[Question #10514] STD and HIV Risk Assessment-USA

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22 months ago
Hello Doctors.

I recently had unprotected oral and protected vaginal intercourse with someone I just had met through mutual friends while at a bar. Both in our 40s. I know she is a bit promiscuous and I don’t know her status beyond her telling me, “she doesn’t have anything.” 

Before completion, I saw that my condom was covered in menstrual fluid. She was embarrassed. It was on the condom, on the base of my shaft, and near my stomach. 

I removed the condom, and she proceeded to use your hands and mouth on my penis. We stopped everything…I rinsed with a bottle of water near the bed. Talked for a minute and I used my hand that took off the condom to completion. I didn’t think about the fact my hand had her vaginal fluid and menstrual fluid on it moments before. 

What STDs could I have exposed myself too? Is there an HIV risk? Other STDs? 

Am I safe to resume sex with my regular partner? 

Do I need to test? What should my concern level be in this situation?

I’m past PEP timelines, but based on your other posts, I would imagine you wouldn’t advise it anyway. 

Thank you!

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Edward W. Hook M.D.
22 months ago
Welcome to our Forum.  Thanks for your confidence on our service and for your detailed description of the events.   This was a virtually no risk exposure.  As a generalization most persons, including those with multiple partners do not have STIs and when they do most single exposures to infected partners do not lead to infection.  

To get to specifics however, first you used a condom. Condoms provide excellent protection against STIs as long as they are worn throughout the encounter and do not break (which happens about 1% of the time).  Your genital exposure was no risk. 

Its not clear to me if your penis, and specifically the tip of your penis, was in her mouth or her mouth.  If it was not, then there is no risk from having your penis and genitals licked/kissed.  OTOH, if your penis was inside of her mouth there is a very slight risk of acquiring gonorrhea (IF she had gonorrhea of the oral cavity and IF your penis was inside of her mouth and IF the infection became established).

FYI, exposure to menstrual blood does not increase risk of acquiring an STI- the amount of infectious material in menstrual blood is about the same as the amount in genital secretions.  Further, transfer of genital secretions or menstrual blood on a person's hands or contact with genital secretions or mensural blood with skin does not put you at risk.

Bottom line, this was a low risk encounter with little chance of infection.  Testing is always a personal decision however I do not feel strongly that you need to test before resuming unprotected sex with your regular partner.  EWH
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22 months ago
Thank you Dr Hooks. I appreciate your quick response! 

Yes, my penis was in her mouth prior to protected sex and after. It was unprotected oral sex. Does that change your assessment on testing? Is oral gonorrhea common? 

We did kiss after all our sexual activity. Would that transfer oral gonorrhea to me? 

Also, just to confirm what I’ve gathered from your response …no risk of HIV and minimal to zero risk of other STDs other then this oral gonorrhea we are addressing. Is that correct?
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22 months ago
Also to be clear, I did masterbate with the hand that took off the condom which had vaginal and menstrual fluid. 

Thank you for allowing me to add those pieces of info. 
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Edward W. Hook M.D.
22 months ago
That you received oral sex slightly increases your risk for gonorrhea but only slightly.  You do not mention symptoms so I presume there are none.  This combined with the overall low risk of STI acquisition from receipt of oral sex still makes it unlikely that you have gonorrhea (or any other STI).  I addressed your concerns about kissing above- no a risk.

I understood the sequence of events with the removal of the condom and masturbation- it was no risk, really!

Correct- no risk for HIV.

It's clear you're having trouble moving forward here.  Testing, while not necessary in my opinion, might be reassuring.  I an confident if you test that your results will prove that you did not acquire gonorrhea or any other STI from the events you describe.  If you choose to test, a urine test and throat swab for gonorrhea will be negative.  EWH
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22 months ago
You’re correct. I’m was just very nervous. It was dark, I didn’t see the blood right away, masterbated, and it  (menstrual blood)was everywhere. 

Thank you. Glad to know you feel that I would be in the clear. I have resumed with my regular partner.