[Question #8696] Potential risks from receptive Oral Sex
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41 months ago
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Hello! Although I had asked a similar question several months ago (sorry if I'm being repetitive), I find myself a bit confused as to the risks of receiving unprotected fellatio from CSWs. About 11 days ago, an erotic massage slipped into some unprotected oral, followed by protected vaginal intercourse. I didn't know anything about the status of this girl, nor could I ask because of language barriers. I must admit the unprotected oral didn't last more than some 20 seconds; in fact I asked her to use a condom for it. I had mixed feelings about the whole thing, which resulted in a rather anxious more than enjoyable experience in the end! I guess I'm still quite concerned about the risks of acquiring Gonorrhea via unprotected fellatio. I haven't had any penile burning sensations or discharge, but I was worried during the first 3-5 days.
To be more precise, do you have any statistics on the percentage of CSW in the US who have Gonorrhea, and of those, how many do acquire Pharyngeal Gonorrhea? My understanding is that a woman can contract Gonorrhea vaginally, but this doesn't mean it is in her throat, correct? And if a girl has Pharyngeal Gonorrhea, is there a 10% chance of passing it via unprotected fellatio? I recently saw an old post on MedHelp, on which I would value your expertise:
"An oral gonorrhea infection will not typically infect the mouth or tongue, but in rare cases it may infect the throat. Gonorrhea of the throat is also known as pharyngeal gonorrhea. This type of oral gonorrhea infection is almost always considered harmless. Most people will not experience symptoms, the oral infection is difficult to spread to others, and the oral infection will usually go away by itself without treatment."
Do you find these statements accurate? At the end of the day, am I (or anyone else) at such risk of contracting Gonorrhea from any episode of unprotected oral, or the chances are somewhat similar to being struck by a lightening? Thanks in advance for your reply!
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Edward W. Hook M.D.
41 months ago
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Welcome back to the Forum although I'm sorry you felt the need. These are almost the same questions that you asked none months ago and the answers have not changed. i.e.:
1. Most people, even most commercial sex workers do not have oral gonorrhea. Even in the highest risk populations (men with other men as sex partners, the risk is lower for women) the gonorrhea rate in the throat is only about 5%)
2. Gonorrhea is more difficult to spread through oral sex than genital-genital sex. At most, 10% of exposures to infected partners through oral sex result in gonorrhea acquisition and that figure is likely too high.
3. When persons acquire gonorrhea, at least 90% of them become symptomatic, typically within 3-5 days.
As you point out, a person can be infected at one site (such as the genital tract) and not be infected at other exposed sites. Non-exposed sites will not be infected.
The statements you dug up from our MedHelp posts are correct.
Given the variables mentioned above, the likelihood that you acquired gonorrhea from the brief exposure you described is around the same as your risk of getting struck by lightening. I urge you not to worry. EWH
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41 months ago
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Thank you Dr. Hook. Your clarifications will make me feel less anxious in the future. Since it's not so practical or reasonable to ask a girl whether she has had an oral swab for Pharyngeal Gonorrhea (most wouldn't even know what it is!), Is it then safe to resume unprotected sex with my regular partner following an unprotected fellatio (from a CSW), or should I at least wait 3-5 days before resuming that? I guess this primarily has to do with the likelihood of acquiring Gonorrhea from an oral exposure in the first place....
Also, does a deep-throat blowjob increases the risk of getting infected, or this is an irrelevant assumption anyway? I understand that Pharyngeal Gonorrhea would seat rather deep in the throat, no? Thanks a lot....
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Edward W. Hook M.D.
41 months ago
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In general, receipt of oral sex is low risk for the reasons mentioned above and for this reason it is reasonable to not abstain from unprotected sex with your regular partner. While the risk is not zero, it is quite low.
Whether or not the exposure involves "deep throat" exposure or not and its impact on transmission risk is unknown
EWH
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41 months ago
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Many thanks again!! I'm more convinced now about the statistically low risk of transmission from this sexual practice. This should be reinforced by the fact that the percentage of Pharyngeal Gonorrhea cases among CSW in the US must be something like 1-2% (do I remember that correctly?), in spite of the fact the disease may not be detected by a urine test, but only throat swab, sounds like...Anyway, I'll try to be less anxious next time and focus more on enjoying the experience!
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Edward W. Hook M.D.
41 months ago
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Among at risk women we found the prevalence of pharyngeal Gonorrhea to be about 3%.
I agree with your plan. Take care. EWH
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