[Question #10722] Risks for STI's
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20 months ago
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Hello Doctors,
I have a bit of an unusual cirmanstance which brought me to post a question. About 3 years ago
I had a messy breakup with my girlfriend, and than from that point on made the decision about having no more serious
relationships for awhile. I decided I only wanted to interact with female companions only from a known trusted site,
and they all were all expensive by appointment only. I have had sex with approx 33 different CSW
(all women and absolutely no MSM) in the span of about 3.5 years some CSW were regulars which I have seen several
times, so maybe close to a total of 85-95 sexual encounters in about 3.5 years with all these different women.
My situation is probably a little different than most as I do self catherization on a daily basis and because of this
I am prone to UTI's and epididimydis more often. I am also allergic to latex which seems bother me very little with skin
contact to which I still choose to use latex condoms because I feel they're a safer option for STI's prevent and don't
really think minor skin irriatation is a concern over the risk of having a possible STI. Given my circumstances, and
I do not like living my life in fear I wanted to post a couple questions. If it helps I am 42.Over the course of all these interactions with about 85-95 different sexual encounters with 33 different CSW I have had both covered and uncovered oral sex both on the giving and receiving end, and penetrative vaginal; which was all covered, and nothing anal. I can only think of maybe one mis-step in all these interactions which involved the condom slipping off before completion. The provider did not have any more condoms available, and we were not close to being done. We decided to carefully put the used condom back on; as there was no evidence of breakage and continued until completion. Hopefully no risks? With my repeated interactions and UTIs mentioned earlier any concerns?
I have a bit of an unusual cirmanstance which brought me to post a question. About 3 years ago
I had a messy breakup with my girlfriend, and than from that point on made the decision about having no more serious
relationships for awhile. I decided I only wanted to interact with female companions only from a known trusted site,
and they all were all expensive by appointment only. I have had sex with approx 33 different CSW
(all women and absolutely no MSM) in the span of about 3.5 years some CSW were regulars which I have seen several
times, so maybe close to a total of 85-95 sexual encounters in about 3.5 years with all these different women.
My situation is probably a little different than most as I do self catherization on a daily basis and because of this
I am prone to UTI's and epididimydis more often. I am also allergic to latex which seems bother me very little with skin
contact to which I still choose to use latex condoms because I feel they're a safer option for STI's prevent and don't
really think minor skin irriatation is a concern over the risk of having a possible STI. Given my circumstances, and
I do not like living my life in fear I wanted to post a couple questions. If it helps I am 42.Over the course of all these interactions with about 85-95 different sexual encounters with 33 different CSW I have had both covered and uncovered oral sex both on the giving and receiving end, and penetrative vaginal; which was all covered, and nothing anal. I can only think of maybe one mis-step in all these interactions which involved the condom slipping off before completion. The provider did not have any more condoms available, and we were not close to being done. We decided to carefully put the used condom back on; as there was no evidence of breakage and continued until completion. Hopefully no risks? With my repeated interactions and UTIs mentioned earlier any concerns?
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20 months ago
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I have mentioned to my doctors about some encounters give or take a few weeks prior, and chlamydia and
gonorrhea tests have always been ran with no detection; so I am absolutely not concerned about these STI's as
possible exposures because every one of these tests were negative. However UTI's have always tested positive and
I am always treated with doxy or cipro, and not even sure if these antibiotics would clear up any other STI's anyways
even if I tested positive for other STIs.
My only concerns at this point are things like HIV, herpes, and syphilis; which I have never been tested for which
I really have had little concern for but value any feedback given the interactions described. I have had little reason
to believe I have herpes or syphilis as I have never seen any noticeable outbreaks, but I do not want to assume I don't
have it based on no symptoms. I suppose my biggest question is for HIV given the fact I wore a condom correctly about
94 times out of 95?
gonorrhea tests have always been ran with no detection; so I am absolutely not concerned about these STI's as
possible exposures because every one of these tests were negative. However UTI's have always tested positive and
I am always treated with doxy or cipro, and not even sure if these antibiotics would clear up any other STI's anyways
even if I tested positive for other STIs.
My only concerns at this point are things like HIV, herpes, and syphilis; which I have never been tested for which
I really have had little concern for but value any feedback given the interactions described. I have had little reason
to believe I have herpes or syphilis as I have never seen any noticeable outbreaks, but I do not want to assume I don't
have it based on no symptoms. I suppose my biggest question is for HIV given the fact I wore a condom correctly about
94 times out of 95?
