Dear Dres., 

this question may be a bit repetetive but I am trying to make important points of my sexual lifestyle and overall wellbeing clear, once and for all! Sadly I couldn't get back to a sexual relationship with my wife, we tried hard (counseling!) but failed. We have no, i.e. zero sex! To cope with my strong sex drive I visit massage parlors, on average twice, sometimes trice a week; and I am doing this for many many years now. Once in a while I had tests, but the waiting (window) period always literally tortures me. I have attentively read the Q&A, here and on Medhelp, for years. So I always! restrict my risks to (a maximum) of mutual masturbation. Handjobs, fingering, sometimes back and forth, but no vaginal, anal or oral sex, not even frotting. I am aware that your respected professional assessment of these exposures is "no risk", which I love to hear... But then I think of the hundreds and hundreds, indeed thousands! of exposures over the years (in one year it is somewhat between 100 and 200). And being a "numbers man" I am aware that risk is: STD-risk per each exposure x numbers of exposures. So my repetitive fear is that the high numbers of exposures cumulates a negligible risk which in total becomes substantial. 

My questions: 

1) What do you make out of my reasoning/analysis? 

2) Taking into account the high number of exposures, would you still advise "no testing needed"? 

3) If you think, I should opt for testing, so what would be an appropriate intervall and which tests should I have performed? 

4) Do you have any more advice, that with your vast experience, you consider to be helpful in my situation, that causes me so much pain and anxiety over the years?  (I do work with a counselor)

It probably doesn't fit in the messy picture you get from my story, but I am actually head of a big german organization, responsible for important challenges and a lot of people. Any additional advice or numbers to explain my low risk are appreciated! 

Kind regards Karl 

1) Of course your reasoning is correct. If the risk of a particular expousre is, say, 1 in 10,000, then after 100 exposures the chance of infection is 1%.

2,3) From a strictly medical or risk assessment perspective, your risk is low enough that no tested is needed. However, you probably should do it for its emotional/reassurance value. You may be more reassured by negative test results than by professional opinion and advice, no matter how expert it is. Once a year might be appropriate -- or perhaps after every 100 or so exposures. The decision is yours.

4) We are STI experts, not psychologists. I remembered your professional background, and will add the obvious -- that you do your best to apply the same analytic, objective approach to your sexuality and its risks that you undoubtedly do in your professional work, and that you expect from your senior managers and many employees. We have given numerical risk estimates in replying to some of your previous questions and I have nothing to add; consider re-reading them. 

Best regards--   HHH, MD

thank you for your reassuring reply. You hit the nail on the head (we say so in German) with your answers. Indeed I know that I somehow fail to "apply the same analytic, objective approach to my sexuality and its risks that I do in my professional work..." I was even the one who introduced conceptional risk management in my organisation and published on the topic...

I work with a counselor to address the underlying disorder(s) and decided to "sober up", i.e. stop my extramarital exposures at least for a while to heal the compulsive disorder which has undoubtedly manifested in my personality.

Well, you are STD experts, not psychologists, I know... My last exposure was (the usual) mutual masturbation (no penetration of any sort, not even frottage, as usual) with a CSW on January, 1st (nearly 3 weeks now). I show no signs of STD whatsoever yet. I especially fear syphilis.

I plan to have me tested for HIV, syphilis, gonorrhea and chlamydia and think of doing that in 2 weeks, i.e. 5 weeks post "exposure". I know 6 weeks are the window period but I have a very important, crucial consortial meeting that i am in charge of in 6 weeks and feel that I must shake my fears before.

1) I think I could not miss any syphilitic chancres, given the nature of my exposures, i.e. they would appear on my penis, or unlikely my fingers, but definitely recognizable! Right? 

2) My reasoning is, that without any signs of infection, the low risk of exposures and negative test results after 5 weeks, my chance of being infected must be lower than 1 in a million which is definitely negligible! Right?

3) How high would you judge the accuracy of a syphilis test at the 5 weeks mark?        

I am aware that I tend to ask questions that are beyond the scope of this forum and I don't want to use the forum as a crutch related to my obvious underlying problems. But I have to also say that I am very grateful for the nonjudgemental, professional and somehow compassionate work you do. Kudos!!

Karl 

2) I agree exactly.

3) The historical standard, a “nontreponemal” blood test such as RPR, can take up to 6 weeks. The newer IgG antibody tests probably 4 weeks. But neither of these has been definitively studied, so my view is that 6 weeks remains safest. However, some equally qualified experts believe 4 weeks is conclusive for all tests.

Thanks again for the thanks about your services. However, I’m going to ask that this be. Your last question along these lines. I’m sure you can accurately predict our responses, assuming the types of exposure do not change significantly and you remain asymptomatic. In adddition, repeated anxiety driven questions carry little educational value for other users, one of the forum’s main purposes.