STDs from fellatio

[Bradman2234]

Dr.
About 9 days ago i visited a masseuse, along with the massage she also performed unprotected fellatio on me for several minutes before finishing me with a handjob.  I have been worried sick ever since about any STDs that I may have contracted from the unprotected fellatio.  I think i have been feeling a tingling in the tip of my penis and it also is a little red on one side of the urethra opening.  I have not noticed any large amounts of discharge, there may be a little after I pee, although i am not certain if it is discharge or just pee that did not finish coming out.  Is it a good chance that I contracted gonorrhea or chlamydia from the exposure that I described?  My wife commented to me the other day that she noticed she had some vaginal discharge (and I did have sex with my wife the day after this incident), although she has been having that from time to time anyway after giving birth to our daughter 3 months ago.  Does this seem like an obvious bacterial STD that I have contracted, whether its gonorrhea, chlamydia, or any other STD?  Thanks in advance for your advice!

[H. Hunter Handsfield, M.D.]

You asked similar questions and we went through the low risks of STD by receiving fellatio in at least 3 different threads back in 2005.  The answers have not changed: oral sex is safe sex, with low risk for all STDs -- not zero, but much lower than for vaginal or anal sex.  As discussed back then, chlamydia is no risk because it is rarely carried in the mouth or throat, so there is nothing to transmit by oral sex.  Gonorrhea is possible but uncommon, and not likely to cause infection without noticeable discharge of pus from the penis.  Nongonococcal urethritis, perhaps sometimes due to normal oral bacteria, is possible but the risk level is unknown.  Syphilis is possible but very rare in most heterosexual populations in the US, including most commercia sex workers -- and would not cause the symptoms you describe.  Herpes possible but not common.

Your subtle symptoms, without visible discharge, are not likely to be due to any infection.  Vaginal discharge has many non-STD causes, and since her problem apparently is a recurrence of something related to her recent pregnancy and delivery, most likely your extracurricular activities have anything to do with her symptoms.  On the other hand, the timing certainly is compatible with the possibility you were infected and transmitted something to her.  So to be safe, I suggest that both you and your wife be examined and tested for common STDs.  I anticipate you'll both have negative test results.

Since oral sex is generally safe, condoms are not recommended routinely.  However, given your anxieties about STDs from oral sex, I suggest you start using condoms when you have such exposures, so you don't repeatedly go through these spasms of anxiety about it.

Regards---  HHH, MD

[Bradman2234]

I went last Thursday to my physician and told him about my exposure.  He had me do a urine test for chlamydia and gonorrhea.  Just found out today they were both negative.  My question is how reliable is a urine test when testing for STDs?  I had been drinking a lot of water that afternoon and had urinated approximately 1 hour before I went in and urinated at the doctor office, could that possibly cause a false negative test?  My wife and I had intercourse again a few days ago and said she felt a little soreness and burning  near her bladder and the outer edges of her vagina, could this still be related to a possible STD that I acquired from my unprotected ** exposure?  Please let me know your thoughts, thank you doctor.

[H. Hunter Handsfield, M.D.]

Oral sex isn't a risk for chlamydia.  There is a small risk for gonorrhea, but it is rare to get gonorrhea without obvious symptoms (primarily pus dripping from the penis).  The urine tests are highly reliable an hour after urinating.  You don't have eitehr infection and your outside sexual exposure has nothing to do with your wife's symptoms.  But of course she should see her health care provider if they persist.

That's all for this thread.