[Question #6414] Protected Vaginal and Oral Sex

14 months ago
Dear doctors, I was on a trip and went to a German brothel very recently and would like to hear your advice.  One Romanian girl provides the service to me. She took me to the room and gave me oral sex with a condom for 3 minutes then switch to the doggy position with the same condom for another 5 minutes.  I repeated the above with another girl for about the same time. The condom seems to be intact after we finished in both episodes. I have concerns about the following,

1. Does this raise any concern of STD? I understand that protected vaginal sex is safe with HIV, but how about other STDs? You mentioned that there is some risk associated with HPV, syphilis, genital herpes, and chlamydia because of the lesions. What's the typical percentage of getting these from the episodes that I described? I didn't see any lesions visually on her genital area.
2. I didn't see any visible lesions on my genital area when I had sex, but I found some acne/pimple during showers after two days in the genital area. Are these skin irritation or some symptoms? 
3. Should I get tested for anything? I am trying to get my wife pregnant and would like to know which STD test(s) that you recommend me to do and when I should have these tests. After 3 weeks of this? Can I continue regular sex with my wife?
4. I have read that genital herpes has no cure. So if someone catches it, what's the consequence? Do most people stay symptom-free?  Does that affect pregnancy?

Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome back to the forum. However, having reviewed your three prior threads in the last year and a half, this is basically a repeat of questions already answered. You have had both my and Dr. Hook's advice and opinions about the low risks of HIV and other STDs from the kinds of exposure you described then and also ask about here. The only difference I see is whether sexual positioning might make a difference. It does not:  the important things are that a) oral sex is low risk, even without a condom (and in men with hypospadias), and essentially zero risk with a condom (assuming the head of the penis and urethral opening are covered). 

Those comments address your specific questions, but to assure no misunderstanding:

1,3) These exposures are similar to and no more risky than the ones described in your previous quesitons. I cannot put a percentage risk on the exposures, but it's extremely low -- low enough that I do not recommend any testing on account of these events. Nobody can guarantee you didn't catch anything, but the risk is low enough that if somehow I were in your situation, I would continue unprotected sex with my wife without concern I would infect her.

2) No STD causes acne or pimple-like lesions except herpes, and initial herpes occurs only at the exact sites exposed. If these things look like typical pimples, that's almost certainly what they are, and they are unrelated to the sexual events described.

4) You don't have herpes. The course of genital herpes is highly variable and depends a lot on which virus type is the cause, i.e. HSV1 (from oral sex) or HSV2 (from genital contact). But all infected people are without symptoms the large majority of the time. Beyond that, genital herpes is quite complex -- it would take several pages of writing to comprehensviely answer these questions. Excellent sources are available online. Two of them are the US Centers for Disease Control and Prevention (CDC) and the sponsor of this forum, the American Sexual Health Association:  www.cdc.gov/std, www.ashasexualhealth.org.

Let me know if anything isn't clear.

HHH, MD
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14 months ago
Thank you for your reply. It seems that I have this phobia of STDs. I completely understand that my behaviors are extremely low risk. I would like to know,

1. What are the potential risk of protected oral sex given the condom is intact. 
 2. If I want to do some tests to ease my concerns, what type of tests do you recommend and when should I have that? Thank you. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
I agree this question and your previous ones suggest an abnormal phobia about these issues. If they're on your mind as often and/or as bothersome as they seem to be, consider professional counseling. I suggest it from compassion, not criticism. But you may not use this forum any more for this problem (more comments below).

1. With a properly used condom for oral sex -- i.e. no direct contact before or after the condom is applies, and if the condom remains intact -- I would consider it zero risk for any and all STDs.

2. I see no reason for any testing. However, it makes sense for all people having non-monogamous sex to have routine STD/HIV testing from time to time, maybe once a year. In that spirit, I would normally recommend only testing for gonorrhea and chlamydia (urine, plus throat and rectum if there has been receptive oral or anal sex) and blood tests for syphilis and HIV. No others -- the risks (without obvious symptoms) are too low and/or the tests too unreliable. Gon/Chl testing can be done any time 5 days or more after the last potential exposure; 6 weeks for syphilis and HIV testing. If you decide to do such testing now, since it's on your mind, that would be fine. But this advice has nothing to do with the exposures you have described.

That completes the two follow-up exchanges included with each question and so ends this thread. As implied above, the forum has a policy against repeated anxiety-driven questions on the same topic or exposure. This is your fourth, and it will have to be your last one; future new questions about similar exposures will be deleted without reply and without refund of the posting fee. The policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. (If you remain concerned, I would suggest just re-reading this and your previous threads. Almost certainly any and all issues that might come to mind have been answered, or the answers are obvious, from the current discussions.)

Best wishes and stay safe.
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