[Question #2420] Escort incident

97 months ago

Hi Dr,

I’m happily married in the UK but had a moment of madness with an escort 23 days ago. I booked her to come to my hotel – she wasn’t ‘high class’ but seemed ‘clean’ in that she even used a condom to masterbate me.

No vaginal or oral sex took place, she masterbated me with a condom on, I masterbated myself WITHOUT a condom on and fingered her. My concern is that immediately after fingering her (fingers in her vagina) I touched my bare penis to carry on masterbating but ejaculated immediately. I then used the finger I’d had in her vagina to wipe semen off my meatus so essentially my finger rubbed my meatus on several occasions – up to 6 times say - just seconds after being in her vagina.

2 days and 5 hours after the incident (so 21 days ago) I masterbated at 8am and ejaculated. When I went to the bathroom 4 hours later at 12pm I checked my penis head and noticed what looked liked a small amount of semen on the tip of my penis which was new and which I wiped away.

I haven’t noticed any wetness in my boxers but haven’t been looking at the end of my penis (I am uncircumsized), including when in the shower or when using the bathroom. However, I did check purposely every 2-3 hours from 9am to 7pm yesterday (22 days after the incident) and didn’t see any secretion at all. I didn’t check immediately upon waking or for a couple of hours after however.

1. 1. Is there any meaningful risk here to warrant urine testing as I’ve read hand-to-genital contact is theoretical risk only and secretions would need to be massaged in to the urethra for there to be a risk. Would the fact I’d wiped my meatus several times count as ‘massaging in’?

2. 2. Do you think the secretion I noticed was just semen from that had been in my urethrea from the ejaculation a few hours before, despite having urinated several times in the 4 hours previous, and isn't suggestive of NSU?

H. Hunter Handsfield, MD

97 months ago

Welcome to the forum. Thanks for your confidence in our services.

Your opening comments suggest you might have seen comments on the forum that female escorts tend to be safe partners, with low rates of HIV and other STDs. That your partner was not "high class" might be a marker for somewhat higher risk, but still I would guess it is very unlikely she has HIV or other active STDS. But even if she did, you describe totally safe sexual practices. To your specific questions:

1) You are seriously overthinking the mechanics of HIV/STD transmission. The notion that one's own hands might be contaminated with a partner's genital secretions, and then transfer infection to one's own genital area through masturbation, is not scientifically supportable. Even with full-on unprotected intercourse, lasting several minutes, most STDs are inefficienctly transmitted -- that is, most such exposures don't result in infection. The STD bacteria and viruses evolved so that intimate contact with large amounts of them is required for transmission: between dilution and drying, there is no realistic chance your hands were sufficiently contaminated to be a risk of self-inocluation.

2) Having not been there, I cannot judge the small amount of possible secretions you noticed. However, if you had urethritis you would nto have only one or two episodes of discharge, or only intermittent. You would be noticing stains on your underwear and probably seen visible dripping without having to examine yourself. Indeed, we always strongly advise against self examination: anxious persons tend to be more sensitive and aware of their own normal physiology, such as occasional urethral moisture. Also, repeated "stripping" the penis in a search for discharge can irritate the urethra, with painful urination and/or scant discharge due to the minor trauma.

Don't confuse your apparent guilt or shame over a sexual decision you regret with the STD/HIV risks of that decision. They aren't the same. You really needn't worry about any disease consequences. I recommend against self examination or testing, and that you continue your normal sexual practices with your wife. She will not be at risk.

I hope this information is helpful. Best wishes and stay safe-- HHH, MD

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97 months ago

Thanks Doctor, that's very helpful. Some additional info below:

- I did in fact notice some new stains in my boxer shorts this morning (what looked like dry semen stains) but I didn't ejaculate yesterday and don't remember having an erection in the night This was the first time I've checked my shorts.

- I've felt what could be described as an obvious 'tickling' sensation in my urethra on 3-4 separate occasions over the last couple of weeks which last for c.20-30 seconds and then go

Follow up Questions:

1) You understand that I would have had wet vaginal secretions on my fingers that within a few seconds (say 3 seconds) came into direct contact with my meatus with several wipes of my finger right across it (no tissue used) and this doesn't change your advice re. meaningful risk?

