[Question #8379] Risk for STI's from oral

45 months ago

Hey Docs, again I just want to say I appreciate everything you guys do. If you would please give me a risk analysis of my exposure. I received oral sex from a early 20s yo male. I am also a male. He performed oral on me unprotected for approximately 3 seconds, until I told him to stop and he proceed to put a condom on me and I finished while protected. I had no other exposures, the condom didnt have any holes or leaks that I noticed. I asked him before we met if he had been tested he said yes and that he was negative. I know that the risk for HIV is low, but is there anyway I am at risk for any other STIs? Should I get tested? This happened earlier today btw.

H. Hunter Handsfield, MD

45 months ago

Welcome back. Thanks for your continued confidence in our services.

The condom covered portion of course was no risk for any STI. There are no data on which to estimate risk for such a brief oral-to-penis exposure, i.e. 3 seconds before the condom was in place. But with even prolonged oral exposure having quite a low risk for all STIs (and zero risk for some), such a brief event must be very close to zero risk. I would not recommend any testing on account of this event.

In fact, I would recommend that you not ever be tested after any single sexual exposure unless it is demonstrably high risk, such as unprotected anal sex with a known infected partner. Instead of testing after individual events, a smarter approach for most people is to have regular testing at intervals -- which could be anywhere from every 3 months to once a year, depending on frequency of exposure, condom use, and so on. And of course if and when any symptoms show up.

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

HHH, MD

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45 months ago

Thanks for getting back to me doc. I understand that the risk is low but just for my peace of mind I still wanna test. So best I can research online is that my only real main risk is gonorrhea. How long after exposure should I test? And I know its not likely but is there anyway hiv could be spread this way or is that the one that has no risk?

H. Hunter Handsfield, MD

45 months ago

The main risks of unprotected fellatio (for the penile partner) are gonorrhea, nongonococcal urethritis (often due to entirely normal oral bacteria), and genital herpes due to HSV type 1. Gonorrhea almost always causes obvious symptoms, with dripping pus and painful urination, onset usually within 5 days. If you're not having such symptoms by 5 days, you can safely assume you didn't catch it. (You can find all sorts of information saying that urethral gonorrhea can be asymptomatic, but that is extremely rare, especially in men who have sex with men.) But if you still go ahead with testing plans, it will be valid any time more than 2 days after exposure. There is no test for asymptomatic NGU: you'll know you don't have it if no penile discharge within 2 weeks. And asymptomatic herpes due to HSV1 also is uncommon, and the tests for it are unreliable.

So only gonorrhea. Chlamydia testing is almost always automatic along with gonorrhea testing, but chlamydia rarely infects the oral cavity and therefore is rarely transmitted by oral sex; so you can also expect that result to be negative.

There has never been a scientifically documented case of HIV transmission oral to penis. That doesn't mean it's zero risk, but it's awfully close and you're not going to be the world's first case.

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