[Question #4684] Risk assessment

26 months ago
Hello Doctor,

Im a sexually active male, 28 years old living in the middle east. I have had an encounter with a CSW in bahrain who is russian. Some kissing was there, protected oral. Then, she was on top for like less than a minute, of course protected, i noticed in her groin area one red skin tag, it is not on the vagina but groin top right corner like 2 inches away. Then, i went on top for like 3 minutes and stopped. Some normal masturbation followed after. I have never had encounters with CSWs without protection even for oral. My question is, im not an expert to distinguish the skin tag if it is HPV related or not but for sure i did notice that she might had a bacterial infection due to a very faint smell. I did ask her and she said it is from birth and she also showed me many moles that she has in other areas and said it is similar. But that one is a growth for sure, red skin tag. I didnt check further if she had any hpv signs on the vagina. Doctor, based on the events, if that was hpv, can it be transmitted, i was covered all time during penetration, and how much is hpv a risk. I already have plantar warts that are giving me hard time to remove. Also, should i test for anything ? What are my risks from this exposure ? 

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

If I correctly understand the exposure, it was entirely safe. But I'm not sure what you mean by "I went on top for like 3 minutes...." Was that vaginal sex? If so, apparently it was with a condom, right?

Skin tags are entirely different from warts. From what you say, I see no reason to be worried about warts or HPV. Of course, if you are not a virgin -- if you have ever had vaginal or anal sex, even condom protected --then probably you already have had HPV and might still be carrying it. Condoms are not very good for HPV prevention, and at least 90% of sexually active people catch genital HPV at least once, usually within their first 3 lifetime sex partners. Fortunately, most HPV infections never cause warts or other symptoms and are cleared by the immune system, never causing harm. In the slim chance your partner had warts and you caught the HPV causing them, it probably will be many months (maybe a year) before warts show up.

That your partner had some apparent vaginal odor could indicate an increased risk for STDs like gonorrhea or chlamydia. On the other hand, with a condom there was little risk for these infections.

So all things considered, you are at very low risk from this exposure and probably don't need testing. However, if you would be more reassured by negative test results, you could have a urine test at any time for gonorrhea and chlamydia; and blood tests for syphils and HIV after 6 weeks.

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

HHH, MD
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26 months ago
Hello Dr. Handsfield, 

Thank you for your answer. When i said i was on top, i meant missionary position and it was protected. 
Gon and chlam can go on their own, right ? And it they present, its always with symptoms ?

Thank you again doctor.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
I'm not sure what you mean by "Gon and chlam can go on their own". As I said above, you were at very low risk for them, given the condom use. Gonorrhea almost always causes prominent symptoms, with pus dripping from the penis and painful urination. Chlamydia usually causes milder symptoms and often none at all. As I said above, if you would like 100% confirmation you did not catch chlamydia, you can be tested for it. (Chlamydia testing almost always includes and automatic gonorrhea test as well.)---
26 months ago
Thank you doctor, i meant that these infections would go on their own in the case of me choosing not to test which is my current choice as this isnt a high risk encounter. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
I think you mean "go AWAY on their own". Yes, the immune system eventually clears gonorrhea or chlamydia. However, this takes a few weeks or even several months. During that time, serious compications can develop, with damage to the genital tract; and can be transmitted to partners. I agree the risk is low enough that you do not need testing. But that has nothing to do with whether or not the infections go away without treatment.

That concludes the two follow-up comments and replies included with each question, and so ends this thread. I hope the discussion has been helpful.
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