Risk from unprotected oral encounter

[UKGran_Guy]

Dear Doctors. Firstly, many thanks for contributing to what is a great website providing really informative and pragmatic advice and guidance.

I am posting following a regrettable and spur-of-the-moment incident with a female UK CSW back in early June last year (10 months ago) when I received unprotected oral sex that lasted 5-10 minutes. I read a wide number of comments that you have both posted on the website following the incident and after a few months felt confident that I was okay (i.e. no abnormal symptoms). However, I recently became aware that whilst uncommon some STD’s that can be transmitted by oral sex are asymptomatic. My understanding is as follows, but please correct me if I am wrong:

1) Oral sex is low risk with no (effective) practical risk of either HIV or chlamydia – principal STD’s that can practically be transmitted are herpes, gonorrhoea, syphilis and NGU but these are low.

2) Typical symptoms of these manifest themselves in the order of several days (i.e. gonorrhoea) through to several weeks to a couple of months for syphilis. However, gonorrhoea in men will ‘cure itself’ over the course of several months.

My concern is that 10 months after the incident and with no abnormal symptoms (i.e. pain whilst urinating, penile discharge or cancurs), there still may be a practical possibility that I could be carrying an asymptomatic STD. I am married and deeply regret what has happened – we have not had sex for about 18 months because my wife has been suffering from ongoing chronic back pain, but I want to feel confident that when we resume sex I won’t be putting her at risk. Is there any knowledge of how long STD’s such as NGU and syphilis can remain asymptomatic? Would you recommend me getting tested?

Many thanks for your time.

[Edward W Hook, MD]

Glad to hear it. Thanks for the follow-up. Take care. EWH

[UKGran_Guy]

Dear Dr Hook. Just a quick follow-up. My results came back negative - time to learn from the past and look forward now. Thank you ever so much for your help and advice. Best wishes

[Edward W Hook, MD]

I'm pleased I was helpful.  Feel free to post your results when available.  Take care.  EWH

[UKGran_Guy]

Dear Dr Hook. Many thanks for your helpful and pragmatic comments which I very-much value and appreciate. I think you have hit the nail-on-the-head regarding guilt. I have taken your advice and just been tested. If you don't mind I'll let you know my results when I get them back. Many thanks again.

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help. Thanks as well for taking the time to look at other posts on the site.  There are several issues at play here.  In your summary your forgot to mention (although I am confident that you realize this) that most sexual encounters with new or casual sex partners do not lead to infection, even if the new or casual partner does happen to be infected which, in and of itself, is also rare.  You are also correct that while most STIs are symptomatic, a small proportion in men tend to be asymptomatic and these asymptomatic infections can persist for months or perhaps even years.  A proportion of infections will clear without treatment.  

Putting all of these facts together, I hope you will agree that statistically the likelihood that you were infected through the encounter 10 months ago is quite low.  Conversely, there is a very small chance that you could have been infected.  From your post, it appears that, perhaps in part related to guilt over your extramarital encounter, the concern that you might be infected is continuing to trouble you.  For that reason, my advice is to go get tested so that you can put your lingering concerns behind you.  Testing for gonorrhea, chlamydia, NGU, syphilis and HIV can be easily performed.  When you are tested, the other important thing is to believe the test results.  I am confident that your tests will be negative and I recommend testing primarily to eliminate your concerns, not because I think it is likely you are infected.

I hope my comments and perspective are helpful.  EWH