[Question #161] Extreme Anxiety/HIV & STDs Exposure

95 months ago
Dear Doctor, 
First of all, thank you very much for this great service that extends to so many people everywhere. 
Now to a small story of paranoia, I hope not. I might get into very specific details so i only hope you will be patient. 15 days ago, I had an encounter with an Armenian CSW in a middle eastern country called Bahrain. So, i had two protected vaginal Intercourse sessions along with some mouth, breast kissing and some rubbing with my fingers for the girl. The first session took less than 2 minutes and I came into the condom. At the end I noticed some white liquid at the lowest part of the condom (inside) that actually only covered like 60%. That liquid was actually like cum but i became concerned as I saw a drop of exactly like cum just downside of the girl's labia. I became paranoid and thought that might be someone's cum and asked but she said that she always uses condoms and explained that as her vaginal secretions which was strange for me. I said those last details because I was concerned that maybe some of her secretions or any secretions present there might of got into the condom. After that, she took a new condom after washing and started to roll it on me and at some point I saw she had quite longer nails which were on the condom as she put it on so I'm a bit concerned if the nails could compromise the plastic barrier in any way. We had vaginal Intercourse then for almost 6 minutes until I finished in the condom and pulled out. As far as i remember, the condom was fine as I took it out and the same also for the first condom. 
I'm almost sure that I'm overreacting to all of what happened but i need to have comfort from an expert in all details. 
In the past two weeks, I didn't notice anything out of the norm except the following:
- 6 days after I had an itchy urethra for like 3 minutes and then disappeared. Just one time. 
- 12 days after I started having chills, mild fever (max is 37.6), mild sorry throat and congested nose which later became runny with sneezing until like today but now I'm feeling better. Chills were only first night and day. 
- I noticed some acne in my face two days ago like four or five spots. 
- this one maybe it's there since long before but I never noticed it which is on my penis head one side there is like a small spot 3mm by 2mm that is brighter than the rest of the skin. It is just skin. 
- General feeling of itchiness that comes and goes each time in a place of the body.
- Lastly, 5 days ago I had like dull pain in the groin area at the top of pupic area just under belly button by 2 inches down and 2.5 on right that resolved the same day. 

After all of this:
1. Did I put myself at risk of any STD especially HIV ?
2. Are any of the health concerns or symptoms suggestive of any STD? 
3. Do i need to test for anything ? 

I'm really feeling bothering by too much details. I really appreciate your help. I'm feeling so anxious and stressed with thoughts of catching an STD.
Best Regards, 
H. Hunter Handsfield, MD
95 months ago
Welcome to the forum. Thanks for your question, which came in while I was logged in. Most users shouldn't expect nearly real-time replies!

Condoms work well, and and most of the protection doesnt depend on complete coverage of the penis. The most important thing is that your urethral opening and the head of your penis apparently were protected. A certain amount of skin contact, and contact with genital fluids, always occurs above the condom. 60% coverage of the length of the penis is actually pretty good; probably it's never better than ~75-80%. Fortunately, intact skin is pretty resistant to STDs. But of course not 100% resistant, which is why condoms work less well against STDs transmitted by skin-to-skin contact (herpes, HPV, syphilis) than those transmitted primarily by genital fluids (e.g. HIV, chlamydia, gonorrhea). Still, the large majority of exposures like yours don't result in any STD.

To your specific questions:

1) This exposure was low risk for all STDs and essentially zero risk for some of the most important, including gonorrhea, chlamydia, other kinds of urethritis (NGU etc), HIV, and viral hepatitis. The risk of herpes, syphilis, and HPV is higher, but still low.

2) None of your symptoms suggest HIV or any other STD. None would cause a single brief episode of urethral itching, and your 12 day symptoms are typical of a garden variety cold, influenza, etc, not STDs or HIV. No STD causes increased acne. I'm sure the penile bump is something you're just noticing because of anxiety, nothing new -- and the only STD that could cause a skin bump is a genital wart, and that can't appear sooner than a couple months after exposure. The itching and pubic area pain sound like the physical manifestations of anxiety.

3) There are no hard and fast rules about HIV and STD testing. From a strictly medical standpoint, testing is rarely needed after any single exposure, especially one of low risk (because of proper condom use). OTOH, testing can have psychological value: negative tests might be more reassuring than my advice, no matter how valid or science-based it is. If so, consider a urine test for gonorrhea and chlamydia (they are valid at any time) and blood tests for syphilis and HIV at 4-6 weeks. But honestly, if I somehow found myself in your situation, I wouldn't feel a need for testing and I would be continuing unprotected sex with my wife without fear of infecting her with anything.

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

95 months ago
Dear Dr. Handsfield, 

Thank you for your detailed assuring response. I'm so relieved to hear from you that HIV and Hep were not a risk. 
This is my last question:
You said there is a low risk from skin transmitted diseases like herpes, Syphilis and HPV. Given that I already passed 15 days since the exposure and as you mentioned none of the symptoms I had relate to STDs, should I still worry about those three ?

Thank you again Doc.
H. Hunter Handsfield, MD
95 months ago
There is no approved test for HPV in males. Even if there were, or if you find a lab that tests men, a new HPV infection probably wouldn't show up on testing (and for sure would not cause symptoms, e.g. warts) for at least a couple of months. But you probably have had HPV anyway, assuming you've had other sexual partners in the past. This event won't make any significant difference in your overall risk of HPV related problems or transmission.

The lesion of primary syphilis -- an ulcer called a chancre -- typically appears 10-20 days after exposure. So once you've gone 3 weeks without such a lesion, you're probably home free. But for 100% certainty you'll need a blood test. The syphilis blood tests are valid after 6 weeks.
H. Hunter Handsfield, MD
95 months ago
I forgot to mention herpes. Symptoms of a new infection typically show up within a week and very rarely beyond 2 weeks, so you're in the clear. Some infections cause no symptoms -- but that's often because people aren't paying attention. Anxious folks who are hyper-alert are likely to notice symptoms. And anyway, the risk is low for any single exposure, and testing for HSV is not recommended in this situation.

95 months ago
Dr. Handsfield, 
Thank you very much for your informative responses. Honestly, what you do and your colleagues should be an example for all doctors in the globe, such dedication and support in all forms. 
A final question or more of a conception to be validated for my own self: 
so, even if the flu like symptoms continue for longer periods, it is never an indication of any STD because of the almost non existent risk ?

Kind Regards,  

H. Hunter Handsfield, MD
95 months ago
Correct. Further, a "flu like syndrome" (which means various combinations of fever, headache, sore throat, muscle aching, and often cough, but not nasal congestion or sneezing) by itself almost never is due to STD. Some STDs may include such symptoms along with others, in particular may accompany genital blisters/sores in a new herpes infection. And of course such symptoms are the norm in those acute HIV infections that cause symptoms of any kind. They can accompany secondary syphilis, i.e. 2-6 months after exposure, but not the initial symptoms. Beyond those examples, I've never heard of "flu like" syndrome as an early sign of STD. At the same time, the large majority of such syndromes in fact are caused by [guess what!] flu, or flu-like respiratory infections. Even in people with high risk sexual events, the vast majority of "flu like" problems have nothing to do with the sexual exposure, just a coincidence. Undoubtely that was the case for you. The duration of the syndrome makes no difference one way or the other.

That will wind up this thread. Thanks for your kind words about our services. Best wishes and stay safe.