[Question #8447] STI and Hep B probabilities from Oral sex with sex worker

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44 months ago
Hi, I'm male, 34, and today received unprotected oral sex from a Thai sex worker from a local bar (first and last time). It wasn't for an extended period of time but rather short teases of 10-20 seconds now and then. I also finished in her mouth at the point of ejaculation, but again for 10-20 seconds. She also had braces but I'm not sure if that matters or not. Reading many of the previous posts it seems like the guidance here on the whole is that receiving oral is a low risk activity but more recently the risk has perhaps increased for some STI's.
For my peace of mind, I'd really appreciate your take on the scenario detailed above and the risk associated with that level of contact and secondly get a bit more understanding on the likelihood of contracting any specific STI's or Hep B.
Thank you in advance.
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H. Hunter Handsfield, MD
44 months ago
Welcome to the forum. Thanks for your confidence in our services.

Thanks also for reading other threads with questions similar to your own. Indeed oral sex can be considered safe sex, with low risk of all STIs and extremely low risk, perhaps zero, for some. The three main STIs for the penile partner after oral sex are gonorrhea, herpes due to HSV1, and nongonococcal urethritis (NGU). NGU from oral sex probably is often caused by entirely normal oral bacteria and likely is harmless, both for affected men and their sex partners. Gonorrhea or herpes can be a big deal, but the actual risk after any single exposure is very low. Hepatitis B and HIV fall into the near-zero-risk category.  

In general, we do not recommend any STI testing at all after any particular oral sex exposure, unless and until symptoms develop, typically in 2-5 days for gonorrhea or herpes, 1-2 weeks for NGU, and 2-4 weeks for syphilis. However, if you would like to be tested for reassurance, I would suggest waiting until 3-4 days have passed and then have a urine test for gonorrhea. (Chlamydia testing almost always is done when testing for gonorrhea, but there is little or no risk of chlamydia from oral sex.) You could also have a syphilis blood test in a few weeks. In absence of symptoms, I would not recommend testing for HIV (there has never been a proved case transmitted oral to penis) or herpes (without symptoms, the available tests are not sufficiently reliable). And also no need to test for hepatitis B virus infection; the risk by oral sex is too low. Also, almost all Thais are vaccinated against HBV, so there is little chance your sex worker contact is infected.

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

HHH, MD
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44 months ago
Thank you for the timely and detailed response. 

Just out of interest, how are you equating low risk in terms of probabilities to transmit? You see so many conservative statistics online that suggest any oral activity is high risk and it would be great to get the facts from someone who is eminently qualified. 

Also, based on your risk assessment, would you advise getting the syphilis test or is this also very low risk and more to alleviate anxiety?

Finally, when you mention Gonorrhea can be a big deal, is this not an easily treatable with a course of antibiotics?

Appreciate your continued support with this request. 


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H. Hunter Handsfield, MD
44 months ago
You are correct that many (most?) STI prevention resources and health education materials -- both online and otherwise -- take a black/white stance on transmission risks:  a particular exposure type is either risky or not, period. However, such advice is often naive and misleading. There are solid data that unprotected vaginal sex with a female partner with gonorrhea carries a 50% chance the male will become infected; whereas receiving oral sex by a partner with oral gonorrhea probably has under one chance in several hundred that the infection will be transmitted. There also are pretty good data that a single episode of vaginal sex with a partner with genital herpes (without current symptoms) carries about 1 chance in 1,000 of being infected. Finally, HIV transmission risk, upon exposure to an infected and untreated partner, varies from 1 chance in a few hundred to 1 chance in 20,000, depending on the exposure type.

Why do some sources take the all or none risk viewpoint? Some are simply naive about the available data. Others may, as you imply yourself, have a political or social policy perspective, hoping to dissuade people from doing things that, in their fevered minds, are immoral or otherwise undesirable. Still others have a legalistic slant, fearing risk of legal action if someone becomes infected after hearing their advice. And so it goes. But on this forum, we stick with the available scientific data; and, where data are lacking (as for most STIs and most exposure types), reliance on known biological principles, anatomic aspects of sex, and so on. Without going into more detail, there are simply no data to suggest a significant risk of most STIs by oral sex; and I'll repeat that it is highly probable your Thai sex worker could not have had hepatitis B due to childhood immunization.

Gonorrhea is a "big deal" in that the risk is real (if fairly low) and easily treated, although sometimes causing dangerous outcomes before treatment. And yes, the chance of syphilis from such an exposure is extremely low; and if infected, you would probably develop an obvious chancre (syphilitic ulcer) of your penis. Without that happening, testing is optional and primarily just for reassurance.
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44 months ago
Thank you again for the detailed response. I have a test booked tomorrow for Gonorrhea and Chlamydia (6 days post exposure) and for completeness will confirm back with the result on this thread.