[Question #6816] Oral Question

14 months ago
I would like to start by saying thank you for this service. I cannot believe the amount of misinformation I received on the internet before coming here. I'm a male, currently in a monogamous relationship...well until 3 days ago. I received unprotected oral sex from a 39 year old female who was also in a monogamous relationship. It lasted about 3 - 5 minutes. At this point I have had no symptoms.

Regretting my decision created some anxiety and for some reason I decided to start Googling STDs. I learned that there was risk of contracting gonorrhea, NGU, and HSV1 among a few others. My further reading showed that Azithromycin cured gonorrhea and chlamydia. Just so happens that I had 1 gram in my medicine cabinet therefore I took it about 11-12 hours after the encounter. After finding this website I realized that it was a mistake taking the medication and that my situation was at low risk for acquiring anything... And Azulithromycin was no longer the recommended treatment for gonorrhea (also too small of a dose) This leads me to a few questions.

 1. I realize that taking the azithromycin was improper however it probably would have prevented a few things. Would 1 gram 12 hours after the encounter be effective at all against gonorrhea? And I'm assuming it would have been close to 100% effective for NGU considering how quickly I took the meds?

2. Can you provide a risk assessment for my encounter? I know its low but some assurance would be helpful. 

3. Do you recommend I test? If so or if I decide to test how long should I wait before expecting accurate results? My main concern at this point would be gonorrhea. 

4. If I decide not to test and taking the antibiotics I took into account, how long should I go, without seeing any symptoms (painful urination or discharge) before assuming I am in the clear? I've read 3-5 days for gonorrhea but I'm assuming the antibiotics I took probably extended that?

5. Should I obtain from sex with my regular partner?

Thanks in advance
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago
Welcome to the Forum and thanks for your question.  I’ll try provide the “punch line” first and then elaborate.  From the outset this was a low risk encounter and while we discourage the sort of anxiety-driven antibiotic use you describe, it likely reduced your risk for infection still lower than it would have been before you took the azithromycin.  Here are some of the details:

1.  This was a low risk encounter. Most people do not have STIs and when they do, most encounters do not result in transmission of infection.  You describe your partner as monogamous and amongst sexual experiences oral sex is a relatively in efficient, from a biological perspective, means of STI transmission.

2,  The azithromycin you took represents recommended therapy for chlamydia, NGU, , and would cure about 2/3 of cases of gonorrhea.  It would also prevent development of Syphilis in the very unlikely circumstance that you were exposed.

At this point I see no need for additional testing. Should you develop obvious symptoms of urethral infection, testing would be appropriate. Otherwise I would not worry. I do not think you need to abstain from unprotected sex with your regular partner.

I hope this information is helpful to you. If anything is unclear, please feel free to use your up to two follow-up questions for clarification. EWH
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14 months ago
Thank you for your reply. My only follow up question would be how long would be sufficient to go without seeing any symptoms of gonorrhea before I know I am in the clear. I've read in your previous reply that if nothing by 5-7 days you are in the clear. I am just curious if the antibiotics would extend that time frame? 

Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago
Following the antibiotics, testing could be inaccurate for as long as a week to ten days.  EWH 
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14 months ago
Ok. And just clarify...taking antibiotics into account...If I do not develop symptoms in 7 days from the encounter I can put this behind me? 

I've read other posts where it was said if antibiotics did not work with gonorrhea you would know fairly quickly (within a day or two) but that post was several years old. 
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago
Correct.  If you get to 7 days without symptoms, I would not worry further.

As you know, we provide up to three responses to each question.  This is the third response.  Thus this thread will close shortly without further replies. Take care.  EWH 
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