[Question #8743] Unprotected Oral Sex

40 months ago

Hello, I am a 36 year old heterosexual male in a long term relationship. Two days ago I went to an Asian massage parlor with no intentions other than a massage. When she flipped me over she started sucking on my penis. It caught me off guard, I was turned on, and ejaculated between 20 and 30 seconds. I quickly got dressed and got out of there. After about 15-20 minutes I slathered hand sanitizer all over my penis (ouch).

The anxiety has been UNBEARABLE, taking Xanax to help calm me down. Another note, I drink a lot of caffeine and I try to stay hydrated but I’m not always peeing clear. My urethra usually hurts slightly when I pee, especially when I ejaculate a lot.

I went back the next day and had her let me examine the inside of her mouth with a flashlight (ballsy, I know). I couldn’t see anything weird. She assured me she’s healthy.

I understand the chances of HIV are probably low. What about all of the other STDs? And when should I go get tested?

Thank you!

H. Hunter Handsfield, MD

40 months ago

Welcome to the forum. Thanks for your confidence in our services.

Oral sex should be viewed as safe sex. It's not entirely free of STI risk, but the chance of any infection are far lower than for unprotected vaginal or anal sex. This is especially true for fellatio, i.e. for oral to penile transmission. First, the frequency of transmissible oral STIs is low. Second, when present, the transmission efficiency is low -- that is, even with infected partner, the large majority of events don't result in transmission of infection. For HIV, there has never been a proved case of transmission oral to penis.

The main STIs that can be so transmitted (although rarely) are syphilis, herpes caused by HSV1, and gonorrhea. Syphilis is rare in female sex workers in most geographic areas, and your flashlight exam probably would have shown if she had a syphilitic lesion in or near her mouth. Same for herpes: without a visible cold sore etc, the risk was extremely low. As for gonorrhea, if you caught it, you would expect to develop symptoms within 5 days, i.e. pus dripping from the penis, painful urination, etc. Conceivably the symptoms you describe could be the early signs of gonorrhea -- but probably not (sounds much more like anxiety increasing your awareness of trivial or otherwise unnoticed symptoms).

Should you be tested? Probably yes -- not because the risk of infection is high, but mainly for reassurance. A urine test for gonorrhea (and chlamydia) can be done at any time, although you might want to wait another day or two to see if your symptoms worsen. A syphilis blood test can be done in a few weeks -- although if you do not develop a penile chancre (syphilitic sore) in the next 2-3 weeks, that will be strongly reassuring. Same for herpes: no blisters/sores in the next few days will confirm you didn't catch it. But I would not recommend blood testing for HSV: the available tests are not sufficiently reliable for use in this situation. HIV testing? Definitely not necessary -- but you're free to do it in a few weeks if you remain concerned, despite the essentially zero risk.

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

HHH, MD

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40 months ago

Thank you! The local STD clinic assured me that if I tested for Gonorrhea and Chlamydia today that results will be accurate. I did submit a urine test, and now I wait. I intend on keeping a close eye on everything and possibly doing a 10 panel at about 4 weeks.

I will never get a massage again!

H. Hunter Handsfield, MD

40 months ago

Thanks for the follow-up. My only additional advice is to not get any "comprehensive" (10 test) STI panel. At least two of the tests (urine gonorrhea & chlamydia) will be irrelevant, and perhaps others (e.g. if the panel includes urine for trichomonas, ureaplasma, and/or mycoplasmas, which do not infect the oral cavity and are zero risk from oral sex); and some of the blood tests also are irrelevant (e.g. HSV and sometimes things like EBV, HTLV, or others). Also, 4 weeks is too soon for any and all STI blood tests. Just have syphilis and HIV blood tests at 6 weeks. It will be less expensive and will not risk misleading (especially false positive) results.---

40 months ago

Thank you for that advice. I never would have know. This has been killing me and you have provided me at least some level of comfort. You are providing a tremendous, and in my opinion, undervalued service.

H. Hunter Handsfield, MD

40 months ago

Thanks for the kind words; that's why we're here. If you'd like to contribute a bit more to the forum sponsor (maybe with an explanatory note similar to this comment), visit www.ashasexualhealth.org and follow the link to make a tax-deductible donation. Thanks for considering it.---
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