[Question #9534] giving oral sex, stis
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31 months ago
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Hi, thank you guys for taking the time to read my question; I
had a recent exposure concerning providing oral sex and wanted to ask a few questions,
if you please don’t mind addressing each of the questions individually in your
responses:
1. I gave oral sex (no condom) 3 times (same
individual, same occurrence); the first time he ejaculated completely outside of
my mouth and the other 2 times I spit out the remainder of what he didn’t pull
out. I do not recall having any cuts on my mouth and he appeared visually clear
as well (mainly concerned about HIV here).
2.
I did NOT allow him to perform oral sex on me (kept
underwear on the entire time); however, he was kissing and licking on my body (near/surrounding
genital area/butt) and I recall him having a random nosebleed. Although I did
not see much visible blood on his face, possibly a small amount, I do not know
if his blood could have gotten into contact with broken skin or the genital
area (mainly concerned about HIV here).
3.
My final concern is regarding HSV1 specifically…
I did not let him perform oral on me, but his mouth/tongue briefly came into direct
contact with my genital area (for about a second) before I was able to move/stop
it.
The only sexual history I know is that he is a straight male
with a high body count who claims to be tested regularly. Solely based on this
exposure, how likely is it that you think I could have acquired HIV, HSV, or
any other STI and/or would you recommend any sort of testing? I have pretty bad
OCD so defining percentages & little vs. no risk would be really helpful to
me. Thanks again, been losing sleep.
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H. Hunter Handsfield, MD
31 months ago
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Welcome back to the forum. I'm glad to have the opportunity to reassure you: all these exposures and STD risks were very low. Not only were the exposures themsslves little or no risk, but your closing comments describe a partner not likely to have active STIs and the time of the exposures described.
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1. Oral sex in general is low risk: all STIs are transmitted infrequently and inefficiently, and some not at all. It has been estimated (by CDC) that performing oral sex on an HIV infected male carries roughly one chance in 10,000 of catching the virus. That's equivalent to giving BJs to infected men once daily for 27 years before being infected is likely. Details like ejacluation in the mouth or not, or of cuts in the mouth, probably make little difference. So even if your partner has HIV, you can be quite confident you didn't catch it. However, there was greater risk for other STIs: gonorrhea is the greatest risk; syphilis is possible; and oral herpes if your partner had genital HSV2. Absence of symptoms is good evidence against infection.
2. With your penis not entering your partner's mouth, there was no risk at all of any STD. Kissing and licking do not transmit STDs. There is no possibility of HIV. (Even with actual oral sex, the risk of HIV is estimated by CDC at one chance in 20,000, if your partner had HIV at the time -- which probably he did not.
3. Again, without direct penile contact with your partner's mouth, there is no significant possibility you acquried HSV1.
In terms of numerical risk estimation, I would say the chance of HIV from these events was under one chance in a million; and of oral gonorrhea maybe one in several thousand. Honestly, I do not recommend you be tested for anything. However, if you would like to be tested for reassurance, you could consider seeking care for a throat swab for gonorrhea, and syphilis and HIV blood tests in a few weeks. Or contact your partner and suggest you both be tested: if he is free of urethral gonorrhea and has negative blood tests for syphilis and HIV, you'll know you were not at risk.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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31 months ago
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Hi Dr. Handsfield, thank you so much for your quick reply. I just wanted to clarify 2 things in case it changes anything 1.) I am a female and my "partner" was a male. I think in the second question you said "my penis" lol, so I wanted to make sure if knowing we were a heterosexual couple changes anything. Also, thank you for your thoughts regarding me getting tested (and the likelihoods), my final question is what are your thoughts of the risk level of acquiring HSV1/2 orally (Question 1) or gonorrhea or syphilis? If I do not develop any symptoms do you recommend getting tested in the throat for those to be safe (alongside HIV I guess?) ? I've had a drier throat and raspier voice than usual, but no other symptoms at all that I am aware of. Sorry if some of this is redundant, I just have to make sure I understand everything clearly.
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H. Hunter Handsfield, MD
31 months ago
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Thanks for the correction -- I thought you and your partner both were male. Apolgies!
Cunnilingus is even lower risk for STI transmission than fellatio. Last I heard, there had never been a reported, confirmed case of HIV transmitted to either the oral or vaginal partner; and transmission of other STIs is rare as well.
Even in longstanding couples in which only one partner has genital HSV2, if no special precautions are taken against herpes transmission except avoiding sex during obvious outbreaks, the risk appears to be about once for every 1,000 episoes of unprotected vaginal sex. HSV1 transmission either from oral or genital infection appears to be even lower -- again, assuming no contact during an obvious outbreak. When you also factor in that you don't know your partner has either genital or oral herpes, I would put the risk at well under one chance in many thousand. Syphilis is even rarer: despite the dramatic rise in syphilis frequency the last few years, most cases continue in men having sex with men and it is very ulikely your partner has it -- and the absence of penetrating sex makes transmission exceedingly unlikely.
As noted above, gonorrhea is the main STI to be concerned about from performing oral on a male partner. Almost all cases are entirely without symptoms; your scratchy throat more likely is just a minor virus or other natural variation in voice etc with humidity, temperature, etc. However, if you decide to have HIV or other STI testing, I would include a throat swab for gonorrhea. (The test will include chlamydia automatically because of routine lab procedures, but chlamydia is exceedingly rare from oral sex; and when present rapidly clears up on its own.)
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31 months ago
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Thanks for clarifying. Since I know this is my last response I just want to sum up everything quickly:
1. In my case I was the female and he was the male (and I was the one performing oral sex not receiving). As a female performing oral sex on a male should I be worried of acquiring HSV2 or HSV1 in the mouth (I have read getting HSV2 orally is rare and/or I would have a noticeable outbreak if I did contract it)? Also, would you recommend any testing for anything, HIV, syphilis , etc? I know you mentioned gonorrhea being the highest risk.
2. My other (original) two questions regarding the brief lick/contact and the nosebleed are still considered to be no risk (me being female is irrelevant in this case I assume)?
And finally, do you think the risk of gonorrhea is worth getting tested for or is it low enough that you would not advise testing?
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H. Hunter Handsfield, MD
31 months ago
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1. As in my last reply, the chance of oral herpes from this one event is under one in many thousands; and yes, most new infections cause obvious symptoms you would not miss. Do not get tested in absence of symptoms: the HSV blood tests are not sufficiently accurate. Absence of an open sore in the next 2-3 weeks also is strong reassurance against syphilis. We generally recommend any STI testing after such an exposure, but you are free to be tested if the negative results will increase your reassurance. If you do so, I would suggest a throat swab for gonorrhea (any time would be valid), and blood tests for syphilis and HIV after 6 weeks. That's all.
2. No risk at all.
3. See above about gonorrhea testing.
As per my original reply, another strategy -- probalby the smartest -- is to contact your partner and suggest that you both be tested for common STIs (gonorrhea/chlamydia at exposed anatomic sites, plus syphilis and HIV blood tests). If both of you are negative, you'll both know you could not have been infected. Maybe you would find he is just as concerned about your sexual safety and his risks as you are about him.
That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. An important bottom line: don't let your OCD get the best of you. Do not keep thiniing about these events, and do not over interpret the negligible risks. And probalby best to lay off the internet, which often is more likely to mislead than to help obsessed or anxious users.
Best wishes and stay safe.
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