[Question #3295] STI risk?

37 months ago
Hi Dr. Handsfield/Dr. Hook

Here is the situation: 


Monday 22nd: flew for work from Seattle to Orlando. met a girl at a bar and she came back to my place. We had unprotected fellatio and cunnilingus..no vaginal sex 

Thursday 25th: before going to bed, I masturbated and didn’t clean as I was too tired 

Friday 26th morning: haven’t showered yet...had unprotected fellatio, cunnilingus and vaginal sex with a woman I met in the hot tub at the hotel. Fly back to Seattle.

Sat 27th/28th: uncircumcised penis feels itchy and red 

Sun 28th: I have gotten watery stool twice today and it went away by the end of the day

Friday 2nd: I was feeling really tired and had a sore throat (keep in mind I have hashimoto’s)

Here are the questions 
1) what are the odds that this is the std? If so, what are likely ones 
2) what symptoms do I need to be on the lookout for?
3) I recognize that I should practice safe sex and I will going forward but how risky was my encounter?

Thanks, 
Anxiousman9
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Welcome to the forum. Thanks for your question.

Your symptoms are not typical for any STD:  there are none that cause penile itching or redness or diarrhea as common symptoms.  That said, you clearly had a relatively high risk exposure, at least the second one (with unprotected vaginal sex). (Fellatio and cunnilingus are low risk for all STDs and zero risk for some, even unprotected.) To your specific questions:

1) Already addressed:  your symptoms don't suggest any STD. Stastically, the most common STDs, and the ones for which you are at greatest risk, are chlamyida, gonorrhea, nongonococcal urethritis, genital herpes, and HPV. 

2) The main symptoms are urethral discharge, pain or discomfort on urination, and genital sores. If you were infected, one or more of these would be most likely within the first 1-2 weeks after exposure. Warts due to HPV take up to a year to become apparent.

3) I cannot estimate the numerical risk you were infected. But in hetersexual settings, quick pick-ups of this sort are definitely on the high risk side. I recommend you have a urine test for gonorrhea and chlamydia, which is valid any time more than 4-5 days after the last exposure; and HIV and syphilis blood tests after 6 weeks. The chance of either of these is extremely low, but both are of course very dangerous and it's reasonable to test despite the low risk. There is no test for HPV, and the herpes blood tests are too unreliable to recommend routine testing unless there are symptoms. And in any case, the risk of herpes is quite low, under one chance in several hundred, considering all the exposures described.

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

HHH, MD

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37 months ago
Dr. HHH,
Thank you for your response. If I understand you correctly, you are saying that while in theory the second encounter was a high risk encounter, the actual chances are low. Is it because the incidence rate is low or the virus/bacterial transmission is not optimum?

Also, I asked the second female if she was tested and she said she was last tested 6 months ago and that she last had sex 2 months ago (she is 44, not sure if age has anything to do with transmission). As for me, these 2 encounters were the first in a year and half. Does this help my case with respect to risk? This is making me super anxious and killing me inside.

Finally, I will get those tests done and also be on the lookout for those symptoms.

Thanks,
Anxiousman9
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Most sexually active people don't have active, transmissible STDs, and STDs in general are not efficiently transmitted -- that is, not all exposures result in transmission. Therefore, almost any sexual encounter is not especially likely to result in infection. Further, a 44 yo woman is especially unlikely to have an active STD, particularly with her testing history.However, that doesn't mean you shouldn't be tested. In any case, my comments were meant to be reassuring -- the odds definitely are that you weren't infected. But you still need to have a common sense perspective. Just because I also recommended testing doesn't itself elevate the risk.

Does that help?



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37 months ago
Thank you so much for the response. I’ll get my chlamydia and gonorrhea tests done tmr as I am seeing my doctor. Then I’ll get the syphillis and big done at 6 weeks and then circle back.

With respect to being sexually active in this period...is it better to hold off?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
The odds are strong that you have no STD, but the risk isn't zero and there are no guarantees. A reasonable approach would be to wait until you have the gonorrhea/chlamydia results. Assuming they are negative, as expected, you can resume sex with very low risk of infecting a partner. The chance of either HIV or syphlis are so low that most people would be willing to take the very small risk in regard to those infections.---