[Question #1206] genital wart and hiv transmission

99 months ago

I am a 25-year male and had 3 exposures with 3 female CSW in Thailand about a week ago. Two of the three intercourses were fully condom protected (both oral and vaginal). But for one time I had unprotected oral (no ejaculation) and then protected vaginal intercourse with the other CSW. I remembered that there were 2 or 3 suspicious rashes on her back, and am not sure if these were due to syphilis.

The condoms did not break/slipped off and the head and most areas of my penis were covered.

Then, one day after my trip I found a small wart (1-2 mm around) on the base (about 0.5 cm above the root) of the penis shaft, which is likely to be a genital wart because of its location (condom can’t cover). I went to see a dermatologist and was told that it is definitely a wart but not sure if is a genital wart.

Here I have two questions:

1. Is condom protected vaginal and unprotected oral sex still safe when there is a small genital wart onsite? Due to the wart’s location, condom couldn’t cover that area, and there must be some contacts between the area and CSWs’ genitals.

2. What about syphilis? When can I expect a conclusive result?

Thank you very much for your help.

H. Hunter Handsfield, MD

99 months ago

Welcome to the forum. Thanks for your question.

First, congratulations on using condoms for these non-monogamous sexual encounters, which therefore were safe. Oral sex is considered safe even without condoms; oral sex is always low risk for all STDs and zero risk for some. Of course, "safe sex" doesn't mean zero risk, especially for the STDs transmitted by skin-to-skin contact (HPV, herpes, syphilis). But still your risk was low.

Even among people at maximum risk for STDs, the vast majority of skin rashes are not syphilis. That you saw something that didn't appear right on one of the sex worker's back doesn't imply a significant risk of syphilis.

I don't understand your doctor's comment about genital versus non-genital warts. If a wart occurs on or near the genital area, it's a genital wart. The HPV types that cause common hand and foot warts just about never occur on or near the genital area.

To your specific questions:

1) Having genital warts (or other HPV infections) has little or no effect on STD risk if exposed. Your wart makes no difference in your risk of any STD, even though condoms don't cover it. The main STD risk associated with your wart is transmission of HPV to your partners. You should advise your partners, including sex workers, about your wart so they can make an informed decision to proceed or not. (That they are commercial sex workers does not reduce your responisibility to inform them. It's their right to make that decision, not yours.)

2) The chance of syphilis is very low, especially having used condoms for vaginal sex, despite the possible skin rash you saw. If you don't develop obvious symptoms within 3 week, usually a painless open sore of the penis, you can be quite confident you weren't infected. But if you would like lab test confirmation, you can have a conclusive blood test 6 weeks after the exposure.

Of course your genital wart should be treated. Most likely the dermatologist did that or prescribed treatment, but if not, contact him for further advice.

I hope this has helped. Best wishes and stay safe-- HHH, MD

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H. Hunter Handsfield, MD

99 months ago

The title of your question mentions HIV, but nothing in the question itself. There was no measurable risk of HIV from the exposures described, since condoms are highly reliable against HIV and oral sex is zero risk for all practical purposes. On the other hand, all non-monogamous sexually active people should be tested for HIV from time to time. If you haven't been tested recently, this would be a good time (when you have the syphilis test), while it's on your mind. But not because of this particular exposure.

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