[Question #520] possible std risk

36 months ago

I am 41 year old male who had an encounter with  CSW with appointment on 21st Jan.. I shaved a few hours using hair removal cream before I met so  had some open cuts in my testicles . Here is what may have put me at risk:
-Uncovered oral sex ( giver and receiver) but after ejaculating  I took a shower and had more unprotected oral sex ( with open cuts in my testicle ) followed by protected vaginal sex. Condom was intact and no blood etc-Protected vaginal sex with condom not covering completely the base of my penis-Deep french kissing

 

Also 10 days later I had covered blow job ( twice) and vaginal sex with csw in Amsterdam– no breakage of condoms,  no signs of any blood etc The CSW had pulled my foreskin back before putting the condom. I felt pain in my penis when I was taking shower lateron

 

I have been having the following Symptoms

  • Around 1st Feb, started to get some tingle at the tip and pain in testicles especially when I was sitting and it would go away if I stood up and walked

  • Started to feel the urge to pee but able to urinate normally all the time and no burning sensation

  • No discharge so far, Pain in the groin area with dark patches between the thighs

  • The pain / pressure groin, tip of penis and testicle eases if I were boxer instead of underwear

  • In my genital area (uncircumcised) when I pull the foreskin back I see a small raise / pimple in one of the nerves ..also the nerve / artery to the opening of urethra looks slight raised ( Herpes / warts ?) – this is the most scary symptom for me. This is from few days ago

  • I used to have wet dreams regularly but last 10 there has not been a single episode

  • Body temperature has been normal throughout the last 3 weeks but feel aches and pains throughout the day

  • No sore threat or rashes yet

  • My weight has been going up and down. Also I feel I am losing 2 pounds between meals which gets recovered and then lost again. Stomach feels very empty within hours of eating heavy meal.

  • White / yellow coating on lounge for last few days with some bad taste in mouth – ended up doing the spit test and saliva went to the bottom ( really worried about oral thrush wrt to HIV based on unprotected oral sex both ways and cuts in my testicle or any other oral STD)

  •  

I went for Chlamydia and Gonorrhea along with 4th Gen HIV test on Friday which was about 22 days after unprotected oral exposure and result should come in next few days..  I plan to do another test in couple of weeks for the remaining STD’s. Based on the symptoms and exposure what will be your assessment having caught any of the possible STD and how much risk I am carrying?

 

Thanks


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Welcome to the forum and thanks for your question. However, you have exceeded the permitted 1,500 caracter length (~300 words) for a new question, as clearly stated on the forum home page. You apparently wrote your question in another program (like Word) then pasted it in, which overrides the software that prevents overlong questions. Please edit down to <1500 characters and re-post it in a follow-up window.

In the meantime, on quick scan I believe you were at little if any risk and that you have no STD. But I look forward to responding in more detail.

HHH, MD
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36 months ago

41 year old male had an encounter with csw by appointment on 21st Jan. Had shaved my testicle and penis with hair removal cream so had some open cuts that has led me to freaking out. Uncovered oral sex ( giver and receiver) and after ejaculation quickly took shower and had some more unprotected oral ( giver and receiver) followed by protected vaginal with no condom breakage or any blood spots. After 10 days had covered blow job (ejaculated)  followed by protected vaginal ( ejaculated again ) in Amsterdam with no breakage of condom. Immediately on 1st Feb started feeling some pain in my tip of penis. After couple of days realized that pain would go away if I stood up and started walking or also no pain experienced while lying down. Also testicle pain was there and followed the same pattern. Same time started to feel the urge to pee frequently and there was no pain during urination. Also since last week in my genital area (uncircumcised) when I pull the foreskin back I see a small raise / pimple in one of the nerves ..also the nerve / artery to the opening of urethra looks slight raised but this I am not sure ( Herpes / warts ?) . My body temp has been normal but felt aches and pains through out the body but no sore throat or rash. My weight has been behaving crazy and losing all the weight between meals stomach feels empty even after heavy meal ( extreme fear and anxiety). Spotted white spots in tounge with some bad taste in mouth.did the candida spit test and the saliva went to bottom which has really worried me wrt to HIV. I went for Chlamydia and Gonorrhea along with 4th Gen HIV test on Friday 22 days after unprotected oral exposure and result expected tomorrow. Based on the symptoms and exposure what will be your assessment having caught any of the possible STD and how much risk I am carrying








H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Thanks for the shorter question. The moderators can't be expected to read long essays!

As I said above, you are not at little or no risk for any STDs from the exposure described. Congratulations on your wise decision to have only safe sex with these partners. Further, your symptoms are not typical for any STDs.

