I had an encounter last Saturday morning (Nov 26) with an agency escort. I suspect she is relatively high volume, seeing about 4-5 guys per day (but I didn't ask). I engaged in unprotected oral sex - fellatio and cunnilingus - for some time. We had protected penetrative sex using a condom. Visually she seemed to not be showing any symptoms and I know she tests every couple months or so. 

I do not have any penile symptoms at all at this time, but on Sunday evening I started feeling a bit rundown. That night (so about 36 hours post activity) I felt my throat had a little something "off" about it. On Monday and today (Tuesday) it became clear that my throat is slightly sore... but not too bad. I can't really tell if my lymph nodes in my neck are swollen or not (I don't really know what they would normally feel like). Along with the throat thing, I still feel a little rundown though I have also not been sleeping well overall fo the past several weeks. Otherwise I feel more or less normal. The sore throat, which as I stated - is quite mild is bizarre to me as it hasn't really changed (gotten better or worse) in the last 36 hours... usually it would, but I guess things can change. Thus far I do not have congestion. 

I should also hasten to add that the same evening of my adventure with the escort, I went to a party for about 1.5 hours... which was pretty packed with people. One of the people I talked with there now has a cold (I don't know the status of others at the party). 

Almost certainly you have a minor viral infection, perhaps during the party or from your escort partner -- sex is obviously close enough for transmission of respiratory viruses. Either way, your symptoms are not at all likely to be related to the sexual exposure described.

Cunnilingus is very inefficient for STD transmission. As it happens, Dr. Hook was the senior author on the main study that showed that it is very rarely a source of oral gonorrhea, even after performing cunnilingus on known-infected partners. (Once again you've hit on a topic on which Dr. Hook and I are among the top experts. I believe this makes it a trifecta!) And chlamydia is probably even rarer. Further, neither gonorrhea, chlamydia, nor any other STD is a common cause of sore throat. Oral chlamydia has never been known to cause symptoms, and over 90% of oral gonorrhea is entirely asymptomatic. In theory, herpes is an issue -- but the minor symptoms you describe really don't fit either, and the chance your partner had transmissible herpes at the time.

We discussed the low risk of fellatio in your previous threads a few years ago. While your penile exposure to your partner's mouth was not completely risk free, the chance of infection was low and assuming you do not develop symptoms (urethral discharge, painful urination, penile sores) in the next few days will be additional reassurance.

For those reasons, I really don't think you need examination or testing at all -- i.e. it isn't a problem and should not be a worry that getting care at this time would be impractical. If your cold clears up in a few days and no new symptoms appear, you can safely just let this go.

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

HHH, MD

I try to do my best to research these matters, and I trust your advice perhaps more than a lot of the information out there that does make it seem like the sky is falling every time one has sex. I notice that both you and Dr. Hook are usually almost the same in your answers (except Dr. Hook is more likely to suggest testing in most cases).

I am glad to know that you don't believe my issue is STI-related. The current status is that my sore throat has gotten and bit worse, focusing/moving to the left side of my throat now. This isn't unusual in terms of the evolution of sore throats and colds... so I will refrain wasting your time by speculating further and will update the thread with my final available follow-up... in a few days, when it should be clearer one way or another.

I continue to have no genital reaction whatsoever, which - unless something is asymptomatic (unlikely, you say), I take as a sign that it's all-clear on that level.

Many thanks!

I'm not convinced Dr. Hook and I have different advice about testing, except that he might recommend it more often despite no risk, as an avenue toward reassurance. I'm confident we do not significantly differ on the level of risk from various kinds of sexual contact.

Just following up on my situation. 
Tuesday evening my throat started get get worse, by Wednesday it was painful and localized to my left tonsil and by Saturday (yesterday) it was very uncomfortable (felt like swallowing glass when eating). With that in mind, seeing as it wasn't getting better - and, as I still had literally no other significant symptoms other than the left tonsil pain, I decided to book a doctor at a walk-in today having come back home after my trip (lucky, as it's nearly impossible to get short notice appointments here). The doctor suspected strep throat, but they don't test for it on weekends, so she just went ahead and gave me a prescription for 300mg of penicillin, 2 pills taken twice a day for 10 days. I will start that this evening. 

I know penicillin isn't what's used for gonorrhea, but on the other hand I have heard that it may help cure it? In any case, this is where I am. The painful tonsil not getting better or evolving in a positive direction, was prescribed penicillin due to suspected (but not confirmed) strep.

I have a busy work week ahead, so am glad to at least be starting the treatment tonight as I won't have time for a doctor during the week.

Peculiar the clinic you found "doesn't test for [strep] on weekends; or for that matter, oral gonorrhea. Although symptoms are rare from gonorrhea, given your exposure it would have been proper to test you for it.

In the very unlikely possibility you have oral gonorrhea, the low dose of oral penicillin you were given may or may not be effective. But strep should do fine. (Of course, it is almost impossible to distinguish strep from viral pharyngitis without lab testing; if you have a viral infection, no antibiotic will help. OTOH, if viral it will be clearing up very soon on its own.

That completes the two follow-up exchanges included with each question and so ends this thread. The bottom line is that there is very little chance you have any infection at all from the sexual exposure described, except maybe an upper respiratory viral infection. I hope the discussion has been useful.