[Question #4588] Transmission Risk

28 months ago
Hello ASHA team! Thanks so much for all you do.
I recently had an unprotected sexual encounter (a few months ago) and I wanted to check to see what I should do. It was unprotected vaginal sex that only lasted a few minutes (maybe one minute). However, even though I had somewhat recently been tested, I have become worried that I possibly transmitted something to her (my partner) in the process (admittedly I have mild hypochondria and major OCD). I just don't want to hurt anyone with my carelessness! Do you know the odds of me transmitting HPV to her after one unprotected encounter? (I was tested for Chlamydia, Gonorrhea, HIV, and Syphilis, all negative a few weeks after the encounter).

Also, a couple days after the encounter, I had some red bumps appear scattered across the underside of my penis. Naturally, as a hypochondriac, I went to urgent care (scared of herpes). But the doctor told me it wasn't much to be worried about, because there was no itching/tingling/burning, and the bumps went away 1 day after noticing them, with no blistering or scabbing. The doctor told me it was probably just irritation. But part of me worries it was either an initial or a recurrent outbreak. Do you know the odds of transmission after a single unprotected encounter? I've heard its pretty small, but I also read a scary article (see: https://www.ncbi.nlm.nih.gov/pubmed/16741881 ) , which says that it usually only takes 3.5 months for herpes to be transmitted in discordant couples who don't know the other person's status. I'm just scared that I was infected by this encounter, or that I infected my partner in this encounter without knowing  it. (I'm sorry that I posted pretty recently. I obviously am struggling with OCD/Anxiety. I just don't want to do the wrong thing). Thanks again.
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
I'm saddened to see your need to return to the Forum.  Your OCD is acting up- you continue to overthink your low risk encounter;  it also appears that as a function of your OCD you may be examining yourself more closely than is necessary, giving rise to your concerns about HPV.   

Let's deal with your HPV concerns first.  Your concerns regarding HPV are misplaced.  Presuming that your partner is about the same age that you are and has had sex with others, she either already has HPV or has been vaccinated for the virus and is not susceptible.  Either way, IF you have HPV, there are no data to suggest the likelihood of infection following a single unprotected exposure.  I would point out that there are no STIs for which a single exposure is more likely than not to transmit infection to an uninfected partner - including HPV.  My advice is to put these concerns aside and not worry about the possibility of having transmitted HPV  to her.  

With regard to HSV, again, you are getting carried away here as well.  You do not know that you have HSV and given your history of condom use in the past, it is unlikely that you do.  That makes your question regarding transmission a "what if" question.  For informational purposes I will tell you that it is our estimate that HSV is transmitted from asymptomatic, infected partners approximately once for 1000 exposures (o.1% transmission rate) or less.  Again, this is not something to worry about.

To repeat myself.  You are overthinking the encounter you had.  I urge you to move forward without further concerns.  If you see a counselor regarding your OCD, I would suggest that you see them and discuss your concerns.  EWH

p.s.  one more thought about HPV.  Given your OCD, it is my advice that you get the HPV vaccine.  it is highly effective and well tolerated.  In turn that will reduce your risk for getting HPV yourself, should you be exposed.  EWH
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28 months ago
Okay thank you Dr. Hook. Was the advice from the doc at urgent care accurate? A few scattered red bumps that never developed into blisters or open wounds...is that enough to warrant a herpes concern? I took her advice at face value at the time, which I think was correct.
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
I was not there to examine you but but self-limited "bumps" which do not progress to blisters or ulceration is really not suggestive of herpes.  I would except what she said. EWH---
28 months ago
Okay thanks again. In studies you've seen, is there a relationship between length of relationship and transmission? I was browsing, including some responses that Dr. Warren gives on here, where she says most HSV2 transmissions occur in the first 3 months of a relationship. Has this been verified or is it just a conjecture? 
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
For herpes, the association is pretty firm although the reason are unclear and probably multi factorial.  In newer relationships, the infected partner may have acquired their infection more recently (and therefore have more recurrences and shedding of the virus), there is more sex early in relationships, and people get better at their protective practices over time.

There are no data of this sort for HPV. 

As you know, we provide up to three answers to each question.  This is my 3rd response.  Thus this thread will be closed later today.  I hope the information I've provided has been helpful.  EWH
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