STDs Expert Forum
chlamydia by cunnilingus
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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chlamydia by cunnilingus

Hello dear doctors.
My name is Alex , I am male and have 28 years.
Yesterday I did a very stupid mistake and I had sex with a very high-class CSW , which was very beautiful, expensive and selective with her clients.I guess it is not a bad thing.
The sex was protected vaginal. No anal ,no kissing .
My exposure comes from the unprotected cunnilingus which I gave to that girl in a moment of losing mysellf into her beauty..stupid moment...
She told me she always has protected sex( oral and normal) with all of her clients but she allows them to perform   cunnilingus on her .
I am particularly worried about chlamydia transmission.
My questions are two :
1. What is my real risk of contracting chlamydia through cunnilingus on this girl ( supposing that she actually has chlamydia)?
2.If she had only protected sex with all of her clients than I am guessing that the only way she could have gotten chlamydia is through her clients performing cunnilingus on her? Can chlamydia transmit by cunnilingus from an infected man to a woman?If yes what are the ways ?By saliva? Or.......?
I am very confused and worried.Please help.
Best regards.Alex.
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.  Briefly responding only to the title, before reading the question itself:  chlamydia rarely infects the oral cavity and is rarely if ever acquired by cunnilingus.  Now I'll read the details, but it is unlikely you have acquired chlamydia through cunnilingus.

Now having looked at the details, some general comments.  I'm using your question as an opportunity for a blog-like response that can be saved to aid in responding to similar questions in the future.  So bear with me!

There is a very common misconception, held by many health professionals, health departments, and even some STD experts, that oral chlamydia is frequent and is readily transmitted by oral sex.  It just isn't true.  It isn't entirely clear how this misunderstanding developed, but I suspect it's because in most details chlamydial infection closely parallels gonorrhea in symptoms, transmission mode, and general epidemiology.  However, the ability of the two organisms to infect the oral cavity (specifically the pharynx, i.e. the back of the throat) is very different, and chlamydia rarely does so.  And when it does, it appears not to be transmitted by oral sex.  Whereas gonorrhea is often transmitted to the male urethra by fellatio (penile oral contact), chlamydia is rarely if ever so transmitted. Several research studies are very clear:  there is no association between oral sex and the frequency of chlamydia.

I was the senior investigator on two of those research studies. We found that although nongonococcal urethritis (NGU) and urethral gonorrhea were fairly common in men whose only recent sexual exposure was insertive oral sex, we found no cases of urethral chlamydia in such men.  Urethral chlamydia was present in men only if they had had insertive vaginal or anal sex.  These results implied that chlamydia either was uncommon in their partners' oral cavities or, if it was present, it was not readily transmitted.  More recent research has confirmed the first:  even with the most sensitive DNA tests, chlamydia is rarely found in the pharynx, even in people who frequenly have performed oral sex on many partners -- far less common than pharyngeal gonorrhea.  And still more recently, Dr. Hook, this forum's other moderator, is senior investigator on another study showing no evidence of chlamydia transmission by cunnilingus.

Partly for these reasons, STD experts and official agencies (e.g., CDC) recommend against even testing for pharyngeal chlamydial infection, whereas testing for pharyngeal gonorrhea is often recommended.

Those comments cover both of your specific questions.  But to be explicit, if your escort partner indeed consistently assures her clients use condoms for vaginal and anal sex and for fellatio, but participates in unprotected cunnilingus,, she is very unlikely to have genital chlamydia (or gonorrhea).  But for the reasons above, even if she should happen to have genital chlamydia, there is little or no chance you would have acquired it in performing cunnlingus on her.

So in final reaponse to your closing questions:  I hope this clear up the "very confused" part; and you should not be at all worried about having oral chlamydia.

Please let me know if there is anything in this you don't understand.  Thanks again for your question and the opportunity to address these issues.

HHH, MD
5 Comments
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239123_tn?1267651214
To clarify my comments about gonorrhea:

My statement "Whereas gonorrhea is often transmitted to the male urethra by fellatio..." should have used "sometimes", not often.

Pharyngeal gonorrhea isn't rare, and is sometimes acquired by performing oral sex on men (fellatio).  However, it is not easily transmitted from the pharynx to other sites.  Performing fellatio can transmit gonorrhea to the penis, but it isn't all that common, and the large majority of urethral gonorrhea is acquired by unprotected vaginal or anal sex.  Oral gonorrhea may occasionally be acquired by performing cunnilingus on an infected woman, but this appears to be very rare; and cunnilingus probably doesn't transmit oral gonorrhea to female partners.  In other words, oral-pharyngeal gonorrhea transmission is a lot more common than for chlamydia, but still not an everyday event and is especially rare by cunnilingus.

There also is common confusion about the symptoms of pharyngeal gonorrhea.  Once in a while it causes severe pharyngitis, mimicking strep throat, but over 90% of such infections are entirely without symptoms.  Sore throat is rarely a symptom of any STD.
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Avatar_m_tn
Can chlamydia of the throat cause reactive arthitris or only genital chlamydia can cause it ?
Can chlamydia of the throat re-activate a treated form of reactive arthitris ?
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239123_tn?1267651214
I guess you didn't undestand the main point of my reply.  Chlamydia of the throat is irrelevant to your situation.  There is no way you have it from the exposure described.

There is no known association of pharyngeal chlamydia with reactive arthritis, but I suppose it could happen.
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Avatar_m_tn
many thanks doc
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