Cunnilingus - Watersports and the Risk of STD

[JGAW]

I am married male, but I sometimes frequent prostitutes and massage parlors.  I never have intercourse – not even with a condom.  I do sometime receive oral sex, but insist on condoms.  If I put my finger in a prostitutes vagina I put a condom over my finger.  I get tested once every 6 months for HIV and STD. I am generally quite cautious as I do not want to bring anything home.  However I recently performed unprotected cunnilingus on a prostitute.  She had several intense orgasms and squirted (urinated) in my mouth.  Frankly I would like to try this again, but worry I could pick up an STD.  I have seen a lot of conflicting info on the web on how safe cunnilingus and urine in the mouth can be.  Many sites say this carries little risk of HIV, but definitely is at risk for other STDs.  I see from your site that Herpes is a possibility from cunnilingus (I already have herpes II), but realistically can I get other STDs from these activities?  I know it may be theoretically possible – but how likely is it?

[H. Hunter Handsfield, M.D.]

I am not aware of any research, or even informal reports, about STD risk from oral exposure to urine ("watersports").  Whatever risk there is probably is very small, for all STDs and probably zero for HIV.  The greater risk is for enteric infections, like salmonella or other gastrointestinal infections, if your commercial partner happens to be infected.

As for cunnilingus itself, the only available data are for gonorrhea, and those results showed that in people attending STD clinics and tested for gonorrhea of all potentially exposed sites, gonorrhea of the throat is very rare in heterosexual men, with no difference in those who have and have not performed cunnilingus recently.  Chlamydia is uncommon in the mouth and throat and probably rarely if ever acquired by cunnilingus; if anything, probably even lower risk than gonorrhea.  To my knowledge, nobody with HIV has ever reported performance of cunnilingus as their only potential route of exposure.  Logically, oral herpes and HPV are possible, but no data are available.  But since you already are infected with HSV-2, you're immune to catching it again, so that's really not an issue.  Hepatitis is not a realistic concern.  Syphilis clearly is possible, but is too rare in most settings (in the US) to be a significant considerration.

All in all, therefore, your risk is probably zero for HIV and very low for other STDs.

Good luck--  HHH, MD