[Question #5191] STI risks and symptoms

23 months ago
Hi, I know you get similar questions but I really appreciate you being able to answer this one for me.  I am a 31 year old male. 6 days ago on 03/23/19 I met an escort in the U.S. I think she was from Russia. We had protected oral sex (fellatio) and protected vaginal sex. The condom did not break, and during the vaginal sex I made an effort that I didn't insert past where I could see the end condom, to avoid skin to skin. I cannot be sure I was successful with that but I made that effort. I have been married for over 5 years and this was my first sexual encounter with anyone besides my wife. My wife as well has only been sexually active with me. 

Starting about three days ago 03/26/19 I started feeling  weird symptoms: A. Inflammation/soreness in the back of my throat. (tonsills?)B. A abrupt  increase in how thirsty I am, needing to drink a lot of water. C. Feeling quite weak and sickish,  my knees feel very week today, headache, D. Disturbing floating sensations that I have never felt before, increase in sensation around my scrotum,  discomfort (prickly, heat) feeling of my skin. Before this encounter I was feeling 100% great. Why would I suddenly start feeling sick?? I generally don't get sick, especially not now in spring. I am very anxious that I caught something and my life and marriage will fall apart. I have never felt this way when I was anxious about other things. 2. What are the chances or probability that I caught ANYTHING at all relating to STI's, including HPV? Should I do any testing at all??
3. I know, HPV is very common, why is it so easy to get if other STI are apparently so much harder to get? What is the chance that I caught HPV from this one time protected encounter?
4. Most importantly, what is the chance that I can pass anything onto my wife, that could be a health issue or later be detected which would be quite a problem. Can I resume unprotected sex with wife?  
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Welcome to the Forum.  I'll be glad to comment.  The sex acts you describe were low risk.  Many of our clients are surprised to hear that most CSWs, particularly those who are not met on street corners, etc. rarely have STIs- they are aware of the risks associated with their professions and are both good at taking precautions and get checked regularly.  Further, condoms are highly effective for STI prevention and it sounds as though you used your condom properly.  Your acute symptoms are not those of any typical STI and are some of the kinds of things some people experience as a manifestation of anxiety.  Alternatively, they are also the sorts of symptoms that some people experience with "every day", non-STI viral illnesses.  In answer to  your specific questions:

1.  I know, HPV is very common, why is it so easy to get if other STI are apparently so much harder to get? What is the chance that I caught HPV from this one time protected encounter?

Your risk for HPV from this encounter is low.  Condoms, while not perfect, certainly reduce the risk for HPV and you only had a single encounter.  Further, your symptoms do not suggest HPV which is typically symptomatic.  Further HPV typically takes several months to become apparent, not days.  As far as why HPV is so very common, part of it is because so many people have it and another contributor is that exposures are frequent (i.e. people have repeated exposure to this chronic illness).  Even so, the risk for HPV acquisition from any single sexual encounter is likely less than 50% and perhaps far lower.

2.  Most importantly, what is the chance that I can pass anything onto my wife, that could be a health issue or later be detected which would be quite a problem. Can I resume unprotected sex with wife?

This exposure was very low risk.  I would not worry.  I really see no medical need for testing at this time nor any reason to abstain from unprotected sex with your wife.

I hope these comments are helpful.  EWH
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22 months ago
Hi Dr. EWH, Thank you for your reply.  However, I am still left confused/scared. 
You wrote in your reply that "the risk for HPV acquisition from any single sexual encounter is likely less than 50% and perhaps far lower."  This comment seems quite worrying.  If there is a 50% chance or less that I caught something from my one protected vaginal sex encounter why shouldn't I be concerned? 50% or anything close to that (even 25% chance) seems quite high and I should be concerned? 

Also, before this encounter both my wife and I didn't have any other sexual partners, so if there was even a 25% percent chance I caught something, shouldn't I be worried I could easily pass that to my wife and then it would be detected?
Also lastly, why would the HPV be caught at such a high rate even with condom use? It seems like all the other STI have a much harder time being caught even without a condom?
p.s. I don't really know anything about HPV, but am asking about it because I saw it mentioned in the forum, and it seems like a concern. 
Thank you so much and I very much look forward to your reply.

Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
I failed to say- from a single unprotected sexual encounter.  You used a condom.  A precise estimate cannot be calculated but your risk is very low.  The incidence of HPV in virgins with no other sexual partners ever is about 15% per year.  Most of the people studied did not use condoms and certainly had sex more than once.  Thus is neither you nor your wife have ever had sex with another person, your risk for infection from the episode you describe is a small fraction of that.  

With all due respect- this was a single low risk encounter with virtually no risk for treatable STIs and a very low risk for HPV.  There is nothing you can do if you were exposed to HPV.  thus my sincere advice is to figure out a way to move forward- either by disclosing your dalliance to your wife or accepting that the risk is low and working to resume your normal life, including normal sexual activities.  I'm not trying to be casual or glib here, from what I've heard, those are your choices.  EWH
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22 months ago
Hi Dr. Thank you for your promt reply. Your reply did not sound glib, I actually find that the more frank the replies are, the easier it is for them to be comforting for the anxious mind. I am following up because I went for my dental check up today. I reported to the dentist that for the past day I felt some type of sore on the roof my mouth. The dentist checked and saw some sores that he called herpes simplex -oral.  I believe that they can be caused by stress and I have been under a lot of stress since the incident on 03/26/19. However, it is freaking me out that I am having some type of oral sore about two weeks after that encounter. Does the presnece of these sores on the roof of my mouth indicate in any way that it is more likely that I did catch something (herpes 2, or any other type of STI, HPV)  from the encounter on 03/26/19, or is it just from stress and not an indication that I caught anything? 
Should I do any testing after this appearance? 

You mentioned that  "The incidence of HPV in virgins with no other sexual partners ever is about 15% per year." Are you saying that in this study both partners never had any other sexual partners but still had 15% rate of HPV, if they didn't catch it from an outside source how did those 15% get it? 

I am also feeling some additional sensations at the had of my penis and scrotum (tingling, itchy, pressure) that in the past I didn't feel. I understand this can be caused by worry about the events that transpired. But I wanted to ask, what sensations or symptoms should i look out for that would be a sign that there is an issue, HPV or other. In other words, unless I feel and see (X) I can know I don't need to worry or have any check ups or continue worrying/ ruminating.

Last question. Would kissing on the lips and protected fellatio put one in any risk for HPV or Herpies 1 or 2 or any other STI.

Truly, thank you again for this service. On the receiving end, it has truly been life saving. 




Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
The lesion on your mouth is not a manifestation of an STI acquired in the encounter you described.  Further. the roof of your mouth would be an unusual place for a cold sore lesion to occur.  With all due respect to your dentist, while the lesion may have been a cold sore, it may not have been either.  Irrespective, it was not related to the encounter you describe.  

No the study I mentioned described the incidence of HPV in virgins but did not describe their sex partners.  It is safe to presume that many of these persons had sex partners who had other partners in the past.

HPV is typically painless. There are no "typical symptoms"  Please don't worry.

Kissing might put you at risk for acquisition of HSV-1, the virus that casues cold sores but htat's about it.

With this third response, this thread will be closed.  In doing so, I urge you to relax and move forward without concerns.  My sense is that you are over thinking the event and worrying unnecessarily.  EWH
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