Unprotected oral during group activity

[joewefind934]

Hi doctor,

One week ago I had a group sexual encounter with 2 other guys and 2 girls (I'm a guy).  I didn't have any insertive sex, but I did finger both of the girls, masterbate, and eat both of them out briefly.  I ate the girls out before they had sex with anyone else, but it's possible the 2 other guys ate them out before and/or rubbed their penis against their vaginas / exchanged fluids.

Now 8 days later, I'm feeling a burning sensation in my urethra as well as an off and on sore throat (not too serious as of now).  I'm checking frequently but haven't seen any discharge or have any other symptoms.

I've read that the risk of most STI's from oral is relatively low, but I'm worried about there being multiple partners.   Is this something I should be concerned about?  I'm pretty sure the two girls were clean, so is mouth to vagina to mouth or penis to vagina to mouth spread possible?  I understand that I'm most at risk for NGU and gonorrhea from this type of encounter.  Is it possible to have gotten the gonorrhea orally but for the symptoms to be showing up as uretheral discomfort?

[H. Hunter Handsfield, M.D.]

That's possible, and you're in a much better position than I am to judge.  But if in doubt it's safest to be professionally evaluated.

[joewefind934]

Thanks for your reply.  

I'll wait and get tested soon, but the uretheral discomfort isn't going away.  If anything it's gotten more pronounced in the last 24 hours and has focused on the tip of my penis.  I've been checking obsessively but there hasn't any discharge.  Is that common?  I'm just wondering (hoping) the feeling is more from worrying / checking often than an actual infection.

[H. Hunter Handsfield, M.D.]

While I cannot say there is absolutely zero risk of getting secretions into your urethra that might cause urethritis, in nearly 4 decades in the STD business I have never seen such a case.  I'm sticking with my advice above:  sit tight for a few days, expecting that the symptoms might clear.  If they don't, or of course if discharge shows up, get professionally evaluated.

[joewefind934]

Thanks doctor.

There was no direct exposure of my urethra to my partners' mouths.  At most these things happened in quick but indirect succession, i.e., one of the other guys rubbing his penis a girl's vagina and then me eating her out, or a girl touching herself and then masterbating me.  I've heard this is an uncommon method of transfer, and am just worried because of the quick succession.  At the risk of sounding vulgar there were fluids all over the place...

Is there anything else or any other way I could be having the urethral discomfort without other symptoms (i.e., discharge)?  I'm trying to understand if this is my mind playing tricks on me or something real, especially given the 7 days since exposure.

[H. Hunter Handsfield, M.D.]

Welcome to the forum. Thanks for your question, which came in just as I was logging on myself.  Most users should not expect immediate replies!

You don't mention exposure of your penis -- but I think you mean that there was oral contact with your penis, i.e. that "no insertive sex" refers only to vaginal and anal insertion.  Correct?  (Presumably you know that you cannot catch something in your oral cavity that then shows up in the lower urinary tract.  If your only exposures were fingering and cunnilingus -- oral-vaginal contact -- then of course you are not at risk for gonorrhea, NGU, or any other STD.)

If your urethra was exposed to your partners' mouths, then it is possible that your urinary discomfort reflects an STD like NGU.  And the timing is right, since NGU symptoms typically begin 1-2 weeks after exposure.  However, the main symptom of NGU is discharge, not the sort of urethral discomfort you report.  Uncomfortable urination sometimes accompanies the discharge, but usually doesn't occur alone.  Gonorrhea is even less likely -- usually the discharge is very obvious, and symptoms typically start within 5 days.  Chlamydia is not a likely issue, which you seem to know, since you don't mention it.  For other readers, I'll add that chlamydia uncommonly infects the oral cavity, so oral to penile transmission is rare.

Another possibility may be adenovirus, which could explain the combination of sore throat with urethral symptoms.  Adenovirus primarily causes sore throat and other cold symptoms, but can simultaneously infect the urethra.

For now, I suggest sitting tight.  If discharge appears, or if the penile discomfort doesn't clear up in 2-3 days, you should be professionally evaluated, preferably by a doctor or clinic with experience in STDs, such as your local health department or a Planned Parenthood clinic.

I hope this has been helpful.  Best wishes--  HHH, MD