Dear Doctors,

It’s with great regret that I have found myself writing to you as I initially believed I would never be in this position but there we are, that’s the way the wind blows.

I have been in a committed relationship for the last 2 and a half years. We were both, to my best knowledge, clean when we started dating. In the last 2 and a half years I have stepped out three times and the most recent has stopped me from moving on in a sensible manner. So down to brass tacks, you’ll notice an alcohol link unfortunately:

Late October 2016, deep kissing and mutual masturbation, no penile penteration of any kind. I assumed this was no/too low risk and moved on

March 2018, unprotected oral and genital rubbing. No penile penetration in vagina or anus. Read here that this is considerably low risk and so, perhaps unnecessarily, put it out of my mind.

3 days ago. No unprotected oral but genital rubbing. She seemed to think I penetrated her briefly at <30 seconds. I don’t remember this and was sure it was non-insertive. Mutual masturbation was the also undertaken

Guilt has consumed and I have ordered a test through Sexual Health London on the NHS. I am worried about the sheer anxiety I have towards the test and the potential results. It is almost enough to stop me pursuing it which I’m aware is a poor attitude. Can you please gauge my risk? Can I expect negative results? I am UK based, for what it’s worth, and the test is HIV, Gon, Chlamydia and Syhillis. Cheers.

H. Hunter Handsfield, MD

82 months ago

Welcome to the forum. Thank you for your confidence in our services.

As I think you understand, you are reacting entirely out of anxiety over some sexual choices you now regret. You need to work to separate that anxiety from disease risk from the events; they aren't the same. And it is clear that intellectually, you understand all three events were very low risk.

First event: what you assumed is exactly right -- no risk from kissing or hand-genital contact.

Second event: this is the most risky of the three, but still very low risk. Oral sex can be considered safe sex, with low risks for all STDs (far less risky than vaginal or anal sex) and virtually zero risk for some. In other words, indeed "considerably low risk" and it was appropriate that you "put it out of [your] mind".

Third event: I'm not sure how to square your belief that there was no penetration with your partner's belief there was. But you seem confident, so probably there was none. And if there was, the very brief exposure implies very low risk. As with the first episode, mutual masturbation is risk free.

You don't say what test is in the works. Routine STD testing in this setting would include urine for gonorrhea and chlamydia and blood tests for syphilis and HIV. I would suggest waiting for the urine test until 5 days have elapsed since the event: 3 days is soon enough for accurate gonorrhea testing, but 5 days is better for chlamydia. It is much too early for the blood tests, except that it's reasonable to have current testing to rule out infection acquired in the past. Assuming negative results, you should consider repeat syphilis and HIV testing after 6 weeks.

Having started down the path to testing, I urge you to go through with it. Clearly the fear you caught something will continue (probably forever) unless and until you are tested. You can expect negative results. Frankly, I have no patience with delaying testing for fear of a positive result, and I'm glad you consider it a "poor attitude". It isn't the test that gives someone an infection or other health problem. And both research and clinical experience show that when testing is delayed for fear of a positive result, anxiety always declines after testing is done, even if the result in fact is positive. Fear of the outcome is more stressful than having the wrong result; there is always benefit to clearing the air and knowing for sure. And of course the vast majority of the time, the result is negative anyway. (These issues are not limited to STD testing. Think of women delaying mammography when worried about a breast lump, or colonoscopy to check for colon cancer; and on and on.)

So in summary: it is extremely unlikely you have any STD, but you still should be tested for the reassurance value. Please return with a follow-up comment to let me know the results. In the meantime, I hope these comments are helpful.

HHH, MD

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