Thank you for this excellent service. 

I'd like to ask your evaluation of my risk for having contracted a STI. The quest is similar to others' for which I apologize, just looking for an estimate in my case. 

I'm a 43 year old man in an established relationship with a woman for 8 years. I have occasionally had sex with fairly high end female escorts (I have asked a question here previously), most recently last Monday. I had vaginal sex twice and she performed unprotected oral sex on me once. I should note the oral sex was very deep and am wondering if this increases risk of transmission. 

I subsequently had sex with my normal partner on Saturday, so 5 days later. On Sunday she complained of having developed a UTI, and I am concerned I picked something up last week. She has previously had recurrent UTIs which have sometimes required antibiotics to clear up. I don't have any discharge or pain on urination, though as I worrying about this I'm wondering if I maybe have some slight pain at the meatus. Nothing significant though. 

What is the risk I've picked up a STI (I guess gonorrhea) and passed it to my partner? Would she have become symptomatic immediately like that? What is your recommended course of action?

Thank you

You mention that the oral sex exposure was unprotected, but what about the vaginal exposure? Oral sex in general is low risk for all STDs and generally viewed (by STI experts) as safe sex. Oral to genital exposure isn't completely free of risk, but the frequency of all STDs after receiving BJs is far lower than from vaginal or anal sex and zero risk for some. (There has never been a proved case of HIV transmission oral to penis.) If the vaginal sex was not condom protected, that was higher risk than the oral exposure was.

In general, escorts -- i.e. costly female sex workers by appointment, as opposed to bar pick-ups, brothel workers, etc -- are believed to have low frequencies of STIs. They usually require condom use (did yours?) and otherwise take care to protect their health with frequent testing and generally low risk clients (men like you).

Absence of abnormal discharge from your penis within 5 days of exposure is strong evidence you did not acquire gonorrhea, which almost always causes both dripping pus and painful urination within 3-5 days. So the possibility of you infecting your regular partner with gonorrhea is very low. However, chlamydia often causes no symptoms, and in women it can cause symptoms similar to UTI. However, in women UTIs themselves are often triggered by sex itself, which can massage vaginal area bacteria into the female urethra. Did your partner see a provider and get diagnosed with UTI? Or just suspicious and treated herself?

At this point, I would recommend you be evaluated for common STIs. Ideally this means in-person evaluation by a provider familiar with STI diagnosis and management, to include evaluation for urethritis (examination for discharge and urethral white blood cells) plus urethral swab or urine testing for chlamydia and gonorrhea. It also would be ideal for your partner to be tested for gonorrhea and chlamydia. However, if  her UTI symptoms clear up with UTI treatment, this can safely be deferred while you wait for your own exam and test results.

Let me know if  vaginal sex with the escort was condom protected. In the meantime, I hope these comments are helpful.

HHH, MD

Apologies for the omission. With the escort the vaginal sex was protected (condom) and oral was unprotected. With my regular partner sex was unprotected. 

My partner did not see a healthcare provider for UTI diagnosis, just on the basis of her experience. 

My understanding was that chlamydia is rarely transmitted to men through fellatio, is that no longer thought to be the case?

There is little or no chance you acquired a chlamydial infection. The condom was highly protective for vaginal sex, and your own prior knowledge is exactly right:  chlamydia rarely infects the oral cavity and, when present, in very small amounts, cleared rapidly by the immune system, and rarely if ever transmissible. There have been very few if any proved cases of urethral infection acquired by oral sex.

Also, the speed of onset of her symptoms is against chlamydia. Gonorrhea can cause symptoms within a couple of days, but for chlamydia it's typically 1-2 weeks, if there are symptoms at all. So your parter very probably had a UTI, i.e. her self diagnosis probably was correct.

So this modified my advice above:  I do not see any need for you to be tested. Although gonorrhea is possible from the unprotected fellatio, if you had gonorrhea it would have caused obvious symptoms by now.