[Question #1817] Question about risk and odds

43 months ago
Hi, I have a question regarding the risk involved in my past activities, and if I should be seriously concerned about sti/std. I went wild over the last two years and had condom protected vaginal intercourse with 10 different woman.   Each of the women I was with only once.  I received unprotected oral from four of these women.  I also had unprotected vaginal penetration with one of these women which lasted one minute at most.  She told me she was sti free because she hadn't been with anyone since her child was born.   I also had one m2m contact in which I was penetrated anally with a condom.  he did not ejacualte inside.  I am wondering what sti I should be concerned about and what your definition of "low risk" is.....numbers might help.  Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. Thanks for your question.

On one hand, you have had a fairly active sex life, with several sex partners, which implies moderately high STD risk. OTOH, most exposures were condom protected for vaginal or anal sex, markedly lowering your risk, especially for the more serious and consequential STDs. Also, you don't mention diagnosis of any STDs, which is good. However, it really isn't possible to quantify the risk, i.e. to provide numberical estimates. Among other things, you say nothing about the nature of your partners, such as where and how you met them:  commercial sex workers? bar pick-ups? people you met at work or introduced by friends? These are important determinants of risk. And of course the risk varies for each of the many STDs -- but no numerical risk estimates are availble for most. Finally, absence of symptoms is good evidence against some STDs. For example, having had no urethral discharge or painful urination is strong evidence you never had urethral gonorrhea.

So rather than trying to estimate risk, my advice is that you be tested. Visit a local health department STD clinic, or a Planned Parenthood clinic, or your personal physicians and have a urine test for gonorrhea and chlamydia and blood tests for HIV and syphilis. You could also have a throat swab test for oral gonorrhea and rectal testing for gonorrhea and chlamydia -- although the chance of either of these, from a single episode of condom-protected receptive anal sex, is very low. I would expect all these tests to be negative, but better safe than sorry.

I hope this information is helpful. Let me know if anything isn't clear. Best wishes and stay safe--  HHH, MD

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43 months ago
Thanks for the reply.  To clarify on the points you mentioned, most of the women were CSW.  All of which were condom protected.  I did receive the unprotected oral from them.  The woman I had unprotected sex with was a friend and sti free from what I was told.  The man also said he was sti and hiv free before we had sex....I have no reason to think he is lying.  I would also like to clarify that I don't and haven't exhibited any symptoms in the last two years.....none that I am aware of anyway.  Also, if you could define what you mean by very low?  I have already gone to a doctor and will be getting a screening done on Monday. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
With this additional clarification, I would guess that there's under 1 chance ina thousand you will test positive for gonorrhea or chlamydia and under 1 in a million for syphilis or HIV. I stress it's only an educated guess, but you're going to be tested, so I don't see it matters what the odds are. The test results will be what they will be.

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43 months ago
Thanks for the response.  Moral judgement aside (not that would expect a moral judgement) if I continued this behaviour but always wore a condom during sexual relations, would you consider my actions low risk?  Regardless of the amount of partners?  Also, out of the scenarios that I described before, which would you be most concerned about as far as transmission of an sti?
Thanks for your help
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
I would place your single (?) unprotected vaginal exposure and the condom protected receptive anal sex exposure as the two highest risk events described.

Under the circumstances described, there will never be certainty that you won't catch one or more STDs. You would be at low risk for all STDs transmitted by genital fluids (HIV, gonorrhea, chlamydia, hepatitis B) but would remain at moderate risk of those transmitted primarily by skin-to-skin contact, i.e. herpes, HPV, and syphilis). And for sure you have already acquired HPV and will probably have new infections as well. But everybody gets HPV and you are at no higher risk than average. I would still recommend roughly annual testing for HIV, syphilis, and (just to be extra safe) a urine gonorrhea/chlamydia test.

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43 months ago
Thanks again, 
Now that I am waiting for my results my mind is playing tricks on me...I think.  Do symptoms tend to come and go when it comes to Urethra discomfort?  As I said earlier I have not experienced any symptoms that I am aware of before now.  Also, to add another point, I have not had a sexual encounter in two or more months.  The one I had at that time was protected but with unprotected oral.....which If I am not mistaken is a poor method for infection.  With gonorrhea cases being still fairly rare, I am assuming that oral transmission is extremely rare....am I correct in assuming that?  One last thing, if you get infected in the anus with chlamydia or gonorrhea can you pass it on through the penis to someone else?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
On and off discomfort is very unlikely to be due to any infection, which would cause continuous symptoms. 

Gonorrhea certainly can be transmitted by oral sex. Inefficiently, in that even when the oral partner has gonorrhea of the throat, probably there is less than a 10% chance of tranmission for any single exposure. If we guess that a maximum of 10% of your partner had oral gonorrhea at the time, that would make a 1% risk for each exposure. 99% of penile gonorrhea causes obvious symptoms within a few days (pus dripping from the penis, often substantial pain on urination). Thus in the absence of symptoms, the likelihood of gonorrhea would be something like 1 chance in 10,000 (0.1 x 0.1 x 0.01 = 0.0001).

Gonorrhea does not travel through the body to infect sites other than the original one. Rectal gonorrhea can only be transmitted by receiving rectal sex. For the same reason, it can be diagnosed only with a rectal swab specimen; urine testing says nothing about oral or rectal infeciton.

We are beyond the two follow-up comments and replies included with each forum question, and so this concludes this thread, which will now be closed. Best wishes and stay safe.

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