Received Oral Sex

[Youngandconcerned82]

Dr.

I recently received Oral Sex from a man, I am gay, about a week ago.  About three or four days ago I began to feel bruning during urination, I have not noticed a discharge as of yet.  Is a discharge with an STD very noticable?  IE would it be easy to see from my underware?  

The only possible other risk exposure is that I received and performed oral sex on a man six weeks ago, he did not ejaculate in my mouth and I did not from his.  If began to feel symptoms only with the last week could that be a possible exposure as well?

I guess I've also become nervous about other STDs, such as HIV, am I at risk from this event as well?  I've heard in the past that receiving one STD puts you at risk for others....

[Edward W Hook, MD]

There's low and then there is exceedingly low.  NGU does occur with oral sex, although rarely (i.e. it is low).  That does not make you a freak of nature, just unlucky.

As for HIV, neither Dr. Handsfield nor I have ever seen anyone (or heard of one for that matter) who clearly got HIV from oral sex, not matter if they had sores in their mouth, gum disease, etc.  So with regard to HIV when we say very low, we mean approaching zero.  EWH

[Youngandconcerned82]

Dr.

Just a quick question/comment, I see many of your reponses and Dr. Handfield's responses saying that getting an STD from receving oral sex is exceedingly low, however it happened to me....am I a freak of nature or does it reallyhappen more often?  You say the same about performing HIV, very low...I can't happen but wonder now how "low" low is....

[Edward W Hook, MD]

Probably mouth bacteria but you acquired those  mouth bacterial sexually!  EWH

[Youngandconcerned82]

Thanks Doctor, your comments really hellped.

Just one clarification, is NGU in my partners throat sexually aquired or is it just mouth bacteria?

[Edward W Hook, MD]

1.  You would not see chlamydia on a urine test (might be worth mentioning to your doctor however that urine can be tested for chlamydia)
2. Chlamydia is not transmitted by oral sex so that is not an issue but nongonococcal urethritis is.  the azithromycin you received would cure this.
3. Probably best to notify both partners.  The symptoms of NGU can take quite a while to become apparent.  Better to over treat than undertreat.
4.  I agree- virtually no risk of HIV

The dose of azithromycin is the recommended dose

The absence of lymph nodes in your groin doesn't help one way or another.

Its unlikely that you had gonorrhea but 2.0 grams (8 pills) will not hurt you

EWH

[Youngandconcerned82]

One more comment-

I read that gonnorea is cured by 2g of azithromycin, so I went ahead and took all 8 pills at 250mg each.

Last comment I promise :-D

[Youngandconcerned82]

Two more quick points:

I took 4 tablets that were 250mg each, will this be sufficent.
He examined my groin for swollen lymph nodes, he did not find any....does this also suggest against a possible infection bacterial infection at all or HIV?

Thanks Dr.

[Youngandconcerned82]

Hi Dr.
Went to the doctor today and provided a urine sample, the doctor looked at it and noticed no bacteria in it so said it was not a Urinary Tract Infection.He said it may be chlymdia due to the fact that I was experiencing the clear discharge however he said he did not want to perform the painful test of the urtheral swab and since I had urinated for the previous test it wouldn't now be useful, but assumed it was based on my symptoms.  He prescribed 4 tablets of Azithromycin to be taken once by mouth, and said that should clear up the symptoms. Just a couple of quick questions:

1) If he did not see bacteria in my urine why did he perscribe the antibiotic?  
2) I thought Chlymdia was only transferred during unprotected anal or vaginal sex, I have had neither in almost a year. Could it be something else, and if so will this antibiotic take care of it?
3) I've had two partners that this possibly be related to, one about six weeks ago, and one about 10 days ago. The first partner I performed oral sex on and received ,the second only received, should I also notify the first partner of this infection?
4) I asked him about HIV, he said given my risks the chance of that is so remote it is not worth testing for at this time, is he correct on this?

[Edward W Hook, MD]

sorry, I was writing too fast.  My concern is that you may have acquired an STD from receiving oral sex.  The fact that you now note a discharge strengthens the possibility and warrants your going to a health care provider and getting it checked out. EWH

[Youngandconcerned82]

I just noticed I a small amoutn of clear fluid coming from my penis, didn't realize that you could get infected so easily from receiving oral sex

[Youngandconcerned82]

The anal sex was protected and I was tested for HIV about 7 months ago....

[Youngandconcerned82]

Dr. I was a bit confused by your first statement

"There is less risk to you from performing oral sex than from receiving it.  The chance that the penile symptoms you have noted are from receiving oral sex are zero.  The symptoms that you describe, burning on urination, even without a discharge, could be an STD.  "

Specifically the chance that the symptoms I have noted are from receiving Oral Sex is zero?  Honestly I have not had anal sex with a man in almost a year, have had no symptoms since then until recently....so is this not an STD?

[Edward W Hook, MD]

There is less risk to you from performing oral sex than from receiving it.  The chance that the penile symptoms you have noted are from receiving oral sex are zero.  The symptoms that you describe, burning on urination, even without a discharge, could be an STD.  The two most common STDs which would result fro such an exposure are gonorrhea and a syndrome called NGU.  Both are easily diagnosed by seeing a health care provider at least two hours after your last voiding and having them test you for gonorrhea (they usually test people for chlamydia in such situations but getting it from oral sex is VERY rare so I did not mention it) and for nongonococcal urethritis (NGU) which is indicated by the presence of white blood cells in your penile secretions.  Each of these infections can occur without a penile discharge but it is more common for NGU.  If either is present, treatment is easy.  You can be checked for these at either your own health care provider or at a local health department STD clinic.

STDs do increase your risk for HIV- this is true however, your risk of STD from the exposures you describe is rather low.  That said, we do recommend that everyone who has multiple sex partners or new partners be checked for STDs once a year as a precautionary measure.  It would be reasonable for you to be checked in this way at the present time.  If the evaluation is negative, you can be comfortable that your symptoms are not due to an STD.

Hope this helps.  EWH