[Question #7457] Oral Sex

4 months ago
Hello Doctors H & H,

What STDs should I be concerned with after receiving oral from a man and giving him oral unprotected? Exposure this past Saturday with a new partner. ( no unprotected penile insertive sex just oral both ways) 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Welcome back to the forum. Thanks for your continued confidence in our services. I'm taking this question, but I reviewed your recent discussio with Dr. Hook. I agree with al he said.

In general, oral sex is low risk for all STDs -- not entirely risk free, but a lot lower risk than vaginal or anal intercourse. Receiving cunnllingus is especially safe:  due to anatomic considerations, STD transmission to women by cunnilingus is stremely rare. In my 40+ years in the STD business, I don't think I ever cared for a woman who acquired any STD by cunnilingus performed on them, with the possible exception of a few cases of genital herpes due to HSV1. Performing cunnilingus (e.g. if you have sex with other women) is also virtually zero risk.

Pefforming fellatio (penile-oral) on men is somewhat higher risk but still low. CDC has estimated the HIV risk at 1 chance in 10,000 if the male partner is infected. That's equivalent to performing BJs on infected men once daily for 27 years until transmission is likely. The highest STD risk is for pharyngeal (oral) gonorrhea -- but since the large majority of urethral (penile) gonorrhea in men causes obvious symptoms, you can avoid risk by not performing oral on men with visible urethral discharge or other symptoms. Chlamydia is very low risk; apparently it doesn't readily infect the oral cavity. Oral herpes, HPV, and syphilis also are all very rare after oral exposure.

No STD testing is routinely recommended after a single exposure of the kind you describe. However, we understand that many people are more reassured by negative testing than by professional opinion based on probability and statistics, no matter how expert the source. (We don't take it personally!)  If you will feel better knowing for sure, then yu can have a throat swb and urine or vaginal swab testing for gonorrhea and chlamydia (valid any time more than 3-4 days aftere exposure); and at 6 weeks or more after the event, blood tests for HIV and syphilis. I really don't think it's necssary -- but an option to consider for reassurance.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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4 months ago
I appreciate your feedback and thoroughness. Based on what you said if I did decide to get tested you wouldn’t expect all negative results off a single exposure like mine? 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
4 months ago
Although oral sex in general is low risk, the actual risk varies between partners. You have said nothing about your partner:  his background, sexual lifestyle, and factors that might raise the chance he has an STD you could acquire by oral sex. As one example, if he has sex with other men, the chance he has pharyngeal (oral) gonorrhea is far higher than for a  guy who only has sex with women. So if he's bisexual, it would be more important for you to have an oral gonorrhea test than otherwise. Similarly, the syphilis risk is much higher for men having sex with men.

Since you're concerned enough to have come to the forum with this question, I recommend you be tested -- not because the risk is high, but because you'll probably keep worrying until you have been tested with engative results. So based on the understanding that you are female and that your exposure was oral sex both ways, I would advise a urine (or vaginal swab) test for gonorrhea and chlamydia, a throat swab for gonorrhea, and blood tests for syphliis and HIV after a few weeks. You definitely can expect all these results to be negative.
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3 months ago
Ok great last question. If I went and got the RNA PCR @ 13 days now would this be conclusive for my worries on HIV? It’s close to Christmas and I would like some peace of mind. I’ve also decided I’m going on a Sabbatical with sex until further notice. My anxiety after is too high just trusting what people say . (On having no STDs)  hence why it on here wondering. 
Last week I was coughing, had head congestion, runny nose, may or may not have had s slight fever, 1 day diarrhea, just felt bad in general for about a week  but didn’t feel flu like or severe.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Your negative HIV test is reassuring, but not 100%; it would detect 90-95% of new infections at 2 weeks. Now that you've started down the HIV testing path, you'll also need an AgAb (antigen-antibody, "4th generation") test 4-6 weeks after the event.

New HIV doesn't cause nasal congestion or cough, and neither does any STD. You're reight to suspect a cold or influenza, but also COVID-19 --that's the biggest concern and you should be tested for it. You also need to isolate yourself at home until you have the result of that test. Check with your personal physician as well. Good luck!
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3 months ago
Thank you sir. I appreciate your response. Respectfully on my last message I was asking if (I haven’t went yet) now looking at testing 15-20 days now past the exposure (12/9) would the RNA early detection test (its says 99% 9-11 days online) be conclusive? I saw a few threads where a negative test at this point with RNA was conclusive. Is this still the case? 
My secondary concern is I had cosmetic lip injections about 8 hours earlier to the fellatio. 
I didn’t know if this made a difference in risk? My esthetician says any injection sites should have been closed in that time frame but I trust your guidance vs hers. 
You asked about the partner -he is from Beaumont Tx area white/Hawaiian decent & heterosexual with single digit partners as I was told. 
He had a physical for work yesterday. His dr said he just had high cholesterol (so he had blood work done. In simple panel would there be something else in the panel was off blood work wise if he had HIV right?) he says he’s clean but that’s just his word. As always thank you and Merry Christmas. 

3 months ago
Also I forgot the RNA test includes a 4th gen combo with it via www.stdcheck:com
3 months ago
Also does it make difference if I have had one bought of diarrhea the last 3 days in the morning? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Sorry I apparently misread -- you were asking about testing plans, not tests already done, right?

Thanks for the information about your partner. The chance someone like him has HIV is close to zero. You didn't even need HIV testing at all on the basis of all you have said about your exposure, your partner, and the symptoms you reported before and now.

Many experts do consider negative HIV RNA testing to be conclusive as soon as 2 weeks after exposure, and some testing services say the same about the tests they offer. However, the research on window periods for ths and other tests is not very precise:  all published or promoted window periods are estimates, not always as conclusive as stated. CDC, usually considered the final word in such things, istimates the RNA test detects around 95% of infections at 2 weeks, and that's our advice on this forum.. The combination of negative RNA at 2 weeks plus a 3rd or 4th generation blood test at 4 weeks is conclusive; so is a 4th gen test at 6 weeks (without RNA testing).

The details of your sexual exposure and trivial symptoms make no difference at all. Please carefully re-read my comments above, every word. I have carefully explained that you do not have HIV. There are no details you have described, and none you may think of going forward, and no symptoms you have now or in the future that have any possibilty of changing my opinion or advice. Have the conclusive testing I hvae recommended to prove it to yourself. In the meantime, please top worrying. You are overracting to everyting. Listen to your wise parents!

That concludes this thread, Do not return with a new qeustion about this exposure and HIV testing. Just sit tight until you have the conclusive tests you intened, then believe those results.

I hope the discussion has been helpful.


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