with a male can cause it as the penis is deeper in the mouth and throat in some cases but hypothetically when licking the anus, if gonorrhea was present on the anus (I assume there would be puss, an oder , or some identifier if I was licking an infect anus), could licking and swallowing the spit allow it to travel to my throat  and take hold or does it die once it hits air?

 

Out of the 555,000 document cases of gonorrhea in the US, how any or what % are pharyngeal gonorrhea or Rectal?


Did the conference with the Australian team shed any light on new theory’s or change you or Dr Handsfields views?

 

Again, the last questions are more for education (for me and others).

 

Amazing work you do, thanks again to you both for helping me understand and realize my risks.

Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Correct.  If your only unprotected activity is analingus, I would not worry about infection and would not pursue testing for STIs.

There are no data on the issue of risk based on with or without swallowing anal secretions.  I presume that for many persons some swallowing is a normal part of activity and would not worry about this variable.

sorry, the CDC's data on the proportion of gonorrhea cases which are anal or pharyngeal only is not available. 

No, all that the interaction with he Australians led to is agreement that more research is needed.


Thanks for your thanks.  As you note and as per Forum Guidelines, this thread will now be closed.  Take care. EWH

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