[Question #1987] Confused about potential risks

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86 months ago
Dear Doctors:

 

Thank you first of all for the great information and services you provide through this website. I have gained a lot of knowledge reading your online answers to the various sexual health topics.

 

I’d like to have your feedback on two recent sexual encounters I had with a CSW. Actually, I met this Asian girl at a massage parlor in NY, and while the first two times we only engaged in mutual masturbation and condom-protected oral sex, some three weeks ago there was also a very brief protected vaginal intercourse and the same happened (in a longer form) 10 days ago.

 

I asked her whether she has got tested for STDs and she told me not to worry. I don’t trust what she said blindly, but from my position I think to have been super careful in the vaginal sex I engaged in with her. Basically, I avoided any vigorous rubbing of the non-condom protected penis against her vagina, and in this respect I don’t even think there was so much contact at all. Also, I didn’t see any signs of herpetic rush in her vagina.

 

The condom remained intact and I checked this very carefully after the ejaculation. With my high level of attention, would you say that there are still potential risks to contract STDs in this sexual activity (i.e. condom-protected sex with minimal or no friction of the scrotum and uncovered penis against the vaginal site)?

 

I wouldn’t want to play any Russian roulette in this and feel that if such an encounter should happen again with this or another girl I can be confident to have had totally safe sex.

 

Obviously, the girl in question sees numerous clients every day, and I’m sure this exposes her to different risks. One thing I can say, however, is that she seems to engage in protected sexual activities. The 2nd time I saw her she wanted to give me an unprotected blowjob but I asked her to use a condom.

 

Anyway, my main question is: as long as the condom remains intact, is the sexual activity I describe safe in all respects?

 

Thank you so much!
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Edward W. Hook M.D.
86 months ago
Welcome to our Forum. I'll be pleased to comment.  Let me start by complementing you on your practice of safe sex.  It will keep you safe.  Regarding the exposures you describe you can be 100% confident hat you did not get an STI from mutual masturbation, irrespective of whether any of her genital secretions came into contact with you.  Mutual masturbation is completely safe sex with no risk for any STI.  As for your receipt of oral sex and your single brief episode of vaginal sex, again there is virtually nothing to worry about. I say this first because most commercial sex workers are quite careful and get tested regularly, making it unlikely that your partner had an STI of any sort.  Even if she did, even without a condom, most exposures to infected sex partners do not lead to infection and when a condom is used, that risk gets close to zero unless the condom breaks. From the sounds of things that did not happen since when condoms fail they break wide open leaving no doubt that they failed.  if your condom appeared intact after sex and was worn throughout the exposure, be confident that it did its job and you did not get an STI.

Finally since it apparently has been several weeks since your exposure, the absence of any symptoms is further evidence that you did not get infected. 

At this time I think it is reasonable to presume that you were not infected by the exposure that you describe.  If you are concerned, you could have a urine test for gonorrhea and chlamydia but this would primarily be for reassurance as I am confident that you did not get an exposure from the exposure you have described.  EWH
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86 months ago

Thank you for your detailed assessment, Dr. Hook. I’m glad to have learned something about “safe sex,” thanks to this excellent website as well.

Your reply suggests that I ask more specific questions this time.


1) Doesn’t the transmission of gonorrhea and Chlamydia require infected fluids to enter the penile urethra? I thought that these are not STDs that are transmissible skin to skin. So, if the condom remains intact, can one rule out completely the possibility of catching either one?


2) More specifically about skin-to-skin transmission of STDs, like I mentioned in my message, I was very careful in preventing frictions of the non-condom protected penis against her vagina. I should add that this excessive level of attention did make the sexual experience less enjoyable in a way. My question here is: as long as the woman presents no visible signs of rushes or outbreaks, is it even so necessary to be worried of the slightest skin contact with the vaginal site? I recently read that the penile skin and scrotum are not mucous membranes.  


3) Is it safe to continue seeing this same woman if I adhere to the kind of safe sex I had before with her? What would be the worst case scenario for me using a condom that remains intact?


4) I have read before on this forum the risk distinction in having sex with escorts who receive by appointment versus brothels and street prostitutes. This obviously implies that the last two categories present more potential risks. Is it because high-end escorts take more precautions, or because it’s more likely they see (rich) clients with fewer risks of STDs?


Thank you once again! 

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Edward W. Hook M.D.
86 months ago
1.  Correct
2.  Correct.  Unless lesions are present, there is no reason to worry about skin to skin contact.
3.  See above.  condom protected sex is safe sex.  If you continue to use a condom and it does not break, you should not be worried.
4.  Both are likely explanations for fewer STIs in "higher end" commercial sex workers- they take more care of themselves and it is likely that their partners are less likely to be infected.  EWH
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86 months ago
Thanks again Dr. Hook. Your answer is reassuring, as the way most websites talk about condom protection looks as though they work only to a certain degree (high as it may be, but not 100%). In this respect, the reassurance I needed is that bacteria and viruses don't pass through intact latex.  

Speaking about latex and condoms, do you know if adding a water-based lubricant to lubricated latex condoms can cause them to break?  

Regarding your reply to point #2 of my second message, I wanna make sure I interpret your words correctly: "Unless lesions are present, there is no reason to worry about skin to skin contact." So, you mean that as long as I don't see signs of herpes or HPV the friction of my uncovered penis and scrotum with her external genitalia shouldn't cause infections. 

My last questions are: 

- Can deep-kissing someone have health consequences I should know (e.g. Gonorrhea, Herpes, HIV, etc.)?

- Does anal sex with condom present more risks than condom-protected vaginal sex?

Thank you!! 

 
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Edward W. Hook M.D.
86 months ago
This is the 3rd reply to your questions, as a result, as per Forum guidelines, this will be my final respnse to your questions.  After I post this question, this thread will be closed in a few hours.

Condoms remain the most effective means of preventing acquisition of HIV or other STIs if exposed.  The do fail less than 1% of the time by either breaking wide open or coming off during sex.  they also may fail if not worn throughout sex.  Water based lubricants to not affect condom performance and from a theoretical perspective could even possibly reduce the risk of breakage .  On the other hand petroleum-based lubricants such as oils and Vaseline can weaken condoms an increased the risk of breakage.  When they do break, condoms break wide open leaving no doubt that they have failed. 

Your summary about my comment related to skin to skin contact is true for all STIs other than HPV.  HPV is more complex and far beyond the scope of this question.  I would not worry about HPV however.  You can learn more about HPV by reading other posts on this site related to HPV (in the title).

There is no risk for STI from kissing of any sort, including deep kissing.

The risk for condom breakage with anal sex is higher than for genital sex but otherwise is not of higher risk than condom-protected vaginal sex. 

This thread is now over and will be closed in a few hours.  EWH
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