[Question #477] Risky exposures

44 months ago
Hi! 

I'm a male in my 40s and despite reading several of your (reassuring) posts I'm in need of clarity after a recent risky exposure with a CSW. I had condom protected oral and vaginal sex but then I happened to read an article on the internet that stated infected body fluids can transmit HIV when coming into contact with the male genitalia...Is the article referring to the area of the penis that is not covered by condom, or such info is totally inaccurate? 

I confess I'm a bit more anxious after coming across that. In general, does condom-protected sex with a woman of unknown HIV status bear any risk (as long as the condom doesn't break, of course)? In other words, should one still get tested after these kinds of exposures or it is not necessary? I'm referring in the case of multiple partners over the months.  

It's true that although the condom didn't show any breakage after the intercourse there was a lot of body fluid around the penis and scrotum area. Is this a reason for concern, also in relation to other STDs (syphilis, Herpes, etc...)? 

Thank you in advance for your kind help and elucidations in this respect. 
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Welcome to our forum. I will be glad to provide some information.  There was no meaningful risk of HIV from the exposure you describe. Most commercial sex workers do not have H I V, even most unprotected exposures to infected partners do not lead to infection, and your exposure was condom protected.  Condoms are the most effective means for prevention of HIV infection and your exposure was condom protected making it safe sex.

The information you some on the Internet is misleading. Genital secretions on intact skin does not cause H IV infection. It is for this reason that mutual masturbation with an HIV infected partner is safe sex with no risk for infection.  Admittedly there is a very small risk of other infections such as genital herpes or syphilis from contact of the sort you describe with genital secretions but that risk is also minuscule.

My advice to you is that if you continue to regularly practice condom protected sex you have no meaningful concern about acquisition of STI's including HIV. I would not worry further.   I hope this comment is helpful to you.  EWH
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44 months ago
Hi, Dr. Hook:

Thank you for your reassuring answer. I gather from it that the internet article I read was inaccurate and perhaps only aimed at creating fears (like much of the internet stuff on the matter anyway). I'd like to make sure i'm interpreting your message correctly though.

When you say "intact skin", would a little abrasion (thou not bleeding in that very moment) in the scrotum area create potential risks for STD transmission? 

Also, in light of the exposure I described, do I need any kind of STD testing? I mean, in general, if one has a condom protected sexual encounter with a CSW, is testing necessary after 4-6 weeks? 

One last thing, in the encounter I described I forgot to mention that there was some unprotected cunnilingus that lasted about a minute. Any risk from this? 

Thank you very much again. 
44 months ago
Hi again,

Since the site says one is entitled to two followups I was expecting an answer to those additional questions within a couple of days. I trust I did not ask any stupid or unanswerable question! Thank you. 
44 months ago
Dr. Hook:

Because of the unusually long time in receiving your response to questions I thought were very clear (thou not so simple perhaps) I sense that you may not have a satisfactory answer to them. I was not looking for your reassurance or statistics which mean so little anyway. Although this site is full of similar questions permeated with anxiety and various fears, I thought what I asked should have been entitled to a precise response. 
  
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Sorry for the delay in responding. 

A small scrotal abrasion which contacted genital secretions from a person with HIV would not pose a risk for infection.  Surface contamination, even of open wounds is not a meaningful risk.  For HIV to cause infection it must be get deep into tissue to cause infection, not just with surface contact. 

Condoms are highly effective for STI prevention.  I see no need for penile STD testing related to the exposure and events you describe.  There is a theoretical risk for acquiring pharyngeal gonorrhea or even chlamydia from performance of cunnilingus on an infected partner so testing of your throat for gonorrhea and chlamydia might be considered. The risk of such an infection occurring however is very, very low- cunnilingus is just not a biologically efficient means of acquiring STIs.  EWH

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44 months ago

Thank you for your response, Dr. Hook. Your answers are totally clear and satisfactory. If I’m entitled to one final follow up on this, I have never heard of Pharyngeal Chlamydia or Gonorrhea. Even though I understand it’s not very common from giving cunnilingus, what would the symptoms and occurrence timeframe of both be?

 

Also, is there a higher risk in sexual activities with CSW versus ‘common’ (for lack of a better word) women who are certainly not as promiscuous? I have always imagined that CSW are exposed to a much higher vocabulary of STIs. Please tell me if I’m wrong to think so.

 

Thank you once again…   

Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Pharyngeal chlamydia is so rare that the CDC does not even suggest testing for it (the organism does not grow well in the throat) but can occur very uncommonly.  Both infections are usually asymptomatic.  There is little more to be said of pharyngeal chlamydia. For pharyngeal gonorrhea, the available data suggests that it clears without treatment in most patients in a week or two after infection. 

You are correct that CSWs tend to have had more STIs than non-professionals but anyone can have an STI.  Most CSWs however are also more aware of their risks and therefore tend to do a better job of protecting themselves and get checked for STIs regularly.  You are probably more at risk for STI following sex with a one-night, casual hook-up with someone you just met in a bar than with a professional although, admittedly there is a spectrum of CSWs and therefore risk.  EWH

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44 months ago
A big THANK YOU for these clarifications as well. Most importantly, I have gathered from this exchange with a professional of your standing that if one does practice "safe sex," then it's not necessary to burden oneself with anxieties and the anxiety of testing. The reason why I lingered of whether it is necessary to get tested for STIs following condom-protected intercourse is because I know waiting for the test results or window period can be much more damaging and painful that the exposure itself perhaps! 
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Your point is a good one.  We DO advocate periodic testing of everyone who may be at risk but DO NOT think testing is needed after every new encounter or experience.  Condom protected sex is safe sex.  Condoms are not perfect but they are very, very good.   For most people who consistently and correctly use condoms, depending on just how active they are and with whom, annual testing is sufficient.  Further, we would encourage testing done in this way to done not looking for infections but rather for assurance that all remains good and healthy.  When testing is viewed from this perspective, it can be much less anxiety provoking as well.  Take care. EWH
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