Oral Sex & Possible Transmission

Hi Doc's,

You both are doing a great job here.

I'm a married man who had a one night stand last week. While intercourse was fully protected with a condom we did engage in significant oral (both giving and receiving) for some time. Exactly 3 days after the exposure I had a urine and oral swab test with my doctor and tested for Chlamydia, Gonorrhea and NGU. These tests came back negative. I did have a sore throat 5 days after which lasted 2 days and there is very mild burning during urination with no unusual discharge.

My questions are whether or not testing orally and with urine 3 days post potential exposure is enough time for these to show up and whether the negative result can be relied upon. I know the risk of transmission from this type of activity is low but I really want to know if I can rely on the results.

Thanks for your time. I know you both are really busy.

Stov

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'll try to help.

If you have spent substantial time on this forum, probably you already know the risk of STD from oral sex is low.

Some interesting older research found that among people attending STD clinics, sore throat was more frequent in people who had performed fellatio or cunnilingus recently.  But no STDs were indentified as the cause and the symptoms tended to clear up quickly on their own.  As for tingling during urination, that's usually not an STD symptom.  A good bet is that anxiety about your sexual exposure is making you notice normal sensations more prominently than otherwise.

The tests for gonorrhea definitely are valid 3 days after exposure.  It might take longer for chlamydia testing to be valid (e.g., 5-7 days after exposure).  But there was no risk to speak of for chlamydia, which rarely infects the throat and therefore is rarely transmitted by oral sex, in either direction.  So that test result isn't an issue one way or the other.  Finally, there is no validated test for asymptomatic NGU.  If you don't develop abnormal urethral discharge in the next couple weeks, you will know you didn't catch it.

Thanks for the thanks about the forum.  Best wishes--  HHH, MD

[The_Stover]

Hi Doc,

As an update, on the 9th day post exposure I had my doctor prescribe Zithromax just to be sure. I took 2x500mg once only. I have not had any type of sexual intercourse since this exposure. Since taking this yesterday, I have experienced very frequent short urination and have had fairly significant amount of clear discharge and a dull but persistent tingling at the tip on my penis. My foreskin is also unusually constrictive.
With a negative test for gonorrhea/chlamydia at 3 days and a very low risk of chlamydia due to it not generally occurring in the throat and the zithromax I am at a loss as to the source of these symptoms

My questions are:
1. Wouldn't this zithromax dose have taken care of any bacteria present since exposure? I assume that after exposure that the bacteria is present and any treatment clears this up.
2. Does zithromax increase urination and clear discharge?
3. Can I reliably put this whole episode behind me taking into account all of the above?

Any thoughts or insights? I assume further testing is no required.

[H. Hunter Handsfield, M.D.]

Taking azithromycin is not something I would have recommended.

1) "Take care of 'any bacteria present'?"  That's a tall order. Azithromycin is active against some but not all bacteria.  It would be effective against most potentially sexually transtmitted ones. In any case, it shouldn't do you any harm.  2) Azithromycin does not cause such symptoms.  3) You should have put this episode behind you after my original reply. You certainly can do so now.  You have no STD from this episode and never did.  No additional testing is necessary.

That's all for this thread.