Transmission of STD's through oral sex

Dear Dr HHH
Around ten weeks ago i visited the GUM clinic, all my tests returned negative. Four weeks ago a women performed unprotected oral sex on me that lasted 8 to 10 minutes, I could not ejaculate (due to the huge amount of alcohol consumed). I looked at her mouth and she had no visible sores or marks plus she showed me a picture of her 2 year old son. 3-5 days past with no change to my penis, i then had unprotected sex with my pregnant gf. 2 days later i had a small red bumpy rash on my foreskin and a red ring around the tip of my penis (i had no other symptons), i showed this to my gf who told me she had thrush, we used a suitable thrush cream which cleared up the rash within two days, i also had a fever at the time that lasted two days, it mainly effected me on the night causing me to sweat and i also had a slight loss of appetite. I originally put this down to six days consuming huge amounts of alcohol and completing a 20 mile charity bike ride? However, two weeks later my gf had sickness and diarrhea that lasted 24 hours and she also noticed her vagina was sore, on inspection she had four small white spots in a line and a sore area directly opposite, we went to the doctors who carried out a full examination (obviously i did not mention my incident of unprotected oral sex), she was not concerned  that it could be an STD that had laid dormant, such as Herpes, instead she prescribed a thrush cream containing HC (seems to be working). Also i re- visited the GUM clinic due to worry, they carried out an examination of my penis and took another swab and urine sample, again all returned negative. They did not do another blood test as they said it was too soon after the unprotected oral sex plus my last test had come back negative. Could i have contracted an STD such as HIV, Herpes or Syphilis and passed it on? Can you please offer any advice or information as i’m extremely concerned i could have placed the health and wellbeing of my unborn child and gf at risk.

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

You neither need to be concerned nor worried about your GF.  Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.  As for HIV, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  

If you had gotten gonorrhea or NGU you would have most likely developed symptoms of urethritis (penile infection) and you have now had two sets of negative tests which further support than you did not get an STD.  Even if the person who performed oral sex on yo, u had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  Most of the genital symptoms you describe both for yourself and your partner are consistent with a fungal infection;  some fungal infections do not respond as well as might be hoped for with a single treatment.

Finally, your feverishness, sweats and diminished appetite are not suggestive of any STD.

You have nothing to worry about.  EWH

[keane1977]

i found this very helpfull

[Pigeon09]

Thank you very much for your prompt reponse, it has put my mind at rest and i have since been able to sleep on a night.

I had previously looked at answers on similar questions from the site and i realised transmission from oral sex was low risk/inefficent. However, it was excellent to get your expert opinion on my own situation and symptons.

Prior to this episode i had not realised there was a risk of transmission via oral sex. I will never put myself in this situation again.

My final question is in regards to the white spots and sore area my gf suffered that i described in my original question. Although the area is no longer sore the white spots are still present and have not changed since arrival two weeks ago, my gf has only been using the new cream/prescription for one week. When would you expect them to disappear?

Does this change anything from your original answer.

Thank you very very much for your help thus far.

[Edward W Hook, MD]

Sorry, I cannot say what the white spots are from your description.  Discolorations are very non-specific.  I would suggest that if it concerns you or your partner you discuss it with a dermatologist.  I doubt that it is anythng of concern.

This does not change my opinion as stated above.  EWH

[Pigeon09]

Hi,

Thank you for all your help thus far, my gf 's white spots have now disappeared following the use of the prescription.

My final question is more general, if you had aquired an STD how long would it be before it became infectious to others?

In my original question, i recieved oral sex from a random women then 4 days later i had unprotected sex with my pregnent gf (no symptons at this stage), 1 day later symptons appeared. I have read on this site that for an STD such as herpes or syphilis to be passed on you have to have developed the symptons such as a chancre and this can take 3-6 weeks?

This wil be my final question.

Many thanks.

Thanks for all your help.

[Edward W Hook, MD]

How long it takes to become infectious following STD acquisition varies from one STD to another.  For diseases like gonorrhea and chlamydia, people can become infectious for partners within 2-3 days following exposure to an infected partner and becoming infected.  On the other hand, syphilis is transmitted by lesion contact and it can take, on average, 3 weeks for a chancre to appear.  For herpes the data is a bit less clear but the initial lesions of herpes typically appear 4-10 days after exposure to an infected partner. Once a person has herpes, they can spread infection to partners whether they have lesions or not from then on.

Take care.  EWH