STDs Expert Forum
Clear up some confusion?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Clear up some confusion?

I think I know the answer to this but want to verify.  In going to other sites about STD risks there is almost universal agreement that there is risk for almost every kind of STDs from oral sex including HIV and HPV etc.  Reading thorough you responses it appears that Oral Sex is pretty much safe sex and that penetration is the key activity that leads to an STD.  

I suspect that you are giving factual information related to material risk or realistic risks.  I suspect that the other sites are showing an abundance of caution in listing a sex activity (oral sex) as a risk if there is ANY risk even if the risk is infinitesimal.  If that is the case, such information not useful and in fact may be harmful.

Some of these other sites give the impression that oral sex is a very serious risk for most all kinds of STDs.  

To me it is not helpful to say there is "a risk", there is a risk to everything.  What is important to me is whether the risk is material.  My sense from your responses to question is that there is some risk of some STD from oral sex, but that that risk is tiny or in the case of herpes or syphilis indicated by an obvious lesion around the mouth (and there is no known risk for HIV).

Is my interpretation reasonable?

Thank you for your work in this area.
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Welcome back to the STD forum.  I'm happy to try to help.  The quick answer is that you and I (and undoubtedly Dr. Hook) are in perfect agreement.

You certainly are correct in your observation about conflicting advice between various websites and other information sources, and in your analysis of at least one of the reasons.  Also, there are other issues that reinforce "an abundance of caution".  In some cases, the facts aren't clear -- and when in doubt, most official sites (CDC, health departments, etc) tend to err conservatively.  Sometimes, though, it is simply naivete.  For example, chlamydia and gonorrhea are so similar in so many ways (types of symptoms, modes of transmission, kinds of complications) that there is a tendency to believe they are similar in ALL ways.  In my opinion, this is why even many apparent expert believe chlamydia is commonly transmitted by oral sex, like gonorrhea.  But chlamydia doesn't "like" the throat, so even exposed people rarely get oral chlamydia -- and thus there is rarely an oral infection to be transmitted back to someone's genitals.  

Finally, another factor is one of degree.  On this forum, we try to put risks in context, whereas official sites tend to take black and white stances:  there is risk or there is none, nothing in between.  This most likely explains why you'll find insightful advisors (like us!) talking about degrees of risk, rather than making dogmatic statements like "oral sex is high risk for herpes"; or that because HPV can sometimes be found in the mouth or under the fingernails, it must be easily transmitted by oral sex or hand-genital contact.  While all these things may in fact happen (rarely), the fact is that single exposures of these types carry very little transmission risk.

Your paragraph "To me it is not helpful..." not only is reasonable, it is nearly perfect.  In fact, I might start using it in future responses to other questions.

Thanks for the opportunity to clarify these important points.  Best wishes--

HHH, MD
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Thanks for your response.   COuld you clear up one more thing for me.  You say:

"this is why even many apparent expert believe chlamydia is commonly transmitted by oral sex, like gonorrhea".

Is gonorrhea commonly transmitted by oral sex?
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239123_tn?1267651214
Yes. Gonorrhea of the throat is less common than genital or rectal infection, but not rare; and sometimes oral gonorrhea is transmitted to partners' genitals (especially to the penis by fellatio -- less so by cunnilingus).  But these days gonorrhea is a pretty uncommon STD outside selected high risk populations.  Your risk for it undoubtedly is low.
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A related discussion, 5 years later was started.
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A related discussion, Pregnant? STD? was started.
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