Hand-genital contact is never a risk, no matter what other extenuating circumstances may be present:  recent pubic or scrotal shaving, genital fluids or saliva are used for lubricant, etc. In theory it could risk one of the skin-to-skin STDs like herpes and HPV, but in my 40+ years in the STD business, I've never seen any STD acquired by hand-genital contact or fingering. Oral sex is very low risk for all STDs (and zero risk for some), even entirely unprotected; with a condom there is no risk at all from oral sex. That leaves the condom protected vaginal sex, which was the only one of your exposures that carried any STD risk. Even that was virtually zero risk for those transmitted by fluids (gonorrhea, chlamydia, nongonococcal urethritis, HIV, viral hepatitis); so any risk was limited to those transmitted skin-to-skin like herpes, HPV, and syphilis (due to contact of skin above the condom). Even these are rare from condom-protected sex.

As for your symptoms, the only one that hints at STD is the pain in the penile tip, and its intermittent nature and absence of discharge are against STD. All your other symptoms sound like you're examining yourself too closely and are hyper-aware, leading you to notice normal body sensations and trivial symptoms that don't mean anything. All this is highly typical of the physical manifestations of anxiety.

In summary, I am confident all your test results will be negative. In fact, I would have recommended against being tested at all. Even if something turns up positive, it would have to go back to some other past exposure event. But I'm confident that won't happen. I will also add that if you have a regular sex partner, you can safely resume your normal sexual relationship and activities.

I hope this has been helpful. Best wishes--  HHH, MD

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36 months ago

Dr. Handsfield

Thank you so much for the detailed response. So essentially the unprotected oral sex ( fellatio and cunnilungus) in the first exposure is theoretical risk. also should I be checking with doctors about the slight bump I see on the foreskin when I pull it back completely and pain in tip of penis ( it could be the foreskin also as I am uncircumcised) which happens majorly when I am sitting and it coming in contacts with my underpants ( in fact if I wear boxers instead of underwear it is completely gone). my partner and I share the same family doctor so trying to avoid a visit if I can or alternatively I can show it different doctor as well.

also is it safe to assume that the  weight loss are more anxiety related and any white tounge has nothing to do with std..I shall update once I have my results and again, thank you for the detailed response

thanks

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Oops -- I spaced out on your multiple exposures, didn't realize that the first fellatio episode was unprotected. And I didn't remember to address your risk of oral infection by cunnilingus. Apologies.

Yes, receiving unprotected fellatio carried low risk of gonorrhea, nongonococcal urethritis (often maybe due to entirely normal oral bacteria), and herpes due to HSV1. However, i stress low risk, and in the absence of obvious symptoms (primarily urethral discharge) I wouldn't recommend testing. That said, if a negative test would be reassuring, feel free to have a urine gonorrhea test. (It will also include chlamydia, almost always done along with gonorrhea. But chlamydia is extremely low risk from oral exposure.)

Genital to oral STD transmission by cunnilingus is very rare. I can't say the risk is zero, but if I were in your situation, in the absnce of oral sores, sore throat, or other oral symptoms, I would not feel a need for testing.

It's hard for me to speculate on the cause of the "slight bump" on your foreskin, except that no STD is a likely explanation -- and for sure no STD that could show up within days of a new sexual exposure. If you happen to have a genital wart, which is the only STD that might be a consideration, it goes back to a distant past exposure. Warts take at least a few weeks, average 3-9 months, to show up. And warts are rarely acquired by oral sex.

So I don't think there would be any problem seeing your family physician. I'm confident s/he would keep any information confidential from your wife; and in any case, it is unlikely you have any STD or other medical consequences from your extramarital adventures. But if that remains a concern, you could see someone else, perhaps a dermatologist; or your local health department, if they have an STD or other appropriate clinic.

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36 months ago
Dr. Handsfield - Thanks for the clarification. Does the white tongue / bad taste in mouth that I mention below qualify as oral symptom . also, what are the possible STD that can be transmitted  from Genital to oral STD transmission by cunnilingus ..sorry for asking so much of follow up questions ..thanks again for the all the help
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
White coated tongue is a very nonspecific symptom that can be associated with minor change in diet, common colds, and probably anxiety. No STD is a known cause.

The "possible" oral STDs from cunnilingus are gonorrhea, herpes, oral HPV, syphilis, and perhaps others. But in my 40+ years in the STD business, I have never had a single patient with any of these whose only exposure was cunnilingus. Any risk is in the lightning strike ballpark and can safely be ignored.

That completes the two follow-up comments and replies that come with each new question. However, since the first follow-up was partly due to my misreading of your question, I'll leave this open in case you have any last follow-up concerns or questions. But really, don't overreact to some sexual decisions that you may regret. Don't confuse sexual regret with STD risk from the exposures; they aren't the same. Deal with the former as you need to, but you really are at very minimal if any STD risk and I am confident you don't have anything.

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36 months ago

Thanks Dr. Handsfield . Ok so one last follow up - Just to give me the peace of mind, the possible open cuts in my testicle due to shaving with hair cream before receiving unprotected oral carried low STD transmission correct?  I shall get back to fixing my issues as I don't want to be in this situation again . Keeping finger crossed for negative test results and thanks for the help

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
I've never seen or heard of any STD being acquired through shaving nicks and cuts. Nothing to worry about.

Thanks for the thanks. I'm glad to have helped. Best wishes and stay safe. 

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