[Question #7261] Chlamydia risk via unprotected oral

8 months ago
Hi Doctors, 

I am concerned about the risk of contracting chlamydia via unprotected oral sex. 

I occasionally see a registered sex worker (legal in my country) for unprotected oral sex. I have seen her a few times in recent months.

A friend of mine who engages in unprotected oral and protected sex with sex workers with a much higher frequency than me, recently told me that he contracted chlamydia. I know he sees the same sex worker I do on a regular basis. 

He told me he always uses protection for regular sex, but not for oral sex. 

I am terrified that I may have contracted chlamydia. My partner is pregnant and I am obviously worried about the chance I have passed it on. 

My friend told me he had no symptoms but his wife has and that is how it was discovered. 

I know the only way for sure is to get tested. Is this the best/only option for me to be sure? 

I want to know what the risks of me having chlamydia are based on oral sex without a condom. It's possible he caught it of the same sex worker I have seen, but he seems to be a much more frequent visitor to a range of sex workers. It possible he is not being truthful about how it was contracted.  

I assume I need a test to be sure. But I'm hoping you could reassure me that my risk is very close to zero based on the fact that I've only engaged in oral sex without a condom. 

I have no symptoms, but I have been doing this a few times a year with sex workers for years. 

Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago
Welcome to the Forum.  I’ll be glad to comment and provide some facts.  Oral chlamydia is far less common than oral Gonorrhea or chlamydia at other sites.  In addition, it is probably less likely to be transmitted through oral sex than through genital exposure to an infected partner.  Finally over time infections tend to be eliminated from the body.

Even if your friend acquired acquired his infection from the same CSW that you visit (you do not know that he did), you do not know if infection was present when you had sex.  While my guess is that you are not infected, about half of chlamydial infections in men are asymptomatic. The best way forward and the only way to know for sure is for you to go get tested.  If your test is negative you are in the clear.  Please DO NOT take antibiotics without testing, this will just obscure things.

I hope this information is helpful.  If anything is unclear or there are further questions feel free to use your up to two follow up questions for clarification.  EWH
8 months ago
Thanks Dr Hook, 

Can I just clarify a few things? 

You mentioned that chlamydia may be eliminated by the body. Is this only in instances where it lives in the throat? 

If this CSW did actually have chalmydia in the throat and gave me unprotected oral while infected, can you give me a ballpark idea on what my risk of contracting it might be? 50%? 5%? 

Does that risk increase with the amount of times I saw her? I think I've seen her two or three times in the last month, which is more than usual. 

If someone had chlamydia and this CSW gave them unprotected BJ, what's the percentage likelihood that they would contract chlamydia in their throat? 

I am going to get tested. I think I just need to be reassured. 

You and the other professionals on this forum constantly advise for people in my position to resume sex with their partners without worry, so I assume the risks I'm facing are extremely low, less than 5%. 

If you could give me an idea I'd really appreciate it and it would calm me down while I wait for the test. Thank you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago
Straight to your follow up questions:

1.  The best data on elimination of chlamydia without treatment is from the genital tract.  In that location 15-20% of infections are no longer detectable about a month following initial diagnosis.  This sort of elimination occurs in the throat but there are no reliable estimates of how frequently.

2.  There are no data to provide an answer to this question.  20-40% of single genital exposures lead to infection. For oral the proportion is probably lower.

3.  More exposure, the likelihood of infection is proportionally higher.

4.  Unknown.

I cannot provide you with a science-based estimate, sorry.  I’d just be making it up. Sorry EWH 
8 months ago
Thank you again, Doctor! 

I feel reassured that my risk is probably relatively low. I will get tested tomorrow. A few more questions if that's ok. This will be my last post, so thanks again. 

With chlamydia specifically, is a urine test sufficient or do I need to insist on a swab of my penis to be 100% sure? 

Dr Hook, if you found yourself in my situation, would you resume sex with your wife before getting tested? 

Thank you so much. 
Edward W. Hook M.D.
Edward W. Hook M.D.
8 months ago
Thanks for your follow up questions. As you pointed out this will be my final set of responses to your questions.

1.  A urine test collected as you begin to urinate, at least one hour after the last time you urinated will provide you with entirely reliable results. There is no need for a swab test.

2.  Your urine tests should be available 24–48 hours after the specimen is submitted. If the test results are available in that timeframe, the safest approach following this exposure is to wait. The likelihood of infection is low but my sense is that you don’t want to take any chances.

I hope that the information I have provided has been used. As performance guidelines this thread will be closed in a few hours. Take care. EWH