[Question #9459] Std or Anxiety after Oral

32 months ago

I wanted to make sure I had the most up to date data as to my risk of an unprotected oral exposure that occurred 31 days ago. I’m a 44 married male and have only had vaginal sex with my wife ever. 31 days ago I was hanging out with a guy I have known for a while. He recently divorced after being married for 25 years and has been dating a 39 yr old female for the past year. While hanging out, I stupidly let her perform unprotected fellatio on me. I have had 0 typical symptoms (no discharge or pain when urinating or ejaculation) except for frequency and urgency that popped up 22 days after my exposure. This came about after my wife started having bladder spasms. This has happened to her in the past and she believes it is because she has a kidney stone in her bladder at the moment. My mind started thinking the worst and I thought back on the oral exposure and wondered if that could be the cause of her symptoms. My questions are as follows: 1) Is chlamydia still an almost zero chance possibility in this instance? I assume pharyngeal chlamydia would be rare and I would also assume that the bacteria load would be so low in the mouth that infection would not be likely. 2) I know Gonorrhea is a possibility, but wouldn’t 95+% of men be symptomatic (3 to 5 days after exposure) and certainly by 31 days? Wouldn’t the fact that her regular boyfriend not having symptoms be even more proof of her not having an infection since I know he has unprotected vaginal and oral sex with her on a regular basis? I have talked with them since the encounter and they assured me that they are very careful and that his girlfriend is scared to death of catching something and because of that they screen well and both test regularly. I am embarrassed and worried that I foolishly have put my wife in danger since we have had sex twice since the encounter 31 days ago. Do any of my symptoms and timing sound like an std? Should I test or put this error behind me?

Edward W. Hook M.D.

32 months ago

Welcome to the Forum. I'll be glad to comment. You are correct that among unprotested sexual encounters, receipt of oral sex is amongst the lowest risk, that oral chlamydial infections are very rare, and that most gonorrhea would be symptomatic within 31 days of exposure. Urinary frequency and urgency are far, far more likely to be due to anxiety than an STI. Finally, on a statistical basis, STIs are rather rare in women in their late 30s. The encounter your describe was not no risk, but very very low risk. In addition, bladder spams are not a sign of gonorrhea in women. Thus, in response to your specific questions:

1) Is chlamydia still an almost zero chance possibility in this instance? I assume pharyngeal chlamydia would be rare and I would also assume that the bacteria load would be so low in the mouth that infection would not be likely.

As explained above, receipt of chlamydia from oral sex is very, very rare and unlikely in your situations.

2) I know Gonorrhea is a possibility, but wouldn’t 95+% of men be symptomatic (3 to 5 days after exposure) and certainly by 31 days? Wouldn’t the fact that her regular boyfriend not having symptoms be even more proof of her not having an infection since I know he has unprotected vaginal and oral sex with her on a regular basis?

Correct on all counts.

Bottom line, the chance that you acquired an STI from the exposure you describe is very, very low and not something that I would worry about. If you want to be 100% confident you were not infected, you can seek testing but, personally, I would not be worried and would not feel the need to test. EWH

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32 months ago

Thanks Dr. Hook. I may get tested just to ease my mind. My wife and I have had sex twice since my exposure. The last time was about 14 days prior to her symptoms. I’m not sure if it matters as far as infection goes, but she has had a hysterectomy. Also, she has been having a prickly feeling at the end of urination, but that feeling is similar to every time she has a stone in her bladder and it usually stays like that until she can pass it. She has not had any discharge or blood visible or pelvic pain. Also, I did use some uti test strips to see if I had WBCs or nitrates in my urine with a first catch morning urination for the past three days and all of those are negative. Just trying to see if a uti or anything was causing my symptoms. Do those results further solidify the fact that I don’t have infection (gonorrhea or ngu)?

32 months ago

Also, 33 days have passed and the only symptom I have is the constant feeling that I need to urinate. Fullness in my bladder. No pain upon urination and no discharge at all. I have tried to squeeze and and express any and there is nothing. When I’m at work and sitting I notice maybe a tingle or tickle in my penis, but when I’m busy I don’t notice anything. When I sleep, I don’t have to wake up and use the bathroom which makes me think it really is more mental anxiety and that I’m focused on my genitalia area. My last question is, of any STIs that could have been caught during the exposure, do any of my symptoms that came about 22 days after exposure seem like an sti?

Edward W. Hook M.D.

32 months ago

The additional information you have provided further reduces the likelihood that you acquired an STI from the low risk encounter you described. The absence of white blood cells in urine suggests no STI is present. Further, the sensations you describe are more consistent with the detection of normal sensations in a state of anxiety-related hyper-vigilance than with an STI.

I really would not be worried if I were you.

You have one follow-up remaining. EWH

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32 months ago

Thanks Dr. My symptoms have pretty much went away since last night.

Edward W. Hook M.D.

32 months ago

Great. No change in my assessment or advice. If I were you I would move forward without continuing concern. EWH---