[Question #10537] Risk Assessment & Next Steps

22 months ago

Dear Experts,

Thanks for the forum, and I hope you all are doing well.

I had protected sex with a new partner (me, male and she female)

Twice, one time, like 5 minutes, and soft, the second time, 10 minutes, a bit more intense. The condom was rolled to the base and did not break.

I am male circumcised, and in the vaginal area, she had no, let's say, physical blister symptoms or anything else that seemed problematic.

I shaved my pubis area but had a bit of hair like a but have a bit of pubic hair. My background is American, and I tested for all STDs negative in the past. She is from Turkey, but we met in Germany, where we work. She has had four partners (unprotected and never been tested) and says she has never had symptoms before.

So, I have a couple of questions so far:

STDs like Hiv, Hepatitis, Chlamydia, and gonorrhea should be okay since the penis head is covered.

How likely is my risk of herpes/Syphilis?HPV?

I recently broke up with a girlfriend but plan to get back together. Can I proceed to have unprotected sex with her, or should I get tested? How would you asses the situation, and should I be on the lookout if symptoms develop, lest, say, the base of the penis or pubic area? Thank you in advance for your help.

Edward W. Hook M.D.

22 months ago

Welcome back to the Forum. Congratulations on the practice of condom protected sex- it will do much to greatly reduce your risk of STIs.

Your risk from the encounter you describe is minimal. Your partner is relatively low risk and most people do not have STIs- when partners do, most encounters do not lead to infection. A condom worn throughout sex that does not break virtually eliminates any risk for gonorrhea or chlamydia, and dramatically reduces your risk of other STIs such as syphilis and herpes if your partner happened to be infected which is unlikely.. As far as HPV is concerned, if you are not already vaccinated, you probably already have it - over 80% of sexually active, unvaccinated persons do. In most cases, when HPV is acquired is is an innocuous, self-limited process which will resolve on its own if present. REgarding your specific questions:

STDs like Hiv, Hepatitis, Chlamydia, and gonorrhea should be okay since the penis head is covered.

See above- virtually no risk.

How likely is my risk of herpes/Syphilis?HPV?

See above. Minimal risk. FYI, over 80% of HSV and syphilis lesions occur on the penis so your condom reduced this risk a great deal in the unlikely circumstance that your partner had one of these infections.

I recently broke up with a girlfriend but plan to get back together. Can I proceed to have unprotected sex with her, or should I get tested?

See above. This is not something I would be too worried about. Testing is always a personal choice. If you are going to test, the most important tests to have would be a urine test for gonorrhea and chlamydia and you can test for these infections accurately any time more than 3-5 days after your encounter..

How would you asses the situation, and should I be on the lookout if symptoms develop, lest, say, the base of the penis or pubic area?

See above. This was a relatively low risk encounter. STIs occurring in the pubic area/base of the penis are quite uncommon.

I hope that this information is helpful. EWH

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22 months ago

Thank you Dr. Hook,

I appreciate your feedback. In this case my risk was minimal as you say and wont pay too much attention.

I would be assuming if I do not develop any symptoms in a week or two i should be fine.

Just some follow up questions if thats ok?

I had some cuts in my fingers, from biting my nails and things like that, and of course i did stimulated her, would that play a risk if any? (Probably not but hey doesn't hurt to ask)
I did wore a condom, so and it did not break, that means I should be good on lets say Chlam & Gono, the testing would be purely lets say, peace of mind right? Would that also include HIV?
Although I am planning to resume my old relationship, we have had our ups and downs. In case I go back to the dating world. Condoms of course are a must, but for example oral sex and things like that. Unprotected oral is risky or it would only be risk if you now the partner has symptoms? Asking since its a scary place out there lol

Thank you for your time and wisdom, I will probably follow up in like 10 days or in case I have some new questions.

Hope you enjoy the weekend!

Kind Regards/ viele grüße from Munich

Edward W. Hook M.D.

22 months ago

Thanks for your thanks. I'm pleased my comments have been helpful. I'll respond to your follow-ups below. As I suspect you are aware, we provide up to three responses to each client's questions, so waiting a week or 10 days until using your final follow-up may be a good idea. FYI, if you were going to develop herpes lesions, they would appear within 10 days of your exposure.

Now on to your follow-up questions:

I had some cuts in my fingers, from biting my nails and things like that, and of course i did stimulated her, would that play a risk if any? (Probably not but hey doesn't hurt to ask). You are correct. Cuts or abrasions on your fingers, no matter how recent would not put you at meaningful risk for any STI.
I did wore a condom, so and it did not break, that means I should be good on lets say Chlam & Gono, the testing would be purely lets say, peace of mind right? Would that also include HIV? Your condom protected you virtually completely against gonorrhea, chlamydia, HIV and hepatitis.
Although I am planning to resume my old relationship, we have had our ups and downs. In case I go back to the dating world. Condoms of course are a must, but for example oral sex and things like that. Unprotected oral is risky or it would only be risk if you now the partner has symptoms? Asking since its a scary place out there lol. Many person with STIs are unaware they are infected, either because their symptoms are minimal or totally absent. Thus the absence of symptoms does not assure you that an STI is not present. Presuming that as you re-start your prior relationship you are in a position to have such a discussion, perhaps you could suggest that as you get back together you each get tested (maybe even going together for testing) so there would be no hesitancy or concern about something that might have occurred during the interval you were apart.

I hope this information is helpful. Take care. EWH

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21 months ago

Dear Dr. Hook,

Once again, thank you very much for your help.

It has been 9 days since my encounter, close more to 10 and still no obvious symptoms of any kind of STD,

I tested for Gono and Chlam today and will have my results by Friday. As well I Have an appointment with my urologist for a check on Thursday (12 days after exposure) I have some questions and then I will let the thread end.

1. Should I test at six weeks for HIV and Syphilis? The condom the first time was intact and the second time I did not really checked it but it did not burst open or anything that I recall.

2. Herpes on the other hand if I do not show symptoms by the two week mark, should i assume I was not infected?

3. I have had some ingrown in the pubic area but they do not hurt or anything and ive had them before, they do not look like the pictures online (water blisters)

4. I did get back with my ex but do not want to tell her of this event. Should I just avoid sex until the six week mark? Or resume unprotected sex with? (she was not with anyone in this time)

5. Once again, thank you so much for the forum and you all offer a great service.

Kind regards from Munich

Edward W. Hook M.D.

21 months ago

Thank you. I am confident that your follow-up tests will show that you were not infected. I'm glad that you are seeing a urologist as well. In response to your final follow-ups:

1. Should I test at six weeks for HIV and Syphilis? The condom the first time was intact and the second time I did not really checked it but it did not burst open or anything that I recall.

As I said earlier, there was virtually no risk form the exposure you describe. I would have no concerns whatsoever about HIV and almost as little concern about syphilis. If I were you I would not bother additional testing for syphilis or HIV.

2. Herpes on the other hand if I do not show symptoms by the two week mark, should i assume I was not infected?

Correct.

3. I have had some ingrown in the pubic area but they do not hurt or anything and ive had them before, they do not look like the pictures online (water blisters)

Folliculitis (ingrown hairs) are more common is the pubic region than other genital sites. They do not pose a risk.

4. I did get back with my ex but do not want to tell her of this event. Should I just avoid sex until the six week mark? Or resume unprotected sex with? (she was not with anyone in this time)

If I were you, I would not worry about unprotected sex with your prior partner. Should your tests on Friday come back positive, you'd need to tell here but this is most unlikely.

5. Once again, thank you so much for the forum and you all offer a great service.

Thanks for your thanks. I'm pleased that the information I have provided has been helpful. EWH

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