[Question #529] STD risk assessment

41 months ago
Hello there and thanks for taking the time to answer my question. I had a negative STD panel in June of 2014. Since then, I've had about 7 encounters. Included in there were 3 instances of unprotected oral, 3 more protected oral, and some just general finger vaginal touching and kissing. In August of 2015 I saw a CSW who I had protected intercourse with. I'm mostly sure the condom remained in tact, although it did slide down about an inch or so as I pulled out. Her skin was even covered around the condom from wearing the type of stocking she had on. 

About a month ago I started having urinary urgency and discomfort. I saw some doctors and had urine tests. I tested negative for chlamydia and gonorrhea on Jan 13th as well as a clean urinalysis and urine culture. A urologist last week told me it was non bacterial prostate inflammation from a vasectomy I had in late November. I only bring all that up to tell you about the negative test results. 

Finally on Jan 18th I had unprotected oral and intercourse (for about 3 minutes) with a non CSW. The week before she showed me her own recent negative STD test results. What I didn't see on there were results for herpes or HIV.  But she told me the hospital told her verbally she was HIV negative and never had any evidence of herpes (nor did I see any) so I took her word on it. 

I plan on getting fully tested once some more time goes by and the herpes test becomes more accurate, but I was hoping you could weigh and access my risks. Thanks again! 

 

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

The encounters you describe are quite low risk.  Most people, even CSWs do not have STIs and when they do, the risk for acquiring infection from any single exposure is always less than 1 in 3 and for some STIs (like herpes) substantially lower.  Further, different sorts of sexual exposures have different risks of infection.  Receipt of oral sex is a very low risk event since throat infections are rare and transmission from the throat to the genitals is likewise biologically "inefficient".   Receipt of condom protected oral sex is a virtually zero risk exposure which should not worry you.    Similarly, neither vaginal touching (masturbation) or kissing carry any meaningful risk for STI.

You have effectively ruled out the most common STIs with your testing by the doctors you saw about a month ago.   I would believe them and your test results.

Finally your exposure on January 18 was the highest risk exposure you have mentioned, in large part because you had unprotected vaginal sex with a new partner.  Even this however was a relatively low risk event because it was statically unlikely that your partner was infected and most exposures do not lead to infection.  That she indicated she had been tested and reported negative test results makes infection still less likely.  The absence of symptoms since that time is likewise in your favor.  Personally, I would not worry further but, if you wish to be tested, at this time, given your lack of symptoms, Your test results for most STIs would be conclusive.  We typically do not recommend testing for herpes following exposures such as the ones you report- testing in this situation is more likely to lead to a falsely positive result than to detect a recent infection.

I hope these comments are helpful to you.  EWH

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41 months ago
Thanks so much, Dr. Hook.  Since I got to actually see written proof of recent negative test results from my partner on Jan 18th (with the exception of HIV and HSV) I'm feeling fairly confident combined with your reassurance. I've also been closely examined by two different doctors since that encounter because of my vasectomy issues in the time period sores could have developed so I'm sure they would have seen something even I hadn't. 

 I'll likely get the tests done anyway... but while I'm waiting for them to come back I won't be tearing my hair out over it. Your advice is very much appreciated!!!