[Question #10905] Recommendation for STD Screening

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18 months ago
I (female) was in a relationship with my partner (male) for 7 months and I was only intimate with him. He admitted to sleeping with another female while with me. I also suspect that he may have been with a man before but it’s only speculation. My partner has had numerous sexual partners in the past before me, at least 11. I never asked him to get tested for STD’s prior to intimacy with me as we never engaged in penetrative sex or intercourse. I never gave him Fellatio either. I I received cunnilingus from him 4 times total that I recall and it was always unprotected. Only one time, he attempted to put his penis on the opening of my vagina and tried to push in his penis for maybe 10 seconds but there was no full insertion (not even the head) or penetration and he was wearing a condom. Our genitals have definitely been in contact numerous times with no protection and to be specific; his penis would touch my buttocks, mons pubis area, outside labia, inner thighs with no condom. He rubbed his penis one time on my inner labia for a few seconds with no condom. My genitals definitely came in contact with his genital fluids even though he always remained outside of the vaginal opening (didn’t get inside). He did say he was screened for STDs twice last year but unsure when is the last time he got tested. His recent sexual encounter outside of our relationship is two weeks ago. Based on the sexual acts I engaged in with him, should I get STD screening? 
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H. Hunter Handsfield, MD
18 months ago
Greetings. Welcome to the forum.

All in all, you describe a low risk situation for all STDs, including HIV. Genital apposition/contact, without penetration, isn't risk free but all STDs are very rare after such exposures. It isn't contact with genital fluids per se that creates most risk:  the main STD bacteria and viruses evolved to require much more, such as exposure of certain cells that exist only inside the genital tract; vigorous rubbing to massage organisms into the tissues; and/or exposure to large amounts of infected secretions (like with ejaculation in the vagina). In addition, oral sex in general is low risk, and all STDs are rare following cunnilingus. Yet another reason for this is that oral STDs are uncommon -- far less common than genital infections especially.

That said, it seems your partner has been at risk, and I understand why you might not be confident in his testing history. 

Going to your core question, whether or not you "should" get STD screening:  I would say yes. Not because the risk is high; if you are tested, I would anticipate all results to be negative. In other words, from a medical/risk perspective, testing is optional and not required. However, many people sufficiently worried to come to this forum or otherwise seek such advice are more likely to be reassured by negative test results than by professional advice, no matter how expert it may be. (We don't take it personally!)

If you decide to be tested, the main tests to consider are a urine specimen (or vaginal swab) for gonorrhea and chlamydia; and blood tests for HIV and syphilis. Ideally, evaluation is done during a comprehensive pelvic exam; the physician can gain information clues by visual exam, evaluation of any vaginal discharge or fluid, etc. But lab testing alone, as just suggested, should be fine assuming you have no symptoms like vaginal discharge or odor, vulvar irritation, etc. Be careful if you choose a lab's "comprehensive" STD panel or some such combination of tests:  although seemingly a good deal, they often include unnecessary or misleading tests. In absence of symptoms I would suggest avoiding herpes testing for example; and for sure no tests for certain bacteria often included but almost never requiring treatment even if positive (like Mycoplasma hominis or Ureaplasma, for example). And your risk is zero for hepatitis B and C, so there is no point in those tests.

I hope this information is helpful. I'll be happy to comment on your test results if you go ahead with testing. In the meantime, let me know if anything isn't clear.

HHH, MD
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18 months ago
Dr. Handsfield- thank you for answering my question. I fully trust your expertise and I personally do not want to test unless I have to (there’s potential risk). I had a traumatic experience with false positive testing before so I am not looking forward to getting tested. 

1. Could you please clarify what STD’s could have possibly been transmitted though I understand you said it’s rare?

2. Do you mean massage organisms inside the vagina and exposure to ejaculation and fluid inside the vagina for transmission to occur? I had been exposed to a decent amount of ejaculation multiple times but it was always on some other part of my body not genitals (closest was buttocks). Also precum fluid did come in contact with my inner labia and probably the outside of vaginal opening too. There was vigorous rubbing for a few seconds too but not inside of my vagina.

3. How long should my partner wait after our last encounter to get a comprehensive STD screening panel? If his tests turn out negative, should I be confident that I am also negative with no need to test myself?
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H. Hunter Handsfield, MD
18 months ago
1) "Possibly" is a very broad qualification. I'll interpret it as "realistically", OK? The main ones for genital contact without penetration--from most serious to least--are syphilis, herpes and HPV. Syphilis is exceedingly unlikely unless your partner has male as well as female partners. Herpes is also very unlikely, and in any case the blood tests are unreliable so I wouldn't advice testing. HPV is common and most likely, but like all sexually active people you can safely assume you have been infected with HPV already and could be carrying it -- so these few contacts did not materially raise your overall chance of having HPV or having a health problem from it someday (like genital warts or an abnormal Pap smear).

2) By "massage" I mean vigorous rubbing of genitals together. It usually is necessary for transmission of all three infections just discussed, and it sounds like that didn't happen.

3) For gonorrhea/chlamydia, 3-4 days after his last sexual contact. For syphilis and HIV, 6 weeks. (There is no need for any others.)
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18 months ago
Dr. Handsfield,

Thank you for the clarification. It helped me understand better.

I’m curious, if realistically syphilis, HPV, and HSV could have been transmitted via the genital contact, can he or I only test for syphilis? Is your recommendation to add HIV, gonorrhea, and chlamydia is due to the oral sex maybe? 

Regarding HPV, I received Gardasil 9 vaccination at least 6 years before becoming sexually active. I’ve only had one sex partner but never had any penetrative sex with anyone in my life. Would you say that this encounter with my current partner has increased my risk of contracting HPV? 

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H. Hunter Handsfield, MD
18 months ago
Glad to hear you were immunized against HPV before sexually active. You are 100% protected from the HPV types that cause almost all warts and cancer. You can consider yourself free of risk entirely (but still should follow standard Pap smear guidelines as the years go by). This encounter has not raised your risk of HPV -- that's why you were vaccinated!

Testing for syphilis is the only practical option. As I said above, the herpes blood tests are too unreliable (and the chances of infection too low) to be worthwhile, and there is no test for recently acquired HPV and you're not at risk anyway. Syphilis also is exceedingly unlikely, but it's very dangerous and testing is accurate and easy, so it would be reasonable to test. Or for your partner to be tested for it.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful Best wishes and stay safe. And try not to worry about these events. They're a big nothing burger in terms of STI risk.
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