[Question #1799] Confused about STD potential risks

42 months ago

Dear Doctors, 

I'm a male (heterosexual) in his late 30s who is experiencing some dilemmas due to conflicted information on the safety of some sexual activities. I should start saying that outside my committed relation I would never seek any sexual practice that holds potential risks. But then the question would be: is there such a thing as 100% safety engaging in sex that is condom protected? I'll try to be more specific though. 

A few days ago I went to an asian massage parlor and as one thing led to another, the girl wanted to engage in sexual intercourse. She seemed very clean but I decided in that moment to refuse to have sex with her. Afterwards I started regretting this, although I knew I may have also regretted (or felt VERY anxious) if I had fully pursued my sexual instincts. There is a part of me that was telling me I was an idiot not to pursue my desire for this girl, and another part of me that was also telling me "what would have been the risk to have a condom-protected intercourse with her, after all?" 

1) If the condom doesn't break, is there a way viruses (especially HIV) can pass through the Latex material?

2) If the non-covered part of the penis does not come to contact with her vagina, is there still risk of (skin-to-skin) STDs?

3) Had I engaged in condom-protected vaginal sex, would I still have to be worried about having caught any STD as a result, with consequent need for testing?

As you can see, I'm very anxious to do something that would put me in a risky situation OR that should require any sort of testing afterwards. I'd like to do things in the safest way so that I can put any fear aside.  

Thank you for any clarifications about this and I appreciate the way you educate people through this website. 


Alex

Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago

Welcome to the Forum.  At present your questions appear to be theoretical and I will be happy to answer them.  Before I do however, I must comment that while some sex acts such as mutual masturbation are truly "safe" and are not associated with any risk for STI, other "safe" sex acts such as condom protected sex are only safe as long as the condom is used throughout the encounter and should the condom break, the act is no longer safe.  Thus there are grades of risk.  Further, all assessment of risk is statistical in nature, and all estimates of what is "safe" are just data-based estimates to which an exception could occur tomorrow.  I hope this perspective is helpful to you as you move forward with your decision making.


1) If the condom doesn't break, is there a way viruses (especially HIV) can pass through the Latex material?

No, viruses, including HIV and hepatitis do not pass through the latex or polyurethane that condoms are made from.


2) If the non-covered part of the penis does not come to contact with her vagina, is there still risk of (skin-to-skin) STDs?

There is a theoretical risk that if the non-condom portion of the penis skin comes in contact with a partner's infectious site, transmission might occur.  This is very rare but the possibility does exist and this can, rarely, occur.  STIs which might be transmitted in this way include, in their likelihood of occurring, HPV-genital warts, herpes, and syphilis.


3) Had I engaged in condom-protected vaginal sex, would I still have to be worried about having caught any STD as a result, with consequent need for testing?

If you had engaged in condom-protected sex your risk for STI and HIV, in general would be very, very low (I would guess certainly less than 1 in 100,000 and probably lower) but not zero.  Thus infection might be possible (just as you might be struck by lightening today) but the risk would be so loew that I would not necessarily recommend testing and would consider such an exposure essentially no risk.

I hope these facts and comments are helpful.  EWH


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42 months ago
Thanks for your very comprehensive and reassuring reply, Dr. Hook. At least now I can be sure that no viruses can pass through an intact condom. Regarding the non-condom portion of the penis that may come to contact with infected site, I'm aware of the risk. Years ago I caught HPV (despite condom-protected sex), and this didn't happen with a CSW but with an ordinary girl I briefly dated. 

In this respect, are HPV, Herpes and/or Syphilis transmitted through vaginal fluids that come into contact with the non-condom portion of the penis, or some vigorous skin-to-skin rubbing is required? I'm still very confused about this. Once I even happened to watch a short documentary in which a doctor was warning on how vaginal fluids can even transmit HIV when in contact with the non-condom portion of the penis/genitals, which seems totally in contrast with what I have read on this forum. 

Also, can one exclude any potential risk of Syphilis transmission if there are no visible sores in the woman's vagina? The non condom-protected potion of the penis would only come to contact with the visible part of the vagina, no? 

Your statistic of  of less than 1 chance in 100,000 exposure is indeed reassuring. It would be more likely to win the lottery, sounds like! I must admit that I tend to be scared (like others I'm sure) at the idea to engage in sexual intercourse (condom protected) with CSWs in general, because of the elevated vocabulary of viruses and bacteria they must be exposed to on a daily basis. I have read that picking up a woman at a bar is perhaps even more risky STDs-wise, but I cannot make sense of the fact a woman at a bar doesn't certainly have sex with a dozen guys every day like CSW do....Is my consideration of this totally irrational? In this respect, what would be the difference risk-wise between an inexpensive CSW and a very high-end one? 

Sorry for asking too many questions. 

Thanks again!

 
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago

Skin to skin contact rather than genital secretions appears o be the major method by which HPV, genital herpes and syphilis are transmitted. The rubbing/abrasion that accompanies most sexual activity is thought to enhance transmission but it is the direct contact that is most important.

Women can have syphilis lesions inside the vagina as well as on the outside.  Since the sores of syphilis are painless, such sores could be a source of infection during unprotected, but not condom protected intercourse.

the reason that picking up an undiscriminating woman at a bar may be a higher risk exposure than having sex with a CSW is that CSWs tend to be aware to their risks and have a business interest which makes avoiding infection a good idea.  On the other hand, a "pick up" may not take such care to be checked or to prevent infection.  EWH. 

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42 months ago
 Thanks again for your reply. When you say that "The rubbing/abrasion that accompanies most sexual activity is thought to enhance transmission but it is the direct contact that is most important", you mean the infected vaginal site has to come to contact with the non-condom protected penile shaft for the transmission to occur? If so, for how many seconds usually? 

What are the statistics to get herpes from a woman who has no visible outbreak?

The other day, after some condom-protected oral sex, we also had intercourse for a few minutes. I didn't come inside the condom but it didn't seem to have broken. Should I be concerned about anything? The non-condom protected penis may have only briefly touched her vagina.

Thanks and I know this is the last reply I'm entitled to.  
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
 Yes, and Infectious syphilis lesion must come into direct contact with another person skin for syphilis transmission to occur. There are no estimates however as to how long search contact needs to take for transmission to occur. It seems reasonable that organisms would be could be transferred immediately but the longer the contact the  more likely transmission is to occur. 

 There are no specific data to inform a person on how likely it is for herpes transmission to occur during unprotected contact with a infected person who has no genital lesions. We know that such transmission occurs. Our estimate is that this is a relatively rare event, occurring less once for every 1000 sexual contacts  with infected partners who have no active lesions at the time of intercourse. 

 If your condom was worn throughout sexual intercourse and did not break there is no meaningful risk for STI & HIV and I would not be concerned  or feel the need to be tested. 

 I hope my comments are helpful to you. As you point out this thread is now complete and will be closed later today.  EWH
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