[Question #8225] Prolonged sore throat after oral
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47 months ago
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Hi - firstly i really appreciate the measured advice the professionals here have given, both here and on Medhelp
I've had a sore throat for 3 weeks following sex with 2 female sex workers that included me giving one of them cunnilingus. I am a 40 yr old man with medical history of asthma and sinusitis which are well controlled on steroid medication. In terms of STI history I did previously once have chlamydia maybe 10 years ago which was treated with azithromycin. I have previously had cold sores but none for maybe 4 years.
I returned to my home town recently and ended up doing some partying including the mentioned escorts. I had protected sex with them using condoms, received oral unprotected sex from both of them and gave oral to one. The following night I was out very late at bars and clubs, and the next day (so 2 days after sex) woke up with a sore throat and somewhat hoarse voice. The sore throat has persisted and it's now just over 3 weeks from when I had oral sex.
Looking in my throat it doesn't look like there's a lot wrong, the tonsils aren't very big and there isn't any obvious pus, exudate or lesions. I don't have a fever, can't feel any obvious lymph nodes, though I can feel it's sore around my larynx, no liver or spleen enlargement that I can tell. COVID has been negative on several rapid tests. I don't have any genital symptoms.
I've returned to the country where I live and the local STI clinic is recommending immediate testing for gonorrhea, chlamydia and syphilis. I have a girlfriend here who I obviously need to protect from my stupidity. From what I read by Dr Handsfield it's unlikely that I have a pharyngeal STI; however I find that difficult to square with some of the information like the below reference suggesting non-zero rates of oropharyngeal infection in heterosexual partners of people who test positive for gonorrhea/chlamydia. What should I do?
https://journals.lww.com/stdjournal/Fulltext/2019/11000/Oropharyngeal_and_Genital_Gonorrhea_Infections.9.aspx
I've had a sore throat for 3 weeks following sex with 2 female sex workers that included me giving one of them cunnilingus. I am a 40 yr old man with medical history of asthma and sinusitis which are well controlled on steroid medication. In terms of STI history I did previously once have chlamydia maybe 10 years ago which was treated with azithromycin. I have previously had cold sores but none for maybe 4 years.
I returned to my home town recently and ended up doing some partying including the mentioned escorts. I had protected sex with them using condoms, received oral unprotected sex from both of them and gave oral to one. The following night I was out very late at bars and clubs, and the next day (so 2 days after sex) woke up with a sore throat and somewhat hoarse voice. The sore throat has persisted and it's now just over 3 weeks from when I had oral sex.
Looking in my throat it doesn't look like there's a lot wrong, the tonsils aren't very big and there isn't any obvious pus, exudate or lesions. I don't have a fever, can't feel any obvious lymph nodes, though I can feel it's sore around my larynx, no liver or spleen enlargement that I can tell. COVID has been negative on several rapid tests. I don't have any genital symptoms.
I've returned to the country where I live and the local STI clinic is recommending immediate testing for gonorrhea, chlamydia and syphilis. I have a girlfriend here who I obviously need to protect from my stupidity. From what I read by Dr Handsfield it's unlikely that I have a pharyngeal STI; however I find that difficult to square with some of the information like the below reference suggesting non-zero rates of oropharyngeal infection in heterosexual partners of people who test positive for gonorrhea/chlamydia. What should I do?
https://journals.lww.com/stdjournal/Fulltext/2019/11000/Oropharyngeal_and_Genital_Gonorrhea_Infections.9.aspx
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Edward W. Hook M.D.
47 months ago
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Welcome to our forms and thanks for your questions. I’ll be glad to comment.
STI‘s, certainly can be acquired following performing oral sex on an infected partner. Precisely how common these infections are as well as their importance in overall transmission of infection is a subjective ongoing debate. The paper you mention is well-known to us. It has been written by a group of Australian investigators whom Dr. Handsfield and I have debated regarding the magnitude of oral STI’s as a public health problem. Cunnilingus in particular is likely to be a particularly low risk activity for Gonorrhea or chlamydial acquisition.
When these oral STI infections occur, the vast majority of them are totally asymptomatic and detected only by testing. Thus symptoms such as you describe would be unusual for someone with an oral STI and the onset was relatively sooner than might be expected following the exposure you have described, if you were going to develop symptoms. Statistically your symptoms are far more likely to be due to a viral pharyngeal infection or streptococci than an STI. That said, there is certainly no reason not to get tested, particularly if that would provide you with ease of mind.
I hope this information and perspective is helpful to you. If there are further questions or clarification is needed, please don’t hesitate to use your updates to follow up questions for that purpose. EWH
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