[Question #13770] Assessing Gonorrhea, Syphilis, and HPV risks

21 days ago

She is a 29-year-old Russian woman living in Dubai. She works as a part-time escort, has a child, and her rate is 1,000 AED (270 USD) per hour. I went to her apartment. The encounter took place 11 days ago.

I want to understand the risk I took, especially for gonorrhea, syphilis, and other STDs, and what I should watch for.

The encounter included intense kissing with tongue, rimming performed by me (external only), and receiving an unprotected blowjob for about one minute.

We also had condom-protected vaginal sex. She was lying on her stomach and I was above her. I ejaculated very vigorously. Because of the semen volume and the downward angle during ejaculation and withdrawal, I saw semen flowing from the base of the condom. While pulling out, the condom seemed to slide off partially; the tip was nearly hanging out of her vaginal opening, and there was fluid everywhere with semen not fully contained. I couldn’t confirm whether semen entered her. She ran to the bathroom afterward, and when I asked if she could feel anything, she said, “How would I know?”

What is my degree of risk? Should I get tested now for gonorrhea and other STDs? If my wife wants sex today, should I proceed or wait for test results?

H. Hunter Handsfield, MD

21 days ago

Welcome back to the forum.

Looking at your three previous threads, it seems you should already understand that this was a very low risk exposure. Having had condom protected vaginal sex, and with a partner who statistically is unlikely to have any active STIs, there was little if any risk this time. I think you are describing partial withdrawal of your penis from the condom while it remained in your partner's vagina. Such events are not believed to increase risk -- i.e. you should consider this a well protected exposure. Whether or not any semen entered her vagina has no bearing on your risk -- only her risk, if you had an STI before this event.

For those reasons, from a medical/risk perspective I would not advise testing and it seems entirely safe to continue unprotected sex with your wife. Of course there are no guarantees -- the only way to be completely certain is to be tested and to not have unprotected sex with your wife until you know the results are negative. If somehow I were in your situation, I would not be tested and would continue sex with my wife. But of course you are free to be tested if it would give you greater reassurance than I have provided. If so, you can have a valid gonorrhea/chlamydia urine test 4-5 days after the event; and blood tests for HIV and syphilis in a few weeks. It's up to you.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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17 days ago

Thank you Doctor. I assume my questions stem from anxiety about missing other new details that might contribute to a change in the overall risk, so I value your reassurance. It seems to me, and forgive me if I'm wrong in assuming, that you only addressed the vaginal withdrawal. What about the rimming performed by me (external only), the cunnilingus with my tongue around the external lips of the vagina (tasted something metallic that wasn't outright offensive but was metallic in taste) and receiving an unprotected blowjob for about one minute? Particularly when it comes to Gonorrhea, Syphilis, and HPV. Thank you.

H. Hunter Handsfield, MD

17 days ago

Sorry to ignore the non-vaginal exposures. I did so partly because they are inherently low risk -- in fact, even though the vaginal sex was condom protected, that likely was higher risk than the rimming or oral sex exposures.

The main risk of rimming is intestinal infections, not STIs -- for example if your partner were infected with or carrying any of several common causes of diarrhea, gastroenteritis ("stomach flu", etc). Both cunnilingus and rimming are very safe in regard to all STDs, with gonorrhea probably the most frequent; and there's never been a known case of oral chlamydia or of acquiring HIV from such an exposure. The main risks from fellatio -- unprotected oral contact with your penis -- are gonorrhea, nongonococcal arthritis (often due to normal oral bacteria), and herpes due to HSV1. But all these are extremely rare. HPV is not a significant risk from any of these events; the highest risk for HPV was from the vaginal sex even though that was condom protected.

There are no tests for HPV in this situation, and the HSV blood tests are not sufficiently accurate to be useful. But if you would like reassurance about the most important STIs in this situation, you could have urine and throat swab testing for gonorrhea and chlamydia after 4-5 days; and blood tests for syphilis and HIV in a few weeks. However, your risks are low enough that I still do not recommend you avoid sex with your wife while you await your test results (if you decide to be tested at all).

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12 days ago

Thank you, doctor. One more follow-up question and the concern will be concluded. When I touched her vaginal area, there was a strong, musky smell that lingered on my hand. I later read that gonorrhea can sometimes cause a mushroom-like odor in women, which made me concerned because that's an accurate description of what I noticed. I didn't observe any discharge or other visible symptoms, but the smell was quite strong and distinctive, and it took time to leave my hand even after a vigorous wash. Should I be worried about this, and is this type of odor actually associated with gonorrhea or other STDs?

H. Hunter Handsfield, MD

12 days ago

You mis-learned something in your online searching. Gonorrhea is not known to cause vaginal odor. By far the main cause is bacterial vaginosis, for which odor (typically described as fishy*) is one of the most frequent symptoms. BV often accompanies other STIs, and so indirectly might be associated with increased chance of gonorrhea. However, this issue means little in comparison with the other factors discussed above -- low risk on account of condom for vaginal sex and little or no risk from rimming an infected person. Therefore, this information doesn't change my assessment and advice above.

* The fishy odor of BV in fact is caused by some of the same chemicals that cause the smell of decaying fish and some rotting meats. When you learn the names, you will never be able to forget them: two of them are cadaverine and putricine as in "putrid").They are produced by bacteria that overgrow in women with BV.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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