[Question #6790] Male to male oral

11 months ago
2 days ago I traded unprotected oral sex with another male. Neither of us ejaculated and this only lasted about 5 minutes. This other male was 18-20 years old and said it was his first time but I really don't know him well and originally met on the app grindr. 
I am not having any symptoms but am nervous about it anyway. Was wondering what I could be at risk for and if there continues to be no symptoms for the next couple weeks should I still get tested? I'm worried about passing something on to my female partner.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Welcome to the forum. Thanks for your question.

Oral sex is relatively low risk for all STDs -- not risk free, but much lower chance of infection than unprotected vaginal or anal sex. For HIV the risk is almost zero:  there has never been a proved case of transmission oral to penis (although  some infected people believe that's how they acquired it) and only a few cases penile to oral. One calculation by CDC a few years ago was a risk of 1 in 10,000 for the oral partner if the penile partner has HIV, and 1 in 20,000 oral to penile. Those figures are equivalant to giving or receiving BJs by infected partners once daily for 27 years or 54 years before infection might be likely.

The greatest risk for a significant STD is gonorrhea, which can be trransmitted in either direction if one person is infected. Almost all urethral (penile) gonorrhea causes obvious symptoms within 5 days, discharge and painful urination, usually very obvious. The opposite is true for pharyngeal (throat, i.e. oral) gonorrhea:  almost never any symptoms at all, only detectable by testing. (A few percent get sore throat, usually mild.) Nongonococcal urethritis (NGU), often perhaps due to entirely normal oral bacteria, sometimes occurs, and genital herpes due to HSV1 (the cause of oral herpes) is possible. In theory, syphilis, which is especially common in men having sex with men -- but uncommon after any single exposure.

All things considered, if no symptoms within about 10 days, you and your partner can be pretty confident you're home free. However, the only proof can come with testing. You might speak with your partner:  if you both are tested now for gonorrhea (urine, throat swab) and blood tests for HIV and syphilis, you'll no neither of you was infected and therefore not at risk from this event. If only you test, wihtout your partner doing so, you would need urine and throat for gonorrhea (valid any time more than 2-3 days after exposure) and blood tests for HIV and syphilis in about 6 weeks.

Of course all this depends in part on your and your partner's sexual lifestyles. If this was a one-off for both of you, the risk may be nil. If either of you has frequent sex with other men, of course the risks are correspondingly higher.

But whether or not you are tested, if you have no symptoms in 10-14 days, you're probably fine.

HHH, MD
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11 months ago
You say if no symptoms in 10-14 days probably fine but if it could be pharyngeal gonorrhea which sometimes has no symptoms I feel I should still test. Being as I don't want to go to the clinic right now with all that is going on is it possible to get treatment without visiting a  clinic. Or if untreated is it possible that it will go away on its own or is there anything that I can take over the counter to treat it?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
11 months ago
Sorry for the longer than usual delay. I answered this yesterday but apparently it ddn't upload.

Pharyngeal gonorrhea clears up on its own, but that takes a few weeks or even months. I agree with not going to a clinic if not necessary. But undoubtedly the clinic understands the situation; perhaps they would provide for a self collected swab at the doorway or curbside? Alternatively, maybe go directly to a lab.

Another approach is for both you and your partner to have urine testing through a lab; if both negative, neither of you would have been at risk for acquiring the infection orally. This could be done any time, and could include syphilis and HIV blood tests -- if negative you'll both know you weren't exposed and no need for fruther testing.
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