[Question #10227] my sexual life and how to prevent STI/STD.

24 months ago

Dear Dr. Handsfield and Dr. Hook

Thank you for the service you provide. I’d like to hear from you some advice about my sexual life and how to prevent STI/STD.

I had too many sexual encounters prior to 2018 mostly with females sex worker, and four transgenders, all my encounters with the female were protected vaginal Sex, for the transgender two time insertive protected anal and one time protected receptive and one time protected oral. Between and after all the encounters I had 3 to 5 – (4^th gen HIV test) which thankfully came back negative plus PCR test that I asked you about on my first post on the forum.

After 2018 I did not have any sexual encounters not even oral sex ((with someone I don’t know)) until 9 months and 1 month ago, please see my questions #9295 and #9951.

This month visited one trans sex worker for four times for massage, happy ending and erotic anal touches no fingering just touches on and around my anus she tried to finger me, but I stopped her, there was no oral or kissing she just kissed my penis from top to bottom, then I told her to stop again. I asked her about her status, she said that she is STD free and tested every six months.

24 months ago

Let us assume that we do not know about her status. Here are my questions:

Q1 If I continue seeing this person with the same activity, I describe do I put myself at any risk.

Q2 let say I continue seeing this person for the next 6 month with same activity, do I need to get tested for any STD/STI?

Q3 is there anything should I be more careful about this kind of activity. What are the risks if here any?

Q4 is this activity risk of HPV.

Q5 If insertive oral, penis to mouth is zero risk or close to zero and there have never been proven documented case dose that mean I can perform it without worrying?

Q6 I have read on the forum that there’s document cases for mouth to penis infections. Are these cases recent?

Q7 Oral sex in general HIV risk free or close to it, to the point some doctors ignore it, is this statement true? And what is your opinion?

H. Hunter Handsfield, MD

24 months ago

Welcome back to the forum. However, I'm a bit mystified why you felt the need. Looking back at your two previous questions and our replies (9 months and 2 months ago), it seems the answers to these questions are there, or should be obvious from those discussions.

First, why would you assume your partner's STD/HIV status is unknown? Why not ask her to be tested? But I'll address your specific questions with the assumption you won't know her "status". (I assume you're most worried about HIV, right?) Second, in that circumstance, I would suggest you keep condoms handy. Decisions to have only safe contacts can disappear in the heat of the moment. In the event you move on to real sex (like anal sex, either giving or receiving), please use condoms!

Q1, Q2) The exposures described would be near zero risk for HIV and other STDs. However, for reassurance you still might consider periodic testing yourself for gonorrhea, chlamydia, HIV and syphilis. Even with safe exposures, you probably would gain additional reassurance from negative test results.

Q3) As just implied, the sexual practices described are very low risk for any and all STDs and HIV.

Q4) HPV can be transmitted by genital skin-to-skin (or genital-anal) contact. These contacts might have smaller risk for HPV. But everybody gets HPV anyway, and given your sexual contacts prior to 2018, you can be certain you have been infected with HPV already, probably more than once. Happily, the large majority of HPV infections cause no significant health problem, so I really wouldn't worry about it.

Q5) The absence of known cases of HIV transmitted mouth to penis does not prove the risk is zero. It is very low, however; you probably could continue such exposure every day the rest of your life and never get HIV, even if your partner has it. But if you want to make these exposure truly zero risk, wear a condom each time.

Q6) This forum has never stated that there are known cases of HIV transmitted mouth to penis.

Q7) Yes, this is true. The average risk for oral sex has been estimated at 1 in 10,000 for the oral partner (if the penile partner has HIV) and 1 in 20,000 for the penile partner (if the oral partner is infected). These figures are equivalent to either performing or receiving BJs with HIV infected partners once daily for 27 years or 55 years before becoming HIV positive might be expected.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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24 months ago

I actually asked her to get tested and she agreed, but then everytime I bring it up she changes the subject.

Sorry I forgot to mention that as per my request she always fully clothed, I'm fully naked, except for one time when she lowered her panties half then touched her butt for a 2 minute or so.

Q1, Q2) why is it "near to zero" not zero. Could you please explain what in my activity makes it not zero since there's no penetration or oral sex. Isn't this considered hand-to-genital which's s zero risk if I'm not mistaken.

I only tested for HIV before,, not for the other STDs, and I'm planning to get test for all STD by next month for reassurance should I be worry specially for HIV?

Q4) Never thought about this before. Thank you doctor

Q6) I do apologize, it's a typo mistake I meant penis to mouth.

Thanks again Dr. Handsfield

H. Hunter Handsfield, MD

24 months ago

I actually asked her to get tested and she agreed, but then everytime I bring it up she changes the subject." It sounds like she's a devious person who doesn't want to acknowledge her own HIV risks. If you re truly and emotionally committed to her, of course that's an important consideration. But if not, you might look for another partner at lower risk for HIV. Or continue to have only 100% safe practices with her, which so far you are doing.

"Touched her butt" does not suggest HIV/STD risk.

"Why 'near zero'"? Because nothing is absolute in biology or medicine. There is no known risk, but nobody can guarantee true zero risk other than self-sex (masturbation).

Q6) Yes there have been a few documented cases of HIV transmission penis to mouth. But still the extremely low risk I described above (one chance in 20,000 exposures).

Thanks for the thanks. I'm glad to have been of help.

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24 months ago

Just to clarify as I mentioned in the upper page "This month visited one trans sex worker for four times"

she's not my partner and I'm not committed to her at all, she works as sex works but we text on the phone almost every day. I know this clarification would not change your assessment.

I will summarize what I've understand. Kindly correct me if I am wrong.

1- for The only four times I've encountered this person the risk is very low, and no need testing. Am I right?

2- if I continue seeing this person for the next 6 months or more is better to get tested for reassurance. Am I right?

I have no further question. Thank you Dr. Handsfield for what you do. I appreciate your time and effort.

H. Hunter Handsfield, MD

24 months ago

1) Correct. But whether you "need" testing is your decision, not mine. From a medical/risk perspective, I see no need. But anxious persons often are more reassured by negative HIV test results than by professional opinion, no matter how expert. So that part is up to you: if a negative test result will make you less worried, why not do it? (This definitely does not mean I think you were at significant risk.)

2) Same question, really. Same answer I just gave -- when you might be tested is entirely your choice.

Thanks for the thanks. Please note the forum policy against repeat questions on the same topic. This being your third with similar issues on your mind, if your sexual intents and practices continue as they are, it should be sufficient to answer any future questions that come to mind. Thanks for your understanding. Best wishes and stay safe.

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