[Question #6934] STI from protected encountered

9 months ago

Hi, thank you for what you all do on this site, it is extremely helpful!

During a weeklong trip to Portland OR about 3 months ago, I met with a couple of appointment based CSWs. All acts involved protected oral and vaginal sex, condoms were used