[Question #7019] Oral exposure to STI?

8 months ago
Hi there. Thanks for your wisdom on this forum.  Over the past year I have had protected sex with (3) massage parlor workers, including unprotected oral (receiving) from 2 of them. The most recent was late February, and only for a minute to get me erect before condom went on. Also Fall of last year were (2) encounters with independent massage sex workers- no intercourse, but unprotected oral from both. Starting about 2nd week of April I began to gradually notice discomfort in my urethra, and sensitivity urinating. It feels "hot" sometimes, but I would not call it "burning".  It seemed to come and go over the last month or so, and came back when I saw my PCP last week, probably because we started talking about it. She was running a number of blood and urine tests (annual stuff), and offered to test gonorrhea/chlamydia. I foolishly declined (guilt and denial probably). I did not disclose what I have told you now re: my encounters. She did not see any outward signs of other infection when looking into my penis, no redness, and did not feel the need to swab. At no point have I had any abnormal discharge during the last year. I am notoriously an anxious person, and now think about my genitals all the time. I am also sensitive lately when masturbating, which I secretly do to pornography. I am married and confident my partner does not have other partners. Based on whatI have told you, what is the risk that I may have contracted something?
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago
Welcome to our forum.  Thanks for your question.  I’ll do my best to help.  Your penetrative vaginal sex was condom protected and thus of minimal risk as long as the condom was worn throughout the encounter.  On the other hand, your receipt of oral sex was unprotected.  The symptoms you describe are mild and could be a manifestation of nongonococcal urethritis (NGU) or they could be due to another process or even heightened awareness due to anxiety. NGU following oral sex can be due to introduction of oral bacteria or, more rarely chlamydia.  Testing would help to diagnosis of chlamydial infection but not infection due to oral bacteria.  NGU can be diagnosed by a test for white blood cells in urethral secretions or a urine collected in a sample of urine collected just as urination begins.  NGU is treated with antibiotics, either doxycycline for 7 days or a single 1.0 gram dose of azithromycin.

My advice is to seek evaluation.  If you are embarrassed to go back to your doctor, your local public health STI clinic may be able to help.   I would advise against seeking treatment without evaluation as precisely what is going on may only lead to further confusion.

I hope these comments help.  If there are further questions or clarification is needed, please use your two follow up questions.  EWH
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8 months ago
Thanks for getting back to me. Can you speak to more to "more rarely chlamydia?" I have been reading on this forum that contracting chlamydia from oral sex is extremely rare. How likely is that? Also, you made no mention of gonorrhea. Any thoughts there? Thank you.  
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago
The data on this topic are sparse however I suspect that less than 1% if NGU following oral sex are due to chlamydia.  Once again I urge you to seek professional evaluation rather than going down a “what if” rabbit hole.  EWH---
8 months ago
Ok final question: do you suspect any transmission or gonorrhea based on what I have told you? Thank you for all of your work and advice.
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago
The likelihood of Gonorrhea is quite low.  Typically gonorrhea causes a very obvious urethral discharge Within just a few days of exposure. That was not your experience. If you follow the testing advice I have provided, tests which include testing for chlamydia also typically test for gonorrhea. My advice remains unchanged. EWH---