HIV/Other STD Risk from Giving Oral Anal Sex

[Ron47]

Dr. HHH

I am a healthy male in my 30s with no history of any STDs. Last night while being very drunk, i had sex with 2 CSWs (african american). Details:

- I performed oral-anal sex on them (i licked their anus) for over an hour combined
- I performed oral-vaginal sex on one (i licked her vagina) for a few minutes
- I had condom protected intercourse with one of them with no condom breakage
- One of them performed fellatio on me with a condom on.

I am now very concerned now about HIV and other STDs especially due to the oral-anal exposure. A lot of sites rate that exposure as high risk. I do have a small cut on the underside of my tongue and on my lip.
The only symptom I have yet (10 hours later) is a dry & sore throat.

My questions are:

1. What is my risk of having acquired HIV?

2. Should I rush to any STD clinic for any preventive measures?

3. What is my risk of herpes, HPV, Chlamydia, Gonorrhea and Syphilis?

4. Should I continue to have protected or unprotected sex with my wife?

5. In general what should my course of action be -- at what point should I go to the doctor, if at all?

Your responses are eagerly awaited and will be highly appreciated.

[Edward W Hook, MD]

1. correct. Condom protected sex is safe  sex.
2.  I would disagree.  There may risk for acquiring a diarrheal disease but not typical STDs.
3.  No they stay at the location where they were acquired.  Pharyngeal infection does not cause penile problems.
4.  No.

EWH

[Ron47]

Thanks a lot, Dr. Hook. It does alleviate my anxiety to a great extent. A few further questions and I will feel even more assured.

1. Maybe I was not clear on this earlier -- the oral sex I received was condom protected. So does mean that I should not be worried about penile infections and NGU at all?

2. May be its just quibbling, but some sites state that performing oral anal sex (licking anus with tongue penetrating) is substantially higher risk than performing oral vaginal sex (licking vagina). Is that true?

3. Can gonorrhea or gonococcal infections spread internally within one's own body  i.e. from my throat to penis or vice versa?

4. Can gonorrhea and gonococcal infections of the throat spread from one person to the other through kissing?

Once again, I will really appreciate your response.

[Edward W Hook, MD]

Welcome to the Forum. I'll try to help. To summarize, you have given an received oral sex from two different commercial sex workers as well as condom protected vaginal sex.  There is no risk from condom protected vaginal intercourse.  Similarly, there is no risk for HIV- HIV is not spread though oral sex (giving or receiving) or from condom protected sex. 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.

So, now let’s deal with the oral sex and other STDs.  Oral sex is an inefficient way to acquire 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.   Similarly, oral HPV is just not a concern.  If you had gotten gonorrhea or NGU you will most likely develop symptoms of urethritis (penile infection - burning or penile discharge) in the next few days (I doubt that this will happen).  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  I would urge you not to worry.  If you want to be completely sure, you can go to an ST Clinic or your own doctor and get tested for penile infections and NGU.  

Your risk of getting an STD from performing oral sex on your partners is lower than your risk of getting an STD (which is not high).  The only STD you are at risk for is gonorrhea and gonococcal throat infections are usually asymptomatic.  If you want to rule out the very small chance that you have acquired a gonorrhea infection of the throat, you need  a swab for gonorrhea taken from your throat.  

I cannot promise you that you do not have an STD, thus there is some risk in having unprotected sex with your wife but that risk is low.  If you do not develop symptoms over the next few days the risk is lower still and if you choose to get tested you can completely rule out infection.

Hope these comments are helpful/.  EWH