[Question #1145] STD concerns

48 months ago
Hello I am concerned about some recent encounters as I am a married man and don't want to put my spouse at any risk.  Over the course the the last few years I have received unprotected oral sex two times at a strip club in Massachusetts.  After the first time I tested negative for gonorrhea and chalmydia.  I didn't test the other time in the absence of symptoms.  This past summer I had protected vaginal intercourse with one stripper (she put the condom on with her mouth) and I received and gave unprotected oral with one other.  I was a bit more concerned from the last encounter as the stripper offered to have unprotected sex (she was a 21 year old Caucasian) who said she was clean.  I told her not without a condom and so we had oral sex instead and briefly she lap danced on my penis (although I was careful not to get the head of my penis near her vagina.  I know these are low risk encounters, but as an individual who take medication for anxiety I guess I am looking for reassurance.  Should I be tested for anything?  Is it safe to continue sex with my wife?  Many thanks.   
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Greetings and welcome to the forum. Forgive the unusually delayed reply.

Your own assessment is correct:  all the exposures described were low risk for STDs. Congratulations for your attention to condoms and other aspects of safe sex, including insistance on a condom even with the partner who offered unprotected sex. Oral sex, even unprotected, should be viewed as safe sex:  the overall risk of any infection is very low for all STDs and virtually zero for some (such as HIV and chlamydia). And even among the most sexually active persons, including sex workers, at any point in time most are not infected. That includes those who do not consistently use condoms. And even if infected, most STDs are transmitted inefficiently; even when a woman is infected, most exposures don't result in transmission to their male partners.

Having said that, you should indeed be tested for STDs. Not because of any one of these particular encounters, but because all people who are sexually active and non-monogamous should be tested from time to time. There is always the potential for an undetected condom failure, a forgotten episode of mistaken condom use, etc. Also, most persons anxious enough to come to this forum will gain reassurance from the negative test results, in addition to reassurance based on probability and statitistics.

But don't overdo it:  you don't need testing for every potential bacteria or virus that occasionally is sexually transmitted. For persons in your situation, standard, routine testing recommendations by all STD experts are for a urine test for gonorrhea and chlamydia and blood tests for HIV and syphilis. Ideally, you should see an STD experienced provider, such as your local health department or a Planned Parenthood clinic. But since you have no symptoms, it would be OK if you decide to test yourself, e.g. by finding an online STD testing service (of which there are several). But don't get sucked in to an expensive "comprehensive STD panel" of tests. Stick with the ones just mentioned. Wherever you are tested, feel free to return with a follow-up comment and let me know the results. Almost certainly they will be negative, but I'll be happy to comment if you would like.

I hope this has helped. Best wishes and stay safe--   HHH, MD
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48 months ago
Thanks Doctor. I was indeed planning to test.Quick follow up. After the gonoreah (sp) test and prior to the hiv and syphillis test would it be safe to have sex with my regular partner?  I understand I can do the standard blood tests at 6 weeks?  Thanks again 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
If somehow I were in your situation, in the absence of symptoms I would not stop having unprotected sex with my wife at all, hence no need to consider whether or not to resume sex at home. The testing approach I have suggested is independent of any particular exposure, just something I would do once a year or so. (In other words, I would take the very small risk of a positive result that would require 'fessing up to my wife.) However, if you want to delay testing (and perhaps forego sex with your wife until tests are negative), 6 weeks after the last extramarital event is the correct interval to encompass both HIV and syphilis. Gonorrhea/chlamdia testing is valid any time more than 3-4 days after exposure.

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48 months ago
Hi Doctor. Can I safely do a 4th generation test for hiv at 4 weeks?  I will do the other tests at your recommend times. If this doesn't close thread I will post all results once I have them.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
The 4th generation HIV blood tests are conclusive any time 4 weeks and more after exposure.

That completes the two follow-up comments/questions included with each new question, so this thread will be closed. You can rely 100% on the negative tests you will get -- you shouldn't need me to reassure you on that point when the time comes.

Best wishes and stay safe.

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