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Can STD Be Contracted Through Oral Sex?
Question: I performed oral sex on a male partner in May. There was some ejaculate in my mouth, but I swallowed it fast and the rest ended up outside of my body. I got an STD test more than 90 days following this encounter to check on my status for STDs. I had no further penetrative sexual encounters more than hand to genital contact. In addition, I was treated for syphilis in March 2015 when my FTA was reactive and my RPR was non-reactive. However, since I had never been treated, they treated me for late latent syphilis. My RPR was always NON-REACTIVE for every test, except this one where I had a titer of 1:1. The doctor said to re-test in one month to see if it changed, or if it was a false positive. This bodes the question, what is your opinion on this result? Would this reactive result warrant a second test for all other STDs?
Brief Answer:
Possibility of active syphilis is unlikely.
Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
Oral sex carries a low risk for HIV or STD.
You got tested for STDs after 90 days after the exposure. So these tests are highly reliable.
FTA test for Syphilis is a specific test. If specific tests are reactive once, They remain reactive for years together, sometimes life long. There is every possibility RPR re-activity lesser than 8 dilutions could be due to biological false positive (due to causes other than syphilis).
As you had been treated for late latent syphilis, you can ignore the one time positive report (1:1).
DR S.Murugan
Possibility of active syphilis is unlikely.
Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
Oral sex carries a low risk for HIV or STD.
You got tested for STDs after 90 days after the exposure. So these tests are highly reliable.
FTA test for Syphilis is a specific test. If specific tests are reactive once, They remain reactive for years together, sometimes life long. There is every possibility RPR re-activity lesser than 8 dilutions could be due to biological false positive (due to causes other than syphilis).
As you had been treated for late latent syphilis, you can ignore the one time positive report (1:1).
DR S.Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What are these causes other than syphilis? Do you still recommend a follow up test in one month?
I should note that my last NON-REACTIVE RPR was in March of 2015, which is before this exposure. Would you expect that another test would show a NON-REACTIVE RPR again?
I gave it some thought. I now remember seeing a red bump on the side of my tongue. I thought I had a sore throat, but instead this bump was slightly tender and sore. It was only 2-3 weeks ago, so a good 8 weeks (at least) after this possible exposure. I had 2 other orogenital encounters in late March as well (after having my blood drawn for my last STD screening for which yielded a NON REACTIVE RPR). No ejactulation in the mouth, however one was not circumsized. Even so, the Titer would be much higher at this point, correct? In addition, I posted photos of the palms of my hands for your review. Any extra input would be appreciated. Would you expect that my follow up test in a month would yield a Non-Reactive RPR again? Would a titer of say, 1:4 warrant treatment again? And in this case, would 1 shot of penicillin be necessary or 3 again?
I should note that my last NON-REACTIVE RPR was in March of 2015, which is before this exposure. Would you expect that another test would show a NON-REACTIVE RPR again?
I gave it some thought. I now remember seeing a red bump on the side of my tongue. I thought I had a sore throat, but instead this bump was slightly tender and sore. It was only 2-3 weeks ago, so a good 8 weeks (at least) after this possible exposure. I had 2 other orogenital encounters in late March as well (after having my blood drawn for my last STD screening for which yielded a NON REACTIVE RPR). No ejactulation in the mouth, however one was not circumsized. Even so, the Titer would be much higher at this point, correct? In addition, I posted photos of the palms of my hands for your review. Any extra input would be appreciated. Would you expect that my follow up test in a month would yield a Non-Reactive RPR again? Would a titer of say, 1:4 warrant treatment again? And in this case, would 1 shot of penicillin be necessary or 3 again?
Brief Answer:
Anti-syphilitic treatment in presence of exposures indicated.
Detailed Answer:
Hi,
Welcome back.
Biological false positive can occur in many conditions. Following a high fever episode (various reasons), vaccination procedures, pregnancy, lepromatous leprosy, auto-immune disorders (various types), drug addiction are some of these causes.
There is no evidence for syphilis in your palms in the picture. Palmar syphilide is a secondary syphilis or tertiary manifestation and not common in primary stage other than felon chancre. (no such evidence).
1:1 Dilution is not necessary to be always a false positive reaction. An early syphilitic dilutions might be low and tend to rise in the coming days. In your case you multiple oral exposures and history of sore tongue are there. I ill recommend repeat the specific tests and RPR test after another 15 days. There is nothing wrong to have an injection of Benzathine penicillin 2.4 mega units as deep IM injection if you are not allergic to penicillin.
