[Question #12077] Risk Assessment

10 months ago

Married 36 year old male here. Sep 4^th single encounter with married 45 year white women school counselor with kids. Shes married for 10 years but sexless for 2. We tested negative HIV/Syphilis/Gon/Chlam before. Protected vag/anal sex. REMOVED condom penetrated slowly couple times to finish in her anus. Both retested anal swab/urine/blood on the 20^th. Both neg for Herp2/Gon/Chlam. Felt great post results. Per DrHH Trich doesn’t infect anus. Concerned now MGen. Symptoms started again. Constantly Inspecting 5 days post exposure Irritated meatus maybe, intermittent stinging/burning after urination/ejaculation. More before bedtime. Sometimes feels like leaking. Never had discharge. Urinalysis negative. Never WBC’s or Leukocytes. Urologist prescribed clotrimazole 2 weeks no improvement. Women was married before to cheater. Tested yearly post-divorce for peace of mind always negative. Pap smears regularly, colonoscopy/endoscopy never abnormal. Claims never had anything. Last anal sex was 2006 with her ex-husband. Realistic risk of MGen/STI from encounter? Would Lube help prevent infection? Does the length(1 min unprotected) slow penetration make difference in transmission? When burning during urination, is it the entire urethra or just the tip? Would MGen cure itself in 2 years? Are negative STI test and Urinalysis assuring?

H. Hunter Handsfield, MD

10 months ago

Welcome to the forum. Thanks for your confidence in our services.

If I were teaching medical students and residents about sexual relationships with little or no risk of HIV or other STD, I could use your situation. The nature of your partner, and your situation (married, age 36, negative STD tests, most if not all exposures condom protected) all speak to zero risk for all practical purposes. Because your risk is close to zero, Mycoplasma genitalium is not a realistic possibility and is mostly harmless anyway. You've spent too much time online-- the internet isn't your friend here -- and are over-relying on sourcesyou should ignore. M. genitalium is mostly harmless. Your "constant inspection" is the only reason or your minimal symptoms. You're looking too closely. I'm confident you are experiencing normal sensations that would not be bothersome or perhaps not even noticed except for your apparent anxieties over an entirely safe sexual relationship. To your specific questions:

"Realistic risk of MGen/STI from encounter?" Zero or close to it.

"Would Lube help prevent infection?" No, not at all.

"Does the length (1 min unprotected) slow penetration make difference in transmission?" Or "slow penetration"? No. These make no known difference in the likelihood of STI transmission. And the possibility your partner has a transmissible STI is close to zero anyway.

"When burning during urination, is it the entire urethra or just the tip?" Unknown, but I don't see that it matters.

"Would MGen cure itself in 2 years?" Probably yes, but no such research has been done.

"Are negative STI test and Urinalysis assuring?" Of course they are.

All is well here. You do not need testing for anything. Stop worrying!

HHH, MD

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10 months ago

Sigh of relief over here. Trust me when I say this, your words have greatly calmed my nerves. I literally read this message when it came in around 2:30am my time. I will not test nor will I ask the women to test anymore. I will also stay off the internet. I do have a follow up though. Ive seen other replies from you about Genital Focused Anxiety and how it can be the precursor to CPPS. You mention the pelvic muscles. Is that why us who have anxiety over stuff like this feel pelvic pain? Also I had a vasectomy 2 weeks prior to the incident. Could the pain be related to the vasectomy and coincidentally have fallen in line with the timing of my event?

H. Hunter Handsfield, MD

10 months ago

While CPPS is a well established entity -- albeit with controversies -- "genitally focused anxiety" is a term I have devised over the years both on the basis of my clinical experience and numerous forum users. Other sexual health experts have the same impressions from their clinical experience but might have other terminologies. In any case, there certainly are striking similarities and I think it likely that GFA evolves into CPPS some of the time. The main difference in symptoms seems to be how long they have lasted; most physicians would not classify a condition as "chronic" until it had persisted for at least weeks or months. (It would be interesting to identify a large number of folks with GFA and follow them to learn how many still had symptoms and could be classified as CPPS months or years later. It would be a difficult and expensive kind of research, though.

Why pelvic pain? Clearly there's a human tendency for discomfort to occur at anatomic sites people are worried about. People worried about their heart are prone to chest discomfort; fears of things like colon or pancreatic cancer will have abdominal complaints; and so on. It's logical for sexually related anxieties to have genital area manifestations. The physiologic mechanism probably is the same everywhere: stress results in increased muscle tension. Everybody understands "tension headache", which is real pain due to increased tension in scalp and neck muscles. Why not pelvic muscle tension?

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10 months ago

You have been an amazing help Doctor! I really appreciate everything you all do for us uneducated in the medical field. I personally feel regular physicians should come on this forum to learn from you all and not scare everyone with wrong/outdated information. I can say with certainty this was my first and will be my last encounter of this sort ever. Few minutes of pleasure are not worth the anxiety that comes with it. At least from a married standpoint Thanks again Doctor! Much appreciated!

H. Hunter Handsfield, MD

10 months ago

Human nature being what it is, you might want to be careful making behavioral pledges. But in any case, I'm glad to have helped; thanks for the thanks. Take care and stay safe.---