Hi Doc. I wanted to follow up to my previous questions if you don't mind.

1. You mention genital contact. For males, this would be penis head,  and shaft? Or mainly penis head? Forgive me, but it's been a long time since Sex Ed. and i just want to get answers from the experts, not google which can drive people crazy.

2. You mention syphilis and HIV being reduced by more than 50% while other STI reduced to close to zero with condoms being used. Why is it "more than 50%" for syphilis and HIV but close to zero for others? Where does that small percentage for syphilis and HIV reside at? What kind of contact?

1.  The most common STIs, such as gonorrhea, chlamydia as well as hepatitis and HIV (neither of which is common) are acquired when the bacteria or viruses which cause the infections get into the inside of the urethra (the tube within the penis you urinate through).  On the other hand so-called "lesion diseases" such as herpes or syphilis can be transmitted through the skin on the outside of the penis or to other genital sites through direct rubbing or an infected lesion with another persons skin. For both herpes and syphilis however, over 80% of genital lesions occur toward the head of the penis which is the reason that condoms are so effective in preventing these infections too.  Nothing you have described however suggests that you have any STI, including syphilis or herpes.  

2.   See above.  A minority of genital herpes and syphilis lesions occur towards the base of the penis or, quite rarely at other sites of DIRECT (not indirect; STIs are NOT transmitted by transfer of infected material from one person to another by transfer of infection on the hands) contact.

I urge you, once again, to put your fears about STIs aside.  EWH

Hi doc. thank you for your reassurance. I ended up talking to my PCP and he agreed that this is a low risk situation. Given the time frame, that i would of had symptoms by now if i did have syphilis. He said he can't remember the last time he saw a heterosexual have syphilis and he has been in practice since 1999. Would you confirm my risk of infection was 1%? i've seen yourself and Dr. Hansfield say this or even go lower to .01%.

I realize this is just anxiety and guilt. also the fact that there is a 3 week incubation period so that is also in the back of my mind.

I do not think that you need to abstain from unprotected sex with your wife.

Once again, I urge you to move forward without concern.  EWH