[Question #1470] Many low risk exposures - risk?

45 months ago
Dear Dr., for the last 6 weeks I messed up my life. I have been with 16 CSW and received erotic massages. I did not have vaginal, anal or oral sex but had intense mutual masturbation, fingering them, handjobs and body-to-body-massages (think it is called frottage). I know that basically with that I might still qualify for "low risk". I just worry a lot that a basically low risk is multiplied by the many exposures and becomes then substantial. I am thinking about getting a std check-up in 6 weeks but still think about the right strategy. With this background here are my questions:
1) What do you think about the multiplied risk and my idea to get tested?
2) I cannot talk to my wife about it (she is deeply religious), but she would be suspicious if I totally resist sex. Can I responsibly have sex with her?
3) I am actually head of a big German organisation, responsible for many people. At the moment I cannot properly function and make mistakes.. I know it is somehow beyond the scope of this forum but from your vast experience, can you give me some advice how to get through the "window period" without a breakdown?
Thank you very much. Keep up this important work!
Karl  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome back to the forum. But I'm sorry to see you remain so concerned following Dr. Hook's reasoned, science-based reassurance. I can confirm all he said. I will add that it is true some STDs (primarily syphilis, herpes, and human papillomavirus [HPV] infection) are transmitted primarily by skin-to-skin contact, but that doesn't meany any and all skin contact. Exposure of non-genital skin is virtually risk free even for these STDs. Without overt sores or other moist skin lesions, no transmission occurs. That includes body to body rubbing and hand-genital contact of all kinds. To your questions:

1) With your corporate responsibilities, you're obviously able to think objectively about these risks. Let's speculate there is some extremely low risk of transmission. Let's say one chance in a million. (Even this might be too high.) If so, 2 exposures raises the risk to 1 chance in 500,000. Ten exposures would bring the risk to 1 in 100,000. And 20 exposures, perhaps an approximation of your experience with 16 CSWs, still leaves the odds overwhelmingly in your favor at 1 chance in 50,000. Still far too low to be tested for anything. Further, your risk is lower still, since you have had no symptoms to suggest any infection. The risk of a false positive test result is far higher than the chance you were infected with any STD.

As this implies, I recommend against any STD testing at all. What were you planning to be tested for anyway? Syphilis? No chance. HPV? No test available, and we all have it anyway. Herpes? Unlikely in the absence of symptoms; the tests sometimes give false results; and 10-50% of the population has a positive result due to past infection. (Data from the US, but I imagine Germany isn't much different.) Even if positive for HSV, it would not implicate your recent exposures. That said, if you simply must be tested for its increased reassurance value, have blood tests only for HIV and syphilis, expecting negative results -- but with risk of confusing and upsetting positive results that would have nothing to do with your recent exposures.

2) You can and should continue sex with your wife. If I were in your circumstances, that's what I would do.

3) As you have predicted, this is beyond the scope of our services. We can offer facts and probabilities, but the rest is up to you. Still, try to separate your guilt and shame over some sexual decisions you regret from the medical consequences of those decisions. They aren't the same. Deal with the former as you need to, but you truly can disregard the latter. Finally, schedule a lovely dinner with your wife, bring flowers, and have a very fine bottle of wine. (I highly recommend a 2000 Bordeaux.)

Thanks for your kind words about the forum. Best wishes--

HHH, MD

---
---
45 months ago
Dear Dr. Handsfield, thank you ever so much for your reasoned and kind advice. My wife and me agree that the 2000 Bordeaux was delicious. I keep the rest to myself and move forward. Best wishes for the Christmastime and a happy and healthy 2017. Karl (no answer expexted)
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Best wishes to you as well. So glad you enjoyed the wine! Merry Christmas.

---