[Question #5428] Risk of this encounter

22 months ago
Thank you Dr. Hook and Dr. Handsfield for the great work you do.

I am a straight middle aged man and met a middle aged woman online. We engaged in genital apposition or outercourse for about 5 minutes. She was on top first and grinding, then I was on top. While I was on top, mainly tip and distal shaft of my condom covered penis was rubbing against her labia and clitoris. But when she was on top, though my penis was condom covered, I think my scrotum was more exposed with the rubbing of her vagina. Then we did engage in brief - like 1 minute of anal sex with my penis tip and distal shaft inside her anus. Condom was worn throughout entire encounter and stayed in tact. But during the genital apposition part when she was on top, I think my scrotum and maybe the very base of my penis not covered by condom was exposed to her vaginal lips.

I asked her afterwards about her STI profile and she says she gets tested every month. We didn't into which tests exactly,  but she said she does this frequent testing because she was previously found to high risk HPV on pap smear.

Is this episode of genital apposition with brief anal sex, full condom protected, considered at risk at all and warrant testing?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome. Thanks for your confidence in our services.

All in all, this was a very low risk exposure. First, you went about it safely, with condom when it might have mattered. Genital apposition without penetration carries little or no risk for the STDs transmitted primarily through fluids (gonorrhea, chlamydia, HIV). There is more risk for those transmitted skin to skin (syphilis, herpes, HPV), but still unlikely. In addition, you used a condom. Contact of skin, or the scrotum or anywhere else, is pretty much risk free. These STDs generally don't take hold unless vigorously massaged into exposed tissues -- which is why initial infections with all three of these generally show up at sites of maximum friction during unprotected sex (penis head and shaft, vaginal opening, labia minor, anus if there is anal sex0. Probably men almost always get partners' genital fluids on their scrotums but it's rare for these infections to show up in that location.

In addition, active STDs are quite infrequent in people 40 and over (guesing on the basis of "middle aged"). That said, it seems your partner might be on the high risk side -- that she is tested for STDs "every month" implies she might be quite sexually active with other partners. (Maybe she's a sex worker?) Still, with active STDs so infrequent at her age, and with apparently negative testing quite recently, it seems unlikely you were at risk at all.

Does this "warrant testing"? That's a personal more than scientific judgment. From a strict risk perspective, I would say the risk is too low to need testing for anything. But bestin also can have reassurance value even when the risks are nil nearly so. If I were in your shoes, I don't think I would do it and would continue unprotected sex with my wife. But I'm not you. If you find yourself worrying about the possibilities, no matter how remote, then have a urine gonorrhea/chlamydia test (valid any time more than 4-5 days after exposure) and syphilis and HIV blood tests at 6+ weeks. If you are tested, you definitely can expect negative results.

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

HHH, MD
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22 months ago

Thank you for your clear and helpful answer, Dr. Handsfield. 

I will opt to proceed based on the scientific data/medical standpoint and move on without worry based on this specific event. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
I'm glad to have helped. Thanks for the thanks.---