[Question #11619] Protected Encounter and Risk to Pregnant Partner
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13 months ago
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Good morning doctors, and thank you in advance for your time and response. I was hoping for your input on my current situation. Yesterday I had protected oral and vaginal sex with a CSW. Both of us were adamant about the use of a condom, with her confirming that she uses condoms with all other clients for oral and vaginal sex. She also clearly communicated that she is very safety/health conscious and gets full STI package screenings monthly and works closely with her doctor who is aware of her profession.
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13 months ago
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My understanding of reviewing this forum is that this situation would be considered very low risk. The use of the condom virtually eliminated the possibility of fluid STIs. While there is still a small potential of skin-to-to skin STIs such as herpes, syphilis, and HPV, the combination of condom use, lack of any sign of any lesions, and the CSW's history of safe sex, the possibility of these STIs is greatly reduced.
However, my wife is currently 9.5 weeks pregnant. Even though I know my encounter was low risk, I am very worried of the slight possibility of me having received one of the potential skin-to-skin STIs and passing it onto my wife and the baby.
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13 months ago
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Due to this added complexity, I was wondering if I could get your input on my situation:1. Do you happen to have exact percentages of the odds that I received a potential skin to skin STI from this encounter? 2. Assuming I did potentially receive an STI, do you happen to have the exact percentage of the odds of me infecting my wife and baby?
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13 months ago
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3. What is your opinion on me having unprotected sex with my pregnant wife?4. Do you recommend testing and if so, after how much of a waiting period?
5. If I have already been diagnosed with HSV1 (fever blisters as a child) does this have any impact on my possibility of receiving HSV2? Thank you again for your time and input. I greatly appreciate your experienced knowledge.
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Edward W. Hook M.D.
13 months ago
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Welcome back to the Forum. Thanks for your continuing confidence in our service. I understand that you feel particularly concerned because of your wife's pregnancy, as indicated by 4 rapid five posts in 4 minutes. That does not change that this was a virtually no risk encounter.
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As we have discussed in the past. most CSWs do not have STIs and the professional whom you interacted sounds particularly low risk. You use of a condom throughout both encounters reduces your risk for infection still more. Let's address your specific questions:
1. Do you happen to have exact percentages of the odds that I received a potential skin to skin STI from this encounter?
There are too many variables involved here to be able to calculate a precise risk however I can comfortably say that chances are more than 99.9% that you were not infected. Factors contributing to this is the low likelihood of infection on your partners, the condom use, and that most single exposures to infected partners do not lead to infection. Remember, most syphilis occurs among men who have sex with other men, not heterosexuals, even heterosexual CSWs.
2. Assuming I did potentially receive an STI, do you happen to have the exact percentage of the odds of me infecting my wife and baby?
Same answer.
3. What is your opinion on me having unprotected sex with my pregnant wife?4. Do you recommend testing and if so, after how much of a waiting period?
Continuing with unprotected sex with your wife is a personal choice. I would have no concerns.
5. If I have already been diagnosed with HSV1 (fever blisters as a child) does this have any impact on my possibility of receiving HSV2?
Your previous diagnosis of HSV-1 reduces your already low risk for HSV-2 acquistion somewhat, perhaps about 30%
Bottom line, your risk for any STI is quite low. You may chose to test for the peace of mind it provides. If you do, I anticipate that your tests will be negative. EWH
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13 months ago
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Thank you very much for your response Dr. Hook, I greatly appreciate it. I was pretty certain that you would consider my encounter to be low risk, but 99.9% chance of being unaffected is very comforting and reassuring indeed! (though again, I understand that is just an educated estimate and not meant to be taken as an exact figure).
To further my education/understanding as well as to help prevent me from feeling the need from asking questions in the future, what circumstances would need to be present for an encounter to be considered high-risk of STI infection? Besides the obvious factor of unprotected vaginal sex?
Also, do you happen to have a figure or another educated estimate on how successful condoms are at protecting against STIs in general, and then how affective they are at preventing skin-to-skin STIs specifically?
Finally, do you know an approximation of how much of the United States adult population is infected with STIs? I saw the CDC once post a stat saying that 1 in 5 Americans has an STI but that did not add up at all to other data that I was seeing the CDC posting; based on their other data the number would be vastly lower by a wide margin. I am assuming that this "1 in 5" stat is counting HPV, which virtually all sexually active adults already have?
I believe I would indeed like to test for HSV and syphilis before engaging with sexual intercourse with my wife even though I know now that the results are highly likely to be positive; just to be extra certain and cautious in protecting the baby. What is the soonest that I could take these tests and be confident in the results? Also I will save my third and final response until after I have received my test results, so that I can communicate them here.
Thank you again for all of your valuable time and information!
To further my education/understanding as well as to help prevent me from feeling the need from asking questions in the future, what circumstances would need to be present for an encounter to be considered high-risk of STI infection? Besides the obvious factor of unprotected vaginal sex?
Also, do you happen to have a figure or another educated estimate on how successful condoms are at protecting against STIs in general, and then how affective they are at preventing skin-to-skin STIs specifically?
Finally, do you know an approximation of how much of the United States adult population is infected with STIs? I saw the CDC once post a stat saying that 1 in 5 Americans has an STI but that did not add up at all to other data that I was seeing the CDC posting; based on their other data the number would be vastly lower by a wide margin. I am assuming that this "1 in 5" stat is counting HPV, which virtually all sexually active adults already have?
I believe I would indeed like to test for HSV and syphilis before engaging with sexual intercourse with my wife even though I know now that the results are highly likely to be positive; just to be extra certain and cautious in protecting the baby. What is the soonest that I could take these tests and be confident in the results? Also I will save my third and final response until after I have received my test results, so that I can communicate them here.
Thank you again for all of your valuable time and information!
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13 months ago
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*Apologies, I meant to say I know I will still test even though I know now that my tests are highly likely to be NEGATIVE.
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Edward W. Hook M.D.
13 months ago
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Factors associated with risk:
1. The presence of a visible genital ulcer
2. A partner who is unwilling to disclose of they have HIV or when they were last tested
3. A lower cost CSW who is met "on the street" or otherwise not associated with a place of business
The 1 in 5 figure was for adolescents in Georgia who were at high risk and may well include HPV
Please don't test for herpes- the tests are not good enough to rely upon in circumstances such as yours- too many falsely positive results, particularly among the more than 60% of Americans who already have HSV-1, the virus that causes cold sores. Further HSV blood tests are not even close to conclusive until 6 months after an encounter. Testing for HSV is best done with a PCR swab test IF visible lesions occur. Syphilis blood tests are more reliable but again you'll need to wait at lest 30 days and preferably 6 weeks for reliable results.
EWH
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