[Question #5422] Risks from Romanian sex worker in Germany

21 months ago

Hello,


First thank you for your advice and help. 


I suffer from depression, anxiety, mild OCD, and sexual addiction. I regularly see a psychotherapist to work through my mental health issues. 


Yesterday, I hit rock bottom and had a sexual encounter with a FSW in Munich Germany at an FKK club (which is a hybrid sauna and brothel) while visiting for work. 


Around 2PM that day, I self treated a boil on my pubic area (near base of shaft, but on pubic mound). I used compresses, then popped the boil, and then cleaned the blood and pus using soap, water, and hotel cloths. 


I later went to this FKK around 9PM and my experience went as follows:


  1. Met Romanian prostitute
  2. Went in hot tub naked with her, she sat on my lap
  3. Took a brief shower
  4. Went to room and cuddled/massaged naked - do not think our genitals touched
  5. Had her put condom on me. She did not squeeze tip but rather stretched the opening over and rolled it down
  6. Received brief fellatio with condom on, did not break (3-4 mins)
  7. Orgasmed on myself with condom off, she then cleaned me off
  8. She then put on new condom (same way) and had brief sex (3-4 mins)
  9. Orgasmed again with condom on, did not break 


I have a long term female partner, and we have unprotected sex, so I am mostly concerned for my her health.


Plan to get tested in 4-5 days at a local clinic for peace of mind. 


What is your advice to do? Am I at risk? Did wound from boil put me at greater risk? If I am infected with something, what is likelihood that I will have symptoms? Is STD test 4-5 days sufficient?


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Welcome to the forum. Thanks for your confidence in our services.

I hope I can help. But you probably know that anxiety and OCD is the main problem here -- and these usually are not much improved by facts and reassurance. The very nature of your questions indicates you are seriously overthinking the details of sexual safety. The facts are that most FSWs have no active STDs, especially in relatively upscale settings where they are aware of risks, use condoms, and typically have fairly low risk clients (men like you). Second, when an STD is present, most exposure don't result in transmission.

Third and by far the most important, you did not have unprotected sex. The important thing is to use a condom for vaginal or anal insertion. Hand-genital contact, oral sex, and indirect exposure to genital fluids are all low to zero risk activities. Finally, skin lesions increase risk little if at all, even when exposed to genital fluids. A fresh, still bleeding cut could be risky. But after as little as an hour, and certainly with problems present hours or days, the healing process effectively seals off the wound. I cannot say the risk is zero from such exposure, but in my 40+ years in the STD business, I have never seen a patient with any STD so acquired.

On the basis of this exposure, I do not recommend you be tested for anything. Of course you are free to do that if the negative results will further reassure you. But if I were in your situation, I would not be tested and would continue unprotected sex with my wife without worry.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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20 months ago
Very much appreciate the reply and helpful information. I did follow through with a test 5-6 days later, and everything was negative. 

Only one follow up question regarding syphilis. Given it’s rare in general, and mostly a MSM disease, I’m not particularly concerned. But I am wondering if there is some risk given skin to skin contact in or near genital area. In other words, a condom would prevent syphilis from entering through the urethra. But what are transmission odds from uncovered skin to uncovered skin if FSW had a chancre? Does the disease actually transmit easily that way? And maybe more fundamentally, are chancres on women even common outside the vagina (vs inside)? I’m trying to get a sense of whether condoms are effective against syphilis, or only somewhat.  

Again many thanks. Your advice has helped calm me immensely. 





H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Thanks for the follow-up; I'm glad the discussion has been helpful so far.

Sometimes people assume that "skin to skin" STI transmission means that any skin contact can be risky. Not so. All three of the STIs generally transmitted by skin to skin (or betweem mucous membranes and skin) -- syphilis, HPV, HSV -- generally must be massaged into the tissues for infection to take hold. Brief contact is almost never sufficient. That's why all three of these generally first show up at sites of maximum friction during sex:  penis head and shaft, vaginal opening, labia minor, anal area. Woudl the risk of fleeting contact be higher if there was contact with an actual chancre?  Probably yes, but since the risk is so low, it still would be a nearly nonexistant risk.

Condoms are highly protective against syphilis, but obviously it depends somewhat on the exact location of chancres or ohter infectious liesions. But even busy STI clinics see very few patients with syphlis acquired from sex with condom use.
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20 months ago
Thanks again.  Very helpful. 

I recognize this is my third reply, so these will be my last questions. Will try to keep brief. 

My partner has recently developed a yellowish vaginal discharge. Of course, mentally I’m wondering if my exposure has anything to do with it since we have had unprotected sex multiple times since. 

