What sexually transmitted diseases (STDs) can men contract from receiving oral sex?

STDs Men Can Contract from Receiving Oral Sex

Men can contract several sexually transmitted diseases from receiving oral sex, including gonorrhea, chlamydia, herpes simplex virus, syphilis, and HIV. 1, 2, 3

Common STDs Transmitted Through Oral Sex

Bacterial Infections

1. Gonorrhea (Neisseria gonorrhoeae)

   • Can cause pharyngitis and tonsillitis in the giver but often asymptomatic
   • In the receiver, can cause urethritis with symptoms including:
     • Purulent discharge
     • Dysuria
     • Urethral itching or burning 1
   • Asymptomatic infections are common and serve as reservoirs for transmission

2. Chlamydia (Chlamydia trachomatis)

   • Often asymptomatic in both the oral cavity and urethra
   • Can cause non-gonococcal urethritis in men receiving oral sex
   • Symptoms may include:
     • Clear or white discharge
     • Burning during urination
     • Testicular pain or swelling 4

3. Syphilis (Treponema pallidum)

   • Primary syphilis can present as a painless chancre on the penis
   • Can be transmitted when oral mucous membranes contact infectious lesions
   • Secondary syphilis can cause widespread rash including the oral cavity 2, 3

Viral Infections

1. Herpes Simplex Virus (HSV-1 and HSV-2)

   • Both types can affect oral and genital areas
   • HSV-1 traditionally causes oral herpes but can be transmitted to genitals through oral sex
   • Presents as painful vesicles and ulcers on the penis 2
   • Can be transmitted even without visible lesions during viral shedding

2. Human Papillomavirus (HPV)

   • Can cause genital warts on the penis
   • Some strains associated with penile cancer
   • Often asymptomatic in males 2, 3

3. HIV

   • Risk is lower for receptive oral sex compared to other sexual practices
   • Risk increases with:
     • Oral ulcers or lesions in the partner performing oral sex
     • Bleeding gums
     • Concurrent STIs 4

Diagnostic Considerations

For men with suspected STIs from oral sex, the CDC recommends:

1. Urethritis evaluation:

   • Gram-stained smear of urethral exudate (>5 polymorphonuclear leukocytes per oil immersion field indicates urethritis)
   • Culture or nucleic acid amplification testing for gonorrhea and chlamydia
   • First-void urine examination for leukocytes 4

2. Additional testing:

   • Syphilis serology
   • HIV testing 4

Prevention Strategies

The CDC recommends several prevention strategies:

1. Barrier methods:

   • Consistent and correct use of condoms during oral sex
   • Male condoms can significantly reduce the risk of STD transmission 4

2. Testing:

   • Regular STD screening for sexually active individuals
   • Both partners should be tested before initiating sexual activity 4

3. Communication:

   • Open discussion about sexual health status with partners
   • Disclosure of known infections 4

Treatment Considerations

Treatment depends on the specific pathogen:

1. Bacterial STIs:

   • Gonorrhea: Ceftriaxone (intramuscular injection)
   • Chlamydia: Azithromycin (single dose) or doxycycline (7-day course) 4
   • Syphilis: Penicillin G (dosage depends on stage)

2. Viral STIs:

   • Herpes: Antiviral medications (acyclovir, valacyclovir, famciclovir)
   • HPV: Treatment of visible warts; no cure for the virus
   • HIV: Antiretroviral therapy

Special Considerations

1. Partner notification:

   • Sex partners should be referred for evaluation and treatment if contact occurred within 60 days preceding symptom onset 5
   • Patients should avoid sexual activity until they and their partners complete therapy and are symptom-free

2. Follow-up:

   • Patients should return for evaluation if symptoms persist after treatment
   • Regular screening is recommended for sexually active individuals with multiple partners 4

Clinical Pitfalls

1. Asymptomatic infections:

   • Many STIs transmitted through oral sex may be asymptomatic
   • Absence of symptoms does not rule out infection
   • Regular screening is essential for high-risk individuals

2. Misdiagnosis:

   • Non-specific symptoms may be attributed to other causes
   • Comprehensive testing is necessary for accurate diagnosis

3. Incomplete treatment:

   • Failure to treat all infected sites
   • Inadequate partner treatment leading to reinfection

By understanding the risks of STD transmission through oral sex and implementing appropriate prevention and treatment strategies, men can protect their sexual health and reduce the spread of infections.