Unprotected Oral - Male Performed On Female

[whathappened]

I had protected sex and performed unprotected oral on July 30th, the next day I had loss of appetite for 5 days and two days later a sore throat developed.  I chaulked it up to anxiety as this is the first encounter outside of my marriage.  I had an STD screen done 8/3 with blood test, urine and throat swab and all were negative.  The sore throat went away after 5 days.  Starting the 14th day after the event throat felt more swollen than sore and continues, also have whitish chancre upper inside lip that appeared 8/14.  I have HSV that has been dormant for years.  Also I have talked to the gal involved and she claims no issues and is regularly tested every 3 months for invitro fertilization procedure but she did not name the tests that are done.  She does have a friends with benefits regular partner and admits not always using protection. I wonder if the 5 day STD test is conclusive and if not when should I get tested again.  Please advise.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

Cunnilingus -- oral exposure to female genital area -- is low risk for all STDs.  Indeed, in 4 decades in the STD business, to my knowledge I have never seen a patient with either an oral or genital infection acquired by cunnilingus.  That said, the latest research (done, in fact, by Dr. Hook and his colleagues) has shown a potential risk of oral gonorrhea.  However, the gonorrhea throat swab is a good test, and 5 days is valid.  Further, most oral gonorrhea causes no symptoms; sore throat can occur, but rarely.  On top of all this, it is very unlikely your partner had an STD; IVF candidates generally are tested very carefully for all STDs.

So most likely your sore throat was just a coincidence, not related at all to the cunnilingus event.  You can be very confident you caught no STD, and no further testing is needed.  If you have a regular sex partner, you can safely continue unprotected sex with no risk to her (or his) health.

I hope this helps.  Best regards--  HHH, MD

[whathappened]

Thank you very much for your reply, I respect your advice very much following a scare with a stripper in 2006 and relied on your advice that kept me sane.  After many years of marriage I have become naive about risks and was surprised that HPV is so common and can be transmitted by touching.  If I acquired HPV can i transmit it to my kids by simply holding hands or is it in the context of sexual touching?  I've read quite a bit and I cant find a distinction of what is meant by touching.  Does it cause sore throat, etc?  Is testing and treatmement available or does it go away on its own?  I read that many strains are out there but I'm wondering if this could be related to my symptoms and lastly does the chancre that I mentioned cause any concerns?  Thanks again and I will not be posting any further comments or questions.  

[H. Hunter Handsfield, M.D.]

HPV is transmitted by sexual intercourse, and probably rarely if ever only by "touching".  Almost everybody gets sexually transmitted HPV; it is a normal part of having sex.  However, the large majority of HPV infections cause no symptoms, and the virus never causes itching etc.  HPV is not a concern for the type of sexual exposure you describe.  Don't worry about it.

[whathappened]

Since the last post I've talked to the gal involved and learned more about her friends with benefits relationship and found that it is very casual, non-conversational and just sex over the past few years, she doesn't really know if this FWB is sleeping with others combined with the fact they dont always use protection has escalated my concern.

When I visited Dr originally for the tests he felt my neck and noticed swollen areas.  The sore throat dissipated and then returned a few days later.  I still have the sore throat and noticed that breathing is a bit labored at rest although fine when I exercise, walked 5 miles recently.  

I realize my Cunnilingus event (forgot to mention previously genitals touched briefly but no penetration prior to condom) is low risk but this lingering sore throat and whitish sore (more of a patch texture now) inside top lip that is healing has me on edge.  As discussed before my STD tests were done at 5 days post exposure and all negative.  Based on the additional information should I retest?  If so should I retest now at 22 days or should I wait for 30 days.  Also not sure what tests were on the STD panel but three vials of blood were taken, urine and throat swab at regular Dr.  If you recommend testing again should I seek out an STD clinic and which tests should I focus on?  Can oral gonnorhea be detected by a blood test or only via throat swab?

Thank you in advance for your patience, I really appreciate your help.

[H. Hunter Handsfield, M.D.]

This information does not change my opinion or advice.  I see no need for additional testing.  No STD causes the sorts of symptoms you describe.  My advice is to move on and stop worrying about this.

[whathappened]

I visited the STD clinic today to have snother throat swab done.  It was much more thorough then the Dr office that I visited previously who barely made contact.  I brought up that I had been online to seek your advice and the gal mentioned she was just with you in a meeting moments before, it would have been great to meet you!  By the way she concurred with your assessment but noticed throat red and irritated... neg strep test, if oral gonnorhea neg should I test for Mono?

[H. Hunter Handsfield, M.D.]

You must have visited the Seattle public health STD clinic at Harborview Medical Center, which I directed for 25 years.  Not surprisingly, I am confident you can rely on the advice you received there.

The very large majority of "red and irritated" throats are due to garden variety cold viruses, allergies, or just have no clear explanation.  But such problems are amost never due to STDs.  Few STDs cause sore throat and then only rarely.  I do not recommend testing for mono.  My advice remains the same as 2 days ago:  "move on and stop worrying about this".

[whathappened]

Yes thsts right, they were fantastic there.

I still have a sore throat 30 days past exposure.  They tested for strep and I've read that oral gonorrhea looks similar.  I'm becoming very worried about the length of time thaf has transpired and my hand joints are stiff.  I read about how it can get into the blood in up to 3% of people.  Could the joint pain in my hands be due to this?  My swab results wont be ready until Tue..  Please advise if the continuing sore throat and joint stiffness is a concern.  If so please advise on what medication to treat with and Ill visit the local clinic tomorrow.

[H. Hunter Handsfield, M.D.]

I doubt your symptoms have anything to do with the sexual exposure.  Oral gonorrhea is usually entirely asymptomatic -- no sore throat, no symptoms at all.  Disseminated gonorrea (bloodstream spread) is nowhere nearly as common as 3% of gonorrhea, and in any case does not cause "stiff joints" without fever, overt arthritis, etc.  Your throat culture for gonorrhea almost will be negative and no treatment will be necessary.  In the off chance the test is positive, the clinic will know what treatment to prescribe.

[whathappened]

Have you seen cases of sore throats that seem to be connected to a sexual event but do not test positive for STD's?  If negative should I see an Infectious Disease Specialist?  Anything specific that you would suggest testing for?

Is throat gonorrhea more likely than reg gonorrhea to turn into a blood infection?

I have total confidence in the STD clinic but I won't have results until Tuesday.  Due to my hunch and the unusual joint stiffness I was wondering what medications are recommended because I was thinking of visiting my Dr's office today to get started on antibiotics just in case.  

Thanks again and I will refrain from posting any further messages.

[H. Hunter Handsfield, M.D.]

Let's stop with the repeated anxiety driven comments.  There is no realistic chance you have any STD from the events described. and your symptoms sound totally psychological.  I also recommend you stop searching the internet about symptoms, treatment, etc.  Hyper-anxious persons have difficulty interpreting what they read and tend to be drawn to out-of-context information that inflames their fears.

Feel free to return one more time to report the results of your tests and any advice or treatment the clinic recommends.  Other than that, this thread is closed.

[whathappened]

Sorry posted before i saw your reply