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H. Hunter Handsfield, MD
20 months ago
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Welcome to the forum. Thank you for your confidence in our services.
You have a mixed picture in regards to sexual safety. You obviously are being very safe in your consistent use of condoms for vaginal sex; and I agree that oral sex is very low risk, even without condom protection. On the other hand, you have had an unusually large number of exposures and partners over the past three years, and of course those numbers elevate the risk. Standard advice in this situation is for routine testing from time to time: even if each event was near zero risk, there are such things as unrecognized condom failures. I would advise regular HIV/STD testing. There are no formal guidelines on frequency, but I would think every 3-6 months would be reasonable for both HIV and syphilis testing. You can expect negative results, but of course better safe than sorry!
Herpes blood testing is never recommended in absence of symptoms that suggest a new HSV infection; the tests simply are not good enough, i.e. the risks of false and misleading results generally outweigh any likelihood of a new positive result.
And despite your confidence about gonorrhea and chlamydia, it still would make sense to me to have a urine test for both of them at the same time as your syphilis and HIV blood tests.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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20 months ago
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Hello,
Thank You for your quick reply. Can I get some clarification on "unrecognized condom failures" past advice seemed to suggest that when a condom breaks / fails it breaks wide open leaving no doubt that it failed; which has never happened in these encounters. Am I missing anything else with any specific type of failure other than the one time slip off? I should also add
that during most of these interactions the condom would have been changed at least one or two times to help reduce the risk of such failures. I am trying to be as safe as possible given the repeated exposures.
I should clarify with the gonorrhea and chlamydia testing I was treated for a UTI / epididymitis about a month ago which aligned about 7 days after to my last sexual encounter, and was tested negative for both, but I was positive for a UTI hence why I was not concerned at this time. I tried to at the very least get an HIV test done by my infectious disease doctor about a year and a half ago who was than treating me for another condition. When I mentioned these similar scenario's to my doctor which than the exposures number were probably half than what was it is now. He advised against testing as he said though the risk is never zero, but it was unlikely due to me not doing any higher risk activities such as IV drug use etc. I don't know maybe with the amount of blood tests he ran back than maybe he would have seen something. This is where my mixed feeling about getting tested started.
Thank You for your quick reply. Can I get some clarification on "unrecognized condom failures" past advice seemed to suggest that when a condom breaks / fails it breaks wide open leaving no doubt that it failed; which has never happened in these encounters. Am I missing anything else with any specific type of failure other than the one time slip off? I should also add
that during most of these interactions the condom would have been changed at least one or two times to help reduce the risk of such failures. I am trying to be as safe as possible given the repeated exposures.
I should clarify with the gonorrhea and chlamydia testing I was treated for a UTI / epididymitis about a month ago which aligned about 7 days after to my last sexual encounter, and was tested negative for both, but I was positive for a UTI hence why I was not concerned at this time. I tried to at the very least get an HIV test done by my infectious disease doctor about a year and a half ago who was than treating me for another condition. When I mentioned these similar scenario's to my doctor which than the exposures number were probably half than what was it is now. He advised against testing as he said though the risk is never zero, but it was unlikely due to me not doing any higher risk activities such as IV drug use etc. I don't know maybe with the amount of blood tests he ran back than maybe he would have seen something. This is where my mixed feeling about getting tested started.
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H. Hunter Handsfield, MD
20 months ago
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The only available research and clinical experience is that people who say they consistently use condoms for HIV/STD prevention or contraception have roughly a 90% reduction in the outcome being avoided, not 100%. The reasons for incomplete protection can be anything from being untruthful (intentional or not, e.g. forgetting), improper use (e.g. transient penetration then putting the condom on only for ejaculation), unknown condom breakage, or who knows what. Obviously a cognizant user who recalls no failures and uses condoms properly has more reliable outcomes. But still it's common sense to be tested from time to time. Of course it's up to you.
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Of course having recent antibiotics active against gonorrhea and/or chlamydia reduces those risks. Still, if at the same times you seek syphilis and HIV testing you have not taken such antibiotics recently, it would make sense to be tested. Your doctor's guesstimate of a 50% reduction in risk might be about right much of the time, but I have no way of knowing that. FYI, doxycycline is 100% protective against chlamydia and syphilis, but not gonorrhea. There are few if any oral antibiotics that are reliable in gonorrhea prevention. OTOH, absence of symptoms (urethral discharge, painful urination) is strong evidence against gonorrhea but not chlamydia. In any case, when either test is done, the other is automatic.
My suggestions are only rough guidelines. You'll need to make your own decisions about what tests to have and their timing.
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