However, from reading other posts on this forum (which are super helpful), I’m fairly confident this is just coincidence for a few reasons:

1. My gonnorhea and chlamydia tests came back negative and urine sample was taken 5 days post exposure. From what I’ve read, this test result is definitive. Correct?

2. Given condom covered tip of penis entire time, I think that would rule out trich. My urine test also showed trich as negative, although it seems testing men for trich may not be 100% accurate. So, if discharge were caused by trich, I’d imagine it may have been from my partner catching it long ago... we’ve been together 7 years though. So seems unlikely. Fair?

So if I had to guess, this is all coincidence and more likely UTI, yeast, BV, or something else. 

One open question though. She is taking sulfamethoxazole trimeth. What STIs, if any, would that cure?

Thanks again Doctor. I’m happy to close thread after this. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Your analysis is reasonable -- I agree that given all we know at this point, your partner's vaginal discharge isn't likely related to an STD acquired from you. But that's not a guarantee -- there's still a slim chance you had a sexual safety lapse that you missed, and/or that you have anSTD that was missed on exam and testing. I'll also point out that when one person in a couple finds a need for other sexual experiences, so does the other. You can judge much better than I can whether your partner is likely to have had sex with anyone else. But even if not, for sure she needs STD testing. Any woman with new, unexplained, or abnormal vaginal discharge requires evaluation including testing for all STDs.

UTI doesn't cause vaginal discharge. It could be yeast, triggered by her current antibiotic treatment. However, the main yeast symptom is itching/irritation, not discharge -- and certainly not yellow discharge. Trichomonas is possible as well. Chlamydia chance is much reduced while on SMX-TMP, but gonorrhea is possible. 

Correct that normally this would end this discussion. But I'll leave it open for a week or so, hoping your partner will have been evaluated, in case you would like to let me know the outcome. But I won't have any other comments or advice until then.
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20 months ago
Hi Doctor. Thanks for the quick response and thanks for leaving this thread open. I'm a little confused by the response though, and hoping you can clarify. And I wanted to clarify something that I think you may have misread. 

You said there's a chance that "you have an STD that was missed on exam and testing." Do you mean that the results are inaccurate, or that labs sometimes forget to test for something? I've copied my results below, which I think show that they tested for gonnorhea, chlamydia, and trich. Also, given that I have had zero symptoms, doesn't that further reinforce that it is unlikely that I have any of these STIs? I just want to ensure that I understand your comments correctly. I'm having trouble reconciling the statements on other threads that gonnorhea and chlamydia tests are definitive at 4-5 days. Given my test was at 5 days, I felt comfortable that it was definitive. Should I not feel that way?

As for my partner having sex with someone else - anything is possible, but I strongly doubt that scenario. 

On her symptoms, she got the discharge prior  to taking antibiotics. She has also experienced itching and discomfort. Then, after a visit, the doctor took a urine sample and said she has a UTI, but also, perhaps a yeast infection at the same time. Maybe that is the case, but do you think it could be BV?

I'm just having a lot of trouble reconciling the facts here. It seems super unlikely based on everything I've read and experienced that I got an STI. At the same time, it's really hard to understand what's happening with my partner (unless she had another sexual partner that I am unaware of).

NAMEVALUEREFERENCE RANGELAB
FHB S AGNon ReactiveNon Reactive TBR
FHCV RATIO0.06<1.0 TBR
FHEPATITIS C ABNon ReactiveNon Reactive TBR
FCTRACHOMATIS RNA,TMA,UROGNot DetectedNot Detected TBR
FNGONORRHOEAE RNA,TMA,UROGNot DetectedNot Detected TBR

FT. PALLIDUM ABNegativeNegative AMD
FT.VAGINALIS RNA,UNISEXNot DetectedNot Detected TBR



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
I meant that some STD lab tests miss infections that are present. But it's rare. In any case, all the test results you list are completely reliable.

I'm glad to hear your partner has been medically evaluated. UTI never causes vaginal discharge, however; so if she has a UTI, she also has something else causing the discharge. Yellow discharge always suggests infection, especially STDs. BV generally causes scant, gray or white discharge, not colored. (The main BV symptom is odor, not discharge.) 

Every STD clinic sees ptients all the time in whom the facts of exposure, symptoms, and partner infection don't line up very well. Usually it's because someone isn't being truthful, but sometimes the tests are wrong. All I can advise in your current situation is that you await your partner's complete test results (I hope she was tested for gonorrhea, chlamydia, and trichomnonas and evaluated by her doctor for BV, yeast, etc. When those results are available, if positive for any STD, you will also need treatment.

That concludes this thread. I hope the discussion has been helpful.
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