[Question #800] Risk from performing oral sex (cunnilingus)

51 months ago
Four days ago I performed oral sex on a female dancer at a strip club. The act was very brief (approximately 1 minute).  I am in a long term monogamous relationship involving unprotected sex, though my partner and I have not had any sexual contact since the incident. I have been racked with paranoia, anxiety, and guilt over this very poor decision. My questions are, What is the level of risk of being exposed to an STI? What specific STIs should I be tested for, and how long do I need to wait before being tested in order to receive reliable results? Thank you. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
Welcome to the forum. Thanks for your question.

You needn't worry about this event. Oral sex is safe sex in general -- zero risk for some STDs, low risk for all, far lower than for vaginal or anal sex. And of all forms of oral sex, cunnilingus is lowest risk of all. The chance of acquiring any oral STD (or any infection at all) from this event is zero for all practial purposes. I recommend against testing for anything. However, if you decide you need testing for its reassurance value, then you can be tested at any time for oral gonorrhea (which requires a doctor visit for a throat swab). The only other STDs you could be tested for are syphilis (blood test in 6 weeks) and herpes (blood test in 3-4 months). But the chance of any of these is extraordinarily low and if I were in your situation I would just forget the whole thing and continue unprotected sex with my wife without worry.

I hope this has helped. Best wishes--  HHH, MD

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51 months ago
Thank you very much, Doctor, for your thoughtful and reassuring advice. This is exactly what I was hoping to hear and I already feel an ease in anxiety (both from this and after having read your replies to similar queries). I appreciate your sharing that, were you in my position, you would not test for anything and would resume unprotected sex with your wife. However, say in the most remote of chances, I did contract oral gonorrhea, is it possible to pass that through unprotected vaginal sex or would me performing oral sex be the only risk? I guess what I'm asking is, if I were to get tested for OG for reassurance, would it be safe to resume vaginal sex and prudent to abstain from giving oral sex, or would it be most prudent to abstain from any and all sex acts?

As for syphillis, I assume you mean that I must wait 6 weeks for testing, but I guess (since my risky encounter was strictly oral on my end) I would ask the same question regarding abstinence from just oral vs any and all. 

I assume I already have herpes (Hsv-1), as I've gotten occasional cold sores all my life. Does this change anything? Actually, in the past hour, my lower lip has begun tingling and swelling slightly, as it typically does before I get a cold sore. But my cold sores are very often triggered by stress and anxiety, which has been my near constant state for 4 days. Still, does this add any further concern or worry?

Thank you again for the reassurance. I know getting tested is ultimately my decision, though it helps to know you feel it would be for reassurance value only and that you do not think it's necessary. I hope these will be my final questions and my last cause for concern.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
If you have oral gonorrhea, the only way you can transmit it is by contact of your oral area with a partner's genitals. It is not transmitted by kissing, and does not travel through the body to enable transmission by genital contact. (By the same token, it cannot be diagnosed by genital or urine testing.) However, it would NOT be prudent to abstain from oral sex. The risk is too low that you are infected. Don't even think it.

Syphilis is different. It disseminates body wide, and once infectious, can be transmitted by any sexual contact -- not only contact at the site it was acauired.

Your HSV1 makes no material difference. Your exposure carried a theoretical risk of HSV2, but not HSV1. Your lower lip tingling, if it means anything at all, might be a recurrence of your oral herpes, but is not likely related to the sexual exposure except perhaps psychologically.

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51 months ago
Thanks again, Doctor. I feel safe trusting your initial advice. Unless you have anything further to add or any revision on your suggestion, I believe I am done here and will move forward with confidence that there is zero chances of having acquired any infection for all practical purposes. Thank you. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
You've got it right. Thanks for the thanks. Best wishes and stay safe.

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