Dr S.Murugan
Anti-syphilitic treatment in presence of exposures indicated.
Detailed Answer:
Hi,
Welcome back.
Biological false positive can occur in many conditions. Following a high fever episode (various reasons), vaccination procedures, pregnancy, lepromatous leprosy, auto-immune disorders (various types), drug addiction are some of these causes.
There is no evidence for syphilis in your palms in the picture. Palmar syphilide is a secondary syphilis or tertiary manifestation and not common in primary stage other than felon chancre. (no such evidence).
1:1 Dilution is not necessary to be always a false positive reaction. An early syphilitic dilutions might be low and tend to rise in the coming days. In your case you multiple oral exposures and history of sore tongue are there. I ill recommend repeat the specific tests and RPR test after another 15 days. There is nothing wrong to have an injection of Benzathine penicillin 2.4 mega units as deep IM injection if you are not allergic to penicillin.
Dr S.Murugan
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
What specific tests should I repeat if I was treated for syphilis in March of 2015? The FTA and TPPA were both reactive. Should an RPR be higher than 1:1 more than 90 days post possible exposure though?
It was a red bump on the side of my tongue. I thought I had a sore throat, but it turned out I had the bump. It was sore (somewhat painful), but it disappeared within a week.
It was a red bump on the side of my tongue. I thought I had a sore throat, but it turned out I had the bump. It was sore (somewhat painful), but it disappeared within a week.
Brief Answer:
Specific test not to be repeated. RPR needs to be followed up.
Detailed Answer:
Hi,
Welcome back.
There is no necessity to repeat your Specific test for Syphilis is already reactive and if had been treated already. RPR has to be followed once in three months, till it becomes non reactive. Increase in RPR dilutions one step ahead is not to be worried and following subsequent examination it may decline. So a long follow-up is necessary following the treatment. It may take 6-12 months to become non reactive in some instance.
Dr S.Murugan
Specific test not to be repeated. RPR needs to be followed up.
Detailed Answer:
Hi,
Welcome back.
There is no necessity to repeat your Specific test for Syphilis is already reactive and if had been treated already. RPR has to be followed once in three months, till it becomes non reactive. Increase in RPR dilutions one step ahead is not to be worried and following subsequent examination it may decline. So a long follow-up is necessary following the treatment. It may take 6-12 months to become non reactive in some instance.
Dr S.Murugan
Above answer was peer-reviewed by :
Dr. Yogesh D
Right, however at the time of diagnosis in 2015 my FTA and TPPA were reactive. RPR was NON REACTIVE. This remained the case through March of 2016. One year. My last test at the end of march yielded a NON REACTIVE RPR. After the blood tests I had those three encounters that I mentioned. Latest being May 22, 2016. Earlier this month I had what I thought was a sore throat, but ended up being a bump on my tongue with mild pain. I don't think it lasted more than a few days, less than a week, unless I did not notice it right away. This past Saturday I did a full STD screening. My RPR was Reactive at 1:1. I am trying to figure out what to do, if I need to seek treatment right away or not. I am very confused.
Brief Answer:
Reinfection of syphilis is a possibility.
Detailed Answer:
Hi,
Welcome back.
You had syphilis and got cured reflected by FTA and TPHA positive and RPR non reactive from one of your old contact.
Possibility of acquired re-infection from one of the last three contact could be the reason for the recent RPR reactive report.
Now there is no role for specific test as they were already reactive. There is no other way to rule out false positive result now. So a single injection of INJ. Benzathine penicillin 2.4 megaunits will solve the problem and you will be free from syphilis. Avoid unprotected sex here afterwards even for oral sex.
Dr S.Murugan
Reinfection of syphilis is a possibility.
Detailed Answer:
Hi,
Welcome back.
You had syphilis and got cured reflected by FTA and TPHA positive and RPR non reactive from one of your old contact.
Possibility of acquired re-infection from one of the last three contact could be the reason for the recent RPR reactive report.
Now there is no role for specific test as they were already reactive. There is no other way to rule out false positive result now. So a single injection of INJ. Benzathine penicillin 2.4 megaunits will solve the problem and you will be free from syphilis. Avoid unprotected sex here afterwards even for oral sex.
Dr S.Murugan
Note: Consult a Sexual Diseases Specialist online for further follow up- Click here.
Above answer was peer-reviewed by :
Dr. Priyanka G Raj
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