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Risk of Transmission/Likelier Candidate

I'm a 30 year-old heterosexual male. In the last three months I've had two sexual partners, both females. Seventeen days ago I engaged in unprotected genital to genital stimulation (rubbing of the head of my penis on my partner's clitoris and vulva - very briefly, perhaps for 10 seconds), performed and received unprotected oral sex, and then had intercourse while using a condom.

My other partner is more long term, though long distance. We've had unprotected sex orally and vaginally innumerable times when visiting each other, first in late October and most recently last weekend. It's been four days since our last sexual encounter, eight since the beginning of our most recent sexual contact.

Two days ago, I noticed a slight discharge emitting from my penis. It has grown substantially, to the point that I'm fairly certain I've received an STI of some sort. I've made an appointment to get tested.

My question is this: How likely is the risk of the transmission in a scenario such as desribed regarding clitoral stimulation with the head of the penis and oral sex? Especially in regards to STI where discharge is a syptom?

Moreoever, though I intend to speak to both partners, I'm feeling dubious about what my long-term, long-distant has been up to. We are not monogamous, yet it was understood that any outside relations would be undertaken safely. I perhaps did not fully live up to this agreement, certainly. I'm feeling like she hasn't either, given the timeline and when my syptoms began. Am I being rash in assuming she's the likelier candidate for the infection?

Thank you for your time. I've found this forum very informative and your responses very astute.
8 Responses
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the STD forum.  I'll try to help.

Urethral discharge almost always indicates an STD, specifically sexually acquired urethritis: gonorrhea, chlamydia, or nongonococcal urethritis (NGU).  All are readily acquired by unprotected vaginal sex, and NGU and gonorrhea (but not chlamydia) can be acquired by oral sex.

At this point it isn't possible for me to judge which partner is the source of your infection.  NGU and chlamydia typically cause symptoms 7-10 days after exposure, gonorrhea 2-5 days -- do your diagnosis may help judge when you were infected.  The important thing is that you be examined and treated, and that you speak with both partners; both of them also need examination and treatment.  If you are diagnosed promptly, you can wait until you know your diagnosis before speaking with them.  But don't delay if it's going to take more than 2-3 days; chlamydia and gonorrhea can cause serious complications in women.

Safe sex is never perfect, so even if you acquired this from your distant (possibly non-monogamous) partner, it doesn't necessarily mean she did not pursue standard safe practices.  And as you note yourself, if you failed to follow your safe sex intentions, you obviously cannot blame her for the same lapse.

Don't delay your own appointment; you should be seen within a day or two for sure.  If your are seeing a general medical provider, be aware that many are not up to speed on STD diagnosis and management.  If you have any doubt, consider visiting your local health department STD clinic for expert care, usually at low cost and often on a same-day or walk-in basis.  

I'll be happy to comment further if you would like to return with a follow-up comment after you have been professionally evaluated.

Regards--  HHH, MD
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
Your oral sex partner remains the most likely source of your infection.  NGU acquired by oral sex is not caused by any of the standard STDs that would have been detected with the tests she had.  Your infection could have been caused by entirely normal oral bacteria.  This isn't known for certain, but it's a likely explanation of many cases of NGU from oral sex.  However, 4 months is too long for NGU symptoms to show up.  But it is certainly possible to have a number of sexual exposures and not become infected until one of the recent ones.

You need to accept the fact that you're probably never going to know for sure when and from whom you acquired your NGU.  I suggest you stop trying to figure it out.  What is immprotant is that your infection is gone (presumably); and that both your partners be treated with antibiotics, if not yet done.
Helpful - 0
Avatar universal
Hello, Doctor:

An update and, if you're willing, another question.

The woman I was involved with who I had unprotected oral sex with one time sought treatment and was given a full battery of tests. She came up negative for everything. So, I must have contracted the STD from my other partner.

My question is thus: Given the situation of having unprotected sex with this woman for the first time nearly four months before I became syptomatic, is it possible that she had the infection from a previous relationship?

We had intercourse nearly twice a day for a week that first visit, then a month later had sex at least four times over a weekend, then a month after again had another week of numerous sexual encounters. I finally experienced symptoms a week after her last visit, on month four. What's the likelihood that she was infected throughout our relationship, but that I did not contract the infection until one of more recent visits?

Thank you so much for your help, Doctor.

Thank you so much for your time.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Alcohol won't affect how well AZM works.  If you were to take the single large dose plus alcohol together, it probably would increase the risk of nausea or cramping.

Thanks for the thanks.  Glad to help.
Helpful - 0
Avatar universal
Thank you very much for your information, Doctor. I found it very helpful and informative.

A final unanswered question - is it okay to consume alcohol while taking azithromycin? The clinic didn't give me much information regarding possible interactions.

Thanks again.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Too bad you weren't tested for chlamydia.  Sorry if I misled you; most public STD clinics have chlamydia testing available.  If you want to know for sure, the chlamydia test would remain positive for a couple of days, even after taking azithromycin -- so you could still be tested, perhaps by your own doctor or another clinic.

16 days is on the long side for incubation of NGU or chlamydia, but not by much.  It's usually 1-2 weeks, but it can be 3 weeks. There are no data on the frequency of NGU transmission from oral sex.  Probably quite a bit lower than from vaginal penetration.  But beyond that I cannot judge.  

Genital apposition, without penetration carries little or no risk for chlamydia or NGU.  You can assume you were infected either from vaginal or oral sex.  Beyond that, I still cannot say when and from whom you were infected.  And frankly, I recommend against trying to figure it out in any further detail.  No matter what, both your partners need to be informed and treated.  And this is also a very imprecise way of judging your long distance partner's sexual safety habits.  The way to learn that is to ask her.  And of course you have an ideal entree to that conversation:  you have to tell her about your diagnosis and advise her to get treated, which no doubt that will lead directly to the safe sex discussion.
Helpful - 0
Avatar universal
I suppose I could boil it down by simply asking how likely is the transmission of chlamydia or NGU from unprotected oral sex and the brief rubbing of the head of the penis on the clitoris and lips of the vulva, followed by protected intercourse.
Helpful - 0
Avatar universal
Thank you for your timely response. I've subsequently been evaluated by my local health department. How adequately, I'm not sure. They did not have the means to test for chlamydia, though they did disqualify gonorrhea. So it can either be the former or an NGU, I suppose. The only additional information I received was that there was a high amount of white blood cells in the sample they took. I underwent antibiotic therapy.

Indeed, I do not moralize or blame either partner for the situation. To me, I see the issue in more biological terms. My main reason in trying to determine what happened is to ascertain my long-distant partner's sexual safety habits. Depending on her reaction to the news, this may be a moot point. And I'm plain curious about this stuff now.

So. Does the brevity of time of physical contact, in this case the rubbing of the head of the penis on the vulva for 20 seconds, decrease the likelihood of transmission? If so, how common is the transmission of NGU via oral sex? And finally, is 16 days an atypical incubation period before symptoms surface?

Thank you so much for your comments. The information is invaluable.
Helpful - 0

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