What sexually transmitted disease (STD) tests are recommended after male to male oral sex?

STD Testing Recommendations After Male-to-Male Oral Sex

After male-to-male oral sex, testing for pharyngeal gonorrhea is strongly recommended, along with screening for syphilis, HIV, and urethral/rectal gonorrhea and chlamydia based on additional exposure history.

Primary Testing Recommendations

Pharyngeal Testing

• Pharyngeal gonorrhea testing is specifically indicated after receptive oral sex 1
  • Nucleic acid amplification tests (NAATs) or culture should be used
  • Testing should be performed regardless of symptoms, as many infections are asymptomatic

Additional Essential Testing

• Syphilis testing using non-treponemal test (RPR or VDRL) followed by treponemal confirmation 2
• HIV testing at initial visit and follow-up at 3-6 months if initial test is negative 2

Testing Based on Additional Exposure History

If there has been additional sexual contact beyond oral sex:

• Urethral testing for gonorrhea and chlamydia if insertive partner 2
• Rectal testing for gonorrhea and chlamydia if receptive anal intercourse has occurred 2, 1

Testing Schedule and Follow-up

Initial Testing

• Testing can be performed immediately after exposure, though some infections may not be detectable right away

Follow-up Testing

• Repeat testing for gonorrhea and chlamydia at 2 weeks post-exposure if prophylactic treatment was not provided 2
• Repeat HIV and syphilis testing at 6,12, and 24 weeks after exposure if initial tests were negative 2

Special Considerations

Testing Frequency

• For sexually active MSM, the CDC recommends at least annual screening for STIs 2
• More frequent testing (every 3-6 months) is recommended for MSM with multiple or anonymous partners 2
• Only 36-39% of sexually active MSM report being tested for gonorrhea and syphilis in the previous year, highlighting the importance of following testing guidelines 3

Test Selection

• NAATs are preferred for gonorrhea and chlamydia detection due to higher sensitivity 1
• For pharyngeal specimens, culture has traditionally been the standard but NAATs are increasingly used 2
• Note that oropharyngeal chlamydia testing is not routinely recommended 2

Common Pitfalls to Avoid

1. Failing to test pharyngeal sites - Extragenital infections are common and often asymptomatic 1
2. Assuming oral sex is low risk - Oral sex is implicated in the transmission of gonorrhea, syphilis, and other STIs 4
3. Not disclosing sexual practices to healthcare providers - Disclosure of male-male sexual contact to healthcare providers is associated with more than double the likelihood of appropriate STI testing 3
4. Inadequate follow-up - Many infections may not be detectable immediately after exposure, making follow-up testing essential 2

Impact of Testing

Frequent and appropriate STI testing among MSM can significantly reduce HIV and STI transmission. Targeting MSM with recent STI diagnoses or multiple partners for regular testing is particularly efficient in preventing new infections 5.