2) You mentioned that the secretion would have dried but given there was no more than 3 seconds between me fingering the girl, touching my penis and then wiping my my meatus with my finger several times there wouldn't have been time for the vaginal secretion to dry. Does this change your advice in any way?

3) You appreciate that I am uncircumsized so given i've not been looking for discharge either on my penis or in my shorts (with the exception of yesterday) it would be extremely difficult for me to notice it.

4) Do the additional potential symptoms I've mentioned at this top of this response (stains in my underwear this morning and urethral irritation) change any of your advice?

I know you'd normally advise to be tested to put mind at ease but I'm reluctant to swab test for NSU in case it picks up elevated white cells that could be there as 'normal' and then open a can of worms unnecessarily. Thanks for the clarification Doctor, it's appreciated.

H. Hunter Handsfield, MD

97 months ago

These questions represent continued anxiety-driven overthinking. The intermittent urethral sensations you describe and maybe some moisture under your foreskin don't fit with any infection. As with discharge, symptoms would be continues and certainly would not come episodically for 30 seconds. My guesswork about drying and dilution of secretions, etc aren't the main point. These are examples why the risks were low, but the biological reasone really aren't important. The fact is that busy STD clinics never see patients with HIV or any other STD who had only the sorts of contact you describe.

I think those comments address all 4 of these questions. Beyond that, I don't know why you assume I would "normally" advise STD testing in these circumstances. I do not. Of course you are free to be professionally evaluated and tested if the expected negative results would be more reassuring than my advice based on probabilities and statistics. If you do it, my advice is that personal evaluation by a clinician experienced in STDs and genital health is just as important as lab testing (perhaps more so) -- i.e. consider an NHS GUM clinic, or a private sexual health clinic (such as London's Freedom Health Clinic). Don't use an online service for lab testing alone. Your fear of false positive urethral WBC assessment isn't warranted.

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97 months ago

Thanks Doctor, that's all clear.

Just for clarification, I didn't say the discharge I'd noticed lasted for 30 seconds, I meant the urethral sensations is experienced lasted for that time.

So just to confirm,

1. You believe there would be millions of encounters where men have got secretions directly on their meatus immediately after fingering an infected female and there are no reports of infection as a result?

2. The white stains I noticed in my shorts this morning can just be put down to normal secretions ?

3. Just to confirm my understanding on discharge as a result of NSU - I've read so many different things on medhelp and other places that leave me confused. You say here it would be 'continuous' but there are other posts on medhelp that say it is often noticed in the morning suggesting that it isn't always present. For my understanding, are you saying that if you have discharge as a result of NSU it would ALWAYS be visible upon looking at your meatus - ie. seeping out? And it's not something that is visible one moment and then a couple of hours not visible?

Thanks for this final clarification doctor. Your help is greatly appreciated.

H. Hunter Handsfield, MD

97 months ago

Thanks for the clarification. I didn't mean to imply only the discharge in my 30 seconds comment. I was thinking of the tingling etc.

1. I'm not sure I would say "millions". But in 40+ years in the STD business, to my knowledge I've never seen urethritis in anyone who had not had insertive vaginal, oral, or anal sex.

2. Probably normal, but you know your genital physiology etc better than I can from this distance. If you are sure this is new or abnormal, best to get checked. But if you have urethritis, I would attribute it to some past exposure, not the recent one described above.

3. The inflammatory response, and therefore discharge, would be more or less continuous, but personal awareness can vary widely. And I can't say abnormal discharge would always be visible -- maybe none for a while after urinating, i.e. a urethral washout. And some people are compulsively aware of every twitch, tingle, or appearnce of their genitals, whereas others are pretty oblivious and might notice it only after not urinating for several hours (e.g. on arising in the morning).

Don't overthink this. The common, everyday explanations and probabilities almost always apply; there is no reason to suppose you're the rare exception. But as I said above, if you remain concerned, get it checked out. Beyond this advice, however, there's not much more I can suggest.

That completes the two follow-up comments and replies included with each question and so concludes this thread. Best wishes and stay safe (as you were this time).

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