[Question #2140] STD General

47 months ago
I (straight male) for many years have been fearful of getting STDs/STIs and subsequently giving it and of the shame that would be attached; partly because I am unsure of how I could contract it. I've inquired in the past in various ways only to leave me riddled by ambiguous responses. I am looking for a conclusive answer in how I could get STDs in anticipation of eliminating the fear and agoraphobia so that I could move on and express myself freely in this area. I've never had STDs before at least I tested negative for it but every time I get involved with a woman Im plagued with intense anxiety about having it or that she has it and/or been given it by someone else she has been with. Please advise.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Welcome to the forum. Thanks for your question.

But I'm not entirely sure what sort of response will be helpful. I'll start by reminding you that although nobody wants any STD and many can be dangerous, the large majority of infections are mild or entirely without symptoms, and most are cleared by the immune system even if never diagnosed or treated. While common sense prevention makes, well, common sense, sexual expression and satisfaction also are important to human health -- ideally but not always in mutually committed relationships. I would never advise anyone close to me, or my patients, to forego sex entirely for fear of STDs.

I'll also add that you can safely assume you have had at least one STD, namely HPV infection -- perhaps several times. The large majority of all sexually active persons become infected, usually acquiring their first infection by the time they have had three total sex partners. This is true even for consistent condom users. (Condoms reduce but definitely do not eliminate risk of HPV.)

So what are the guidelines for "common sense" prevention? One size doesn't fit all. But you can select partners introduced by friends or in other social situations, as opposed to bar pick-ups and one night stands. Use condoms consistently unless and until mutual commitment is assured, and at that time perhaps get tested (along with your partner) for common STDs. Avoid sex when either partner has symptoms typical for many STDs, such as genital discharges, sores, or, for women, abnormal genital odors. Discuss risks and expectations with partners:  if both acknowledge past partners, and therefore at least a slight possibility of infection (if not tested recently), then in the event an STD shows up, the discussion about it shouldn't be all that stressful.

These brief comments can only get you started. Neither this nor any other online service can cover all potential approaches or deal with all the emotions, anxieties, and concerns you may have about it. Assuming these concerns continue, consider professional counseling. Numerous psychologists and other professionals specialize in sexual health; you should be able to find one by online searching, advice from your physician, and so on. Finally, spend some time on the main website of the American Sexual Health Association, the parent organization behind this forum (www.ashasexualhealth.org). The Centers for Disease Control and Prevention's STD information also is very good (www.cdc.gov/std).

I hope this information gets you started in a helpful way. Best wishes--  HHH, MD

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47 months ago
Thank you Dr. Handsfield. I did find comfort in your response. Ideally, I am interested in settling down mutually exclusive with someone. During the process of meeting someone, before I could get comfortable, before we would get tested eventually perhaps (certainly I), I suppose that I could use my best judgement in deciding when to have any sexual interaction. However, my best judgement is still somewhat ignorant of what is "safe" other than what may seem common sense. I think about kissing, oral sex, massages with happy endings, and lastly an appetent foot fetish. I may not feel comfortable doing certain things I would have done years back, but what are relatively safe behaviors for a single person?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Most of the sexual practices you mention carry little or no risk for any STD and are entirely safe. That includes kissing, massage, and any kind of skin to skin contact (or oral-skin or genital-skin exposure) that might occur in someone with a foot fetish. Unprotected oral sex is also considered safe sex, with far lower STD risk than vaginal or anal sex for all STDs and zero risk for some. Condom protected vaginal or anal sex is low risk, but not zero for skin to skin infections (e.g. herpes, HPV) because of skin contact above the condom; and of course risks all STDs in the occasional event of condom breakage. However, as implied in my reply above, I would endorse all these practices as representing a reasonable compromise between sexual fullfillment and sexual safety.---
47 months ago
Very well. Final remarks: How long after an exposure could I reasonably be certain that I have not contracted any STD? In other words, hypothetically, if I were given an STD, what is the latest in time could any infection surface - considering most STDS are mild, nonsymptomatic, and cleared by the immune system? Further, is it that simple to become infected? Lastly, you mention to withdraw from sexual activity if either I or my partner show common symptoms of STIs. One partner in the past, I think mutually exclusive (not too sure about her) had vaginal odor for a period. When it was brought up she took care of it with a soap of such I believe. It started to go away afterwards but it wasn't long before we parted ways (for other reasons). That was likely a bacterial infection correct? I want to conclude with a humble and respectful appreciation for what you do and being available for people who need this education and struggle with the topic. Best regards.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Whether or not you can be "reasonably certain" you didn't catch an STD depends largely on the nature of the relationship, specific sexual practices (vaginal vs oral sex, for example), and condom use. But assuming you fear a possibility your partner might be infected, most STDs cause few or no symptoms. Therefore, the only way to be "reasonably certain" is to be tested. But even this isn't foolprooof; there are no reliable tests for some STDs (HPV for example). But after any single exposure, you could always be tested for gonorrhea, chlamydia, HIV and syphilis, the four main STDs detected by routine testing.

Vaginal odor in women usually is due to bacterial vaginosis, an overgrowth of mostly normal bacteria. STDs are more common in women with BV, but BV itself causes no health problems in men and is not caught from (or passed to) male partners.

That concludes the two follow-up comments and replies included with each question, and so ends this thread. Thanks for the thanks about our services. I'm glad to have helped.

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