[Question #439] Needless Anxiety?

104 months ago

Thank you for taking my question. I have read much of the medically sound advice from Dr. Handsfield & Dr.Hook on this site as well as the Medhelp site. I believe my concern to be more anxiety and guilt driven, than it is medically driven. I have been reading copious amounts of information over the past 3 weeks and I am driving myself crazy.

3 weeks ago I stepped outside my relationship & had protected intercourse with a woman I met in a hotel lounge. She was approximately 50 years old, Caucasian, professional (middle school teacher).

The sex was protected with a condom and was vaginal. We briefly attempted anal sex but stopped as penetration was too difficult as I did not fully penetrate her. I put on a new condom as not to risk passing anything from her anus to her vagina. We then had vaginal sex with a new condom. At one point she partially inserted a vibrator as we were having sex but the condom remained intact. There was NO breakage of the condom.

After reading the many responses from Dr. Handsfield and Dr. Hook I realize this is a very low risk encounter but I guess I am looking for reassurance and advice on whether I should get testes and if so what for.

I believe my chances of contracting HIV are very very close to 0%? Gonorrhea and Chlamydia are statistically more prevalent but the condom remained intact so risk was nil (in addition I believe Chlamydia is quite rare in woman after age 26)? Syphilis could be spread even with a condom but I believe Dr.Hook said without lesions chance of contracting it are about 1 in 1000 occurrences (perhaps less with a condom).

What are the odds I contracted a high-risk strain of HPV and risk it to my partner? And is it possible I contracted trichomiasis and risk passing that?

H. Hunter Handsfield, MD

104 months ago

Welcome to Ask the Expert. Thanks for your question, and for your own research reviewing other discussions.

I agree with your own analysis in practically every detail -- i.e. both your self diagnosis of anxiety as the main problem, and with the risks associated from this exposure. In addition to the low risk nature of the event itself (careful condom use, with no directly contact of your penis with your partner's vagina or anal area), I would point out that active STDs are very strongly age related, and are very uncommon at age 50. That includes very sexually active persons of that age. Partly it's immunity: with increasing age, there is greater chance of past infections that reduce susceptibility. In addition, although social class obviously has no biological effect, higher education and professional background are associated with much lower STD risk overall, and this too is independent of such factors as number of sex partners.

Having said all that, the fact that raises the risk profile is that any woman (or male) who hangs in bars and has sex with people they meet there is, by definition, at high risk. But that doesn't negate the factors discussed above.

As to specific STDs: Very low risk for gonorrhea, chlamydia, trichomonas, and nongonococcal urethritis (NGU), especially with proper condom use. Virtually zero for syphilis -- I'll bet there aren't 10 cases a year in the entire country in women like your partner. The large majority of syphilis these days is in men who have sex with men, especially men who already have HIV; and heterosexually in particular inner city areas and ethnic minority populations. Herpes may be a bit more likely, because of transmissibility by skin contact above a condom, but still not a likely scenario, especially since you're not having symptoms of it (which usually would begin within a few days). There is also no risk in this situation for viral hepatitis.

HPV is more difficult to estimate. Active HPV is uncommon at age 50, so it is unlikely your partner had an active/transmissible infection, with either a high or low risk strain. But even if there was small risk, you should ignore it. In the unlikely chance you were to become infected, and even if your wife were to then acquire it from you, probably neither you nor her would ever know. And if she ever develops an abnormal pap smear due to HPV, there will be no reason to assume or even suspect either of you had an outside sexual encounter. HPV problems appear in any couple and at any age, and could equally plausibly go back to distant past partnerships before marriage. In any case, there is no test you can do, and no preventive steps you can take.

Should you be tested? If somehow I were in your circumstance, I would feel no need. If you do so, it would be primarily for the reassurance value of the negative results, not because of any realistic risk. That said, you are the only one who can decide whether that justifies testing. If you do so, I would suggest a urine gonorrhea/chlamydia test (valid any time ore than 3-5 days after exposure) and blood tests for syphilis and HIV at 6 weeks. I would not recommend any other tests, in particular don't get tested for HSV or hepatitis. But even if you do any of these, I would not recommend waiting to resume sex with your wife.

I hope this information has been helpful. Thanks again for your confidence in our services. Best wishes--

HHH, MD

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104 months ago

Thank you so much for confirming my thoughts. I will try to let reason and rational thought not cloud my judgement. But, just in case- do I need to wait 6 weeks for a syphilis test? Are services like stdexpress.com where you go to lab & have the results emailed to you considered valid.?

Thank you.

H. Hunter Handsfield, MD

104 months ago

As noted above, there was no realistic chance you caught syphilis, and if you had, you probably would have had obvious symptoms. Re-read the last paragraph of my reply above. But if you decide to be tested, you should wait until 6 weeks after the event. It often takes that long for syphilis blood tests ro become positive.

Online testing services do not have their own laboratories. They contract with regular labs, most often one of the two main national labs, Quest or LabCorp. Both are highly reliable and use standard, up to date, accurate test methods and the results are valid.

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103 months ago

Thank you again for your insight. After rereading you original reply I decided perhaps buying lottery tickets would be a better use of my money opposed to a syphilis test :) And, again you are correct- the 2 labs that are used in my area are Quest & Lab Corp. However I have decided of my own accord that testing is not warranted.

I certainly trust your expertise but I have a question about trichomonas- I know you said that I was very low risk for this. Some of the literature I read indicated that incidence of this disease increases with age. Perhaps this literature is agenda driven- so I rely on your judgement. I was wondering if this infection is indeed negatively correlated with age as most STIs are? Or, is the efficacy of condoms that great in preventing the spread of it. This was the one common STI that I never heard of & was initially concerned that I could be at risk of spreading it. I was not sure if it went away on its own in men or woman? However, I trust your assessment of this being low risk as you have no agenda.

This will be my last post to you as I have used my 2 follow ups. I was not even going to post again because my concern about trichamonas was more out of curiosity than concern. However, I would be remiss if I did not thank you for sharing your knowledge. It truly has helped put my mind at ease.

103 months ago

Hello Dr. Handsfield,

I believe my 2nd follow question about trichomoniasis may have have gotten lost in the wash. Thank you again for providing this wonderful service & making your knowledge available. So much information exists out there, it is really nice to get the opinion of an expert. It truly has put my mind at ease.

Thank you.

H. Hunter Handsfield, MD

103 months ago

I don't recall saying trichomonas is strongly correlated with younger age. That's true for gonorrhea and chlamydia, less clear for trich. And there are no data at all on risk of transmission to men from any single exposure. But it is generally believed that condoms are highly protective. (Condoms work well for infections transmitted in fluids, like gonorrhea, chlamydia, trich, HIV) and less well for those transmitted skin to skin (syphilis, HPV, herpes). In any case, trichomonas is harmless in men and rarely causes serious problems in women. If it were to show up in a future partner, there would be no way to implicate you as the source, since infections often show up in women in their 40s and 50s, but usually were acquired years or even decades earlier. Few if any STD clinics routinely test asymptomatic men and I woudn't recommend it for you. And in any case, the only potentially accurate tests are for trichomonas DNA, and those aren't FDA approved for use in men.

Thanks for the thanks about the forum's services. We're happy to help. Best wishes and stay safe!

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