[Question #760] Risk Assessment - Oral Encounter

103 months ago

Hi Dr

I'll state the facts simply as follows:

Day 0 - received unprotected oral with sex worker (Western Europe, I'm a male). She also inserted some fingers into my anus. Fingers were condom covered but she used spit as lubricant.

Days 0-11 - no symptoms

Day 11 - had unprotected oral (receiving) and vaginal sex with regular partner

Day 13 - urine tests for chlamydia and gonorrhoea

Day 14 - tests returned negative. Regular partner reports symptoms of UTI.

Day 15 (Today):

Still no symptoms of note; no noticeable discharge. I suspect probably I'm imagining dull pain or sensations in my penis due to anxiety over the encounter. I intend to have a full blood panel done at day 28. I made contact with the sex worker and enquired if she was clean or not. She replied saying I have nothing to worry about.

Questions:

1. Is it likely or possible that I could have acquired some sort of NGU and passed it onto my partner, this being the cause of her UTI? Or could this be coincidental?

2. I'm going to have my bloods done and I suppose am most worried about the possibility of having contracted syphilis during this encounter. Are there any statistics of probability in this scenario?

Thanks

Edward W. Hook M.D.

103 months ago

Welcome to the Forum. I'm pleased to comment. Your concerns reflect the combination of what I suspect are a certain amount of guilt combined with coincidence. Your test results proved that you don't have gonorrhea or chlamydia and, if you have NGU at all, the NGU that follows receipt of oral sex appears to most often be due to introduction of a partner's normal, oral bacterial into the urethra (penis) following receipt of oral sex. These are normal bacteria which, while sometimes causing irritation for a while, are not transmissible to subsequent unprotected sex partners.

In addition, sex itself does increase the risk for UTIs in women. I would not worry that your partner's UTI,symptoms are due to an STI that you acquired and then gave to your partner.

As for your syphilis concerns, there are no official statistics on this but I can assure you that it is extraordinarily rare to acquire syphilis from oral sex. I urge you not to worry about this.

I hope these comments are helpful. EWH

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103 months ago

Thanks dr hook for the reassurance.

Would you recommend I take antibiotics for the potential NGU (z pack or similar) or let things resolve naturally? The reason for my query is that I have seen on other enquiries that you discourage proactive antibiotic therapy without good reason.

Thanks

Edward W. Hook M.D.

103 months ago

Sorry for the delay in getting back to you, I was traveling. What you describe really is not all that suggestive of NGU and as we have described, you have ruled out the real "troublemakers" (gonorrhea and chlamydia), I would not take antibiotics. Rather be confident that you did not get an STI and try to move forward without further concern. EWH---