[Question #720] Oral Sex with a sex worker

52 months ago
Hi,

Just over 2 months ago, I regrettably received unprotected oral sex from a sex worker (white female in her 40's) in Canada.  There was no other sexual contact between the two of us. At the time of the incident I noticed her teeth we in bad shape, but that was about it. I didn't think anything else of the incident. Over the past several weeks I've been experiencing a weird tingling sensation on the right side of my testicles that seems to come and go, sometimes in the groin area as well. It's not a pain and it's hard to describe. There is no pain when I touch or move my testicles. After doing some research online I've discovered that there was an STI risk with my encounter, and one of the symptoms of chlamydia/gonorrhea is pain in the testicle area. Since reading about these symptoms I've noticed that my urine feels warmer than usual, but no pain or burning during urination. I've had no other symptoms other than these, but have made myself physically sick with anxiety since learning of the risks.

I have since texted the individual who performed the oral sex and she told me she was last tested after our encounter. I'm not sure how much to believe her, and even if she was, would she have been tested for any oral infections?

What are the chances that I've contracted an STI or STD from this encounter? Should I cease all sexual activity with my current partner until I'm tested?

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
Welcome to the forum. Thank you for your question and for your confidence in our services.

I'm afraid you have been mislead by your online research. Oral sex is safe sex. It isn't completely free of STD risk, but the chance of infection is low for all STDs and zero for some -- far lower than for vaginal or anal sex. The chance of any infection from a single exposure is very low. Second, no STD causes symptoms like yours. While it is true that gonorrhea and chlamydia can cause testicular pain, that is never the only symptom -- and the amount of pain would be severe, and you would also have discharge of pus or mucus from the penis. And no STD causes "warm" feeling urine without pain or burning on urination.

So from a strictly medical or risk standpoint, you do not need testing, and can continue sex with your regular partner without risk of infecting her with anything. However, if you would like additional reassurance, you could visiti a doctor or clinic for routine STD/HIV testing. If you do so, I suggest you have a urine test for gonorrhea and chlamdia and a blood test for HIV and syphilis. You can expect negative results.

I hope this has been helpful. Let me know if anything isn't clear or if you have additional questions.

Best wishes--  HHH, MD

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52 months ago
Thanks Dr.

My additional concern would be that I've read both chlamydia and gonorrhea can be asymptomatic. What are the chances that this is the case? Especially Chlamydia where estimates are about half of men show no symptoms.

In the event I was infected and its passed on its own and I pass all tests, could I have still infected a partner unknowingly and they are unknowingly living with it?

You mentioned that if I did want testing you'd recommed an HIV test. I didn't think HIV could be contracted from receiving oral. Is this not the case?

Thanks for your time.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
Both can be asymptomatic. However, chlamydia is not a risk with oral sex; it is rarely carried in the mouth and therefore evern more rarely transmitted mouth to penis. And although gonorrhea can be asymptomatic, that is very rare.

I agree you could not have acquired HIV. If you read my reply carefully, you will understand I did NOT recommend testing of any kind. For many anxious persons, a negative test is more reassuring than an expert's opinion. But if you're already completely convinced and won't worry about it, don't get tested. It's up to you.

I repeat my main concluding advice above:  in my opinion, you did not catch any infection; you do not need testing; and you can continue sex with your regular partner without risk of infecting her with anything.

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52 months ago
Thank you for your reassurance. 

Is there misinformation regarding chlamydia? A lot of medical websites suggest that it can be transmitted via oral sex and one even went as far as to say it was fairly common. I saw a statistic that upwards of 10% of sex workers carry chlamydia in their throats. I've also seen a couple of personal posts from people claiming to have contracted chlamydia this way.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
You are exactly right and thanks for bringing it up.  You have given me an opportunity for a blog-like response that I can refer to in the future.

There are many similarities between gonorrhea and chlamydia, and many seemingly knowledgeable authorities and agencies, make assumptions that everything about them is similar. That has head to statements about oral sex transmission, which is fairly common with gonorrhea. But as noted above, the frequency of oral infection with chlamydia is 10-20 times lower than that of gonorrhea, so much so that CDC recommends against testing even the most sexually active persons for oral chlamydial infection. I've never seen a report showing anywhere near 10% prevalence of oral chlamydia in any group, sex workers or anyone else. 1-2% appears to be tops. And since oral chlamydia is uncommon, it follows that oral to genital transmission is rare; simple presence doesn't necessarily imply it's an efficient source of transmission. (Even for unprotected vaginal sex, probably the risk of chlamydia from any single exposure, if the female is infected, is around 20% -- that is, 4 in 5 exposures don't result in transmission to the male partner.) The issue is further confused because nongonococcal urethritis (NGU) is an occasional consequence of oral sex, and NGU is the main clinical problem for chlamydia in men. NGU from oral sex is virtually never chlamydial, but people often make that connection, reinforcing inaccurate beliefs about oral sex and chlamydia. But studies of men with NGU show very low rates of chlamydia in infected men whose only exposure was oral inserttion, including two such studies I published myself. 

Having said all that, the research field is moving, and with improved testing showing that oral chlamydia is not quite as rare as once thought, it is likely that rare cases are indeed transmitted oral to genital. But I would strongly emphasize "rare". And I would ignore personal testimonials. Chlamydia is a sneaky organism, and many people simply don't know when and where they caught it. For example, a guy who received a BJ from a sex worker may believe that's the source, but in fact his wife has had recurrence of her own distant past chlamydial infection (or she also been screwing around) and he really was infected in the traditional manner. Personal testimonials about rare medical events are just about the very worst way to judge the reality or frequency of rare medical events. (Same deal for all those people who attribute their back pain or leg tingling to genital herpes.)

That completes the two follow-ups included with each new question. Let me know if any last brief questions or concerns, before I close the thread.

Take care and stay safe.
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52 months ago
Thanks for the thorough and detailed responses. Take care