[Question #3257] Lots of sexual encounters want to weigh risk

38 months ago
Ok so here it goes...Me and wife were going through a rough patch over the last 30 or 40 days.During which I visited about ten sex workers.I had protected vaginal intercourse with all to completion and received unprotected Oral sex with a few. Me and my wife have reconciled.I know she was with noone else.We now want to have a child so will be having lots of sex to accomplish this.Im just wondering if this warrants testing since it was protected? Also the unprotected Oral sex? Is that a high risk factor.Also one of the sex workers was on her period and I didn't notice until I seen blood on the condom...There is a lady which does PCR RNA testing...I figure I could go there about day 13 since last encounter...would that be a conclusive result? When is the soonest a Oraquick could b conclusive?...Please help I'm freaking out!!!!!!!
Thank you so very much
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your question.

Congratulations for your and your wife's recommitment to one another:  I hope it goes well for you, and I wish you well in your hopes to conceive.* Also congratulations on your careful attention to safer sex with your CSW encounters.

The risk of an STD in this circumstance is low but not zero. There is always a potential for unrecognized condom failure -- i.e. even consistent condom users sometimes find themselves with STDs. On the other hand, with only around 10 encounters the chance is extremely low for any infection transmitted through genital fluids, i.e. HIV, gonorrhea, chlamydia, trichomonas, etc. However, there is slighly higher risk for those transmitted by skin to skin contact, such as syphilis, herpes, and HPV. Sex during menstruation does not elevate the risk, including HIV risk -- so the blood on the outside of a condom doesn't mean anything. Oral sex is low risk for all STDs and zero risk for some, including HIV.

For reassurance, I would recommend you have a urine test for gonorrhea and chlamydia and blood tests for syphiis and HIV. The gonorrhea/chlamydia test can be done at any time; it is valid any time more than 4-5 days after the last exposure. The HIV PCR test isn't bad, but 13 days is too early; it reaches 90% reliability a few days later, probably about day 15-16. But for 100% conclusive results, you also need a blood test at 4 weeks. Even better, skip the PCR test (which costs a lot) and have an antigen-antibody (AgAb, "4th generation") blood test at 6 weeks. Do not have an the oral fluids home test (Oraquick): it isn't conclusive until 3 months, and even then might miss a few infections.

I think you can safely resume unprotected sex with your wife once the urine test is done and negative. It is extremely unlikely you caught either syphilis or HIV -- low enough that if I were in your situation, I would resume sex with my wife without worry. However, if you need to have 100% conclusive results, you'll need to wait until the 6 week mark, or use condoms until then.

* We don't generally give relationships advice. However, I will point out that many marriage counselors would advise against trying to start a family this soon after "going through a rough patch". So maybe condoms would be a good idea for a while, in addition to waiting until you've had negative syphilis and HIV tests.

In the meantime, stay mellow. "Freaking out" (with all those exclamation marks) is an overreaction. You did use condoms, and the chance you have any STD from these events is low and you can expect all your tests to be negative.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD


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38 months ago
So if you were in my shoes you wouldn't be concerned about contracting HIV from the encounters?
Also by condom failure do mean breakage?
For the most part when I withdrew the condom I do check for breaks or tears in it. And squeeze it and make sure the semen stays in the tip and not leaking out.I am trying to put it in logic perspective however I find myself getting caught up in the what ifs so to speak. What if the condom was defunct ect. Who know what brand they used ect ect...What about home access test? Would that be conclusive result at 45 days?
I'm trying not to be bothersome ...lol
Thank you very much for your honest answers and help.
Cheers 
Jason D
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
No, I wouldn't be at all concerned about HIV.

I don't mean any particular kind of condom failure. We just know that among people who have multiple casual partners and say they use condoms consistently and correctly, and they don't obviously break, the overall STD risk is still somewhat elevated -- a lot lower than with condoms, but higher than if not sexually active or monogamous. It is unknown whether these failures are due to unrecognized breakage, slippage, forgetfulness about proper use, etc. Much the same for pregnancy prevention:  consistent condom users have higher pregnancy rates than those who use birth control pills.

That said, it sounds like you used them correctly and carefully. If they were visually intact, you had maximum protection. There is no such thing as microscopic leaks because of poorly made or cheap condoms. That's an urban myth. (Cheapos may break more readily, but if they don't break, you can assume protection was OK.)

Home Access is an older ("2nd genration") test technology, borderline conclusive at 6 weeks but probably not conclusive until 3 months. There are no home tests that are as good as the lab-based blood tests.

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38 months ago
Good Afternoon , 
This is the last of my follow up questions so you will be rid of me...LOL. 
I do plan on getting the PCR RNA  test at 15 days, so I do appriciate your advice on waiting until it would be more conclusive. 
They state it was a Qualitive test? Does that change anything? 
Would a 4th generation Duo test at 30 days be siginifcant to put all this to bed in my head??( I will definetly do 6 weeks and 3 months as well just to be sure.)
I do appriciate you stating that if you were in my shoes you wouldnt worry about having contracting HIV, and about you wouldnt worry about sleeping with your signifigant other. It does help alot:) 
I guess  Im mostly worried about the number of encounters I had (albeit with a condom) but with sex workers who are causully sexually active all day.
I guess mathematicly it seems super risky to me, just because of the volume ( But again Im not in the STD research field nor as knowlegable as yourself.) 
Thanks again for your time, knowledge and advice  
Anything else you could come up with to calm my nerves would be much appriciated 
Have a great day and evening...
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
This is a low number of encounters. You had quite a few in a short time, but many people have hundreds of partners over a few years and remain free of HIV and most other STDs.

The combination of the the negative results you will have with PCR at 15 days plus Ag/Ab at 4 weeks will be conclusive, with no need for testing at 6 weeks and certainly not at 3 months. (Testing beyond 6 weeks is old news, among people who haven't moved on from the days of older test technologies.) Qualitative PCR is fine.
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38 months ago
Okay...Thank you very much
Your very serious when you say I shouldn't worry about HIV from the encounters right?
Not trying to just ease my suffering??
Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
"Your very serious when you say I shouldn't worry about HIV from the encounters right?" Yes.

"Not trying to just ease my suffering??" Of course not. We never sugar coat nor exaggerate. What you get on this forum is the straight scoop, based on our understanding of the scientific facts and available data or, when clear data do not exist, our expert opinon based on 100+ person years of clinical experience of the three moderators.

That concludes the two follow-up comments and replies (in this case, 3 of them) included with original question, and so that concludes this forum. Do your best to accept the reasoned, science based reassurance I have tried to give and move on without further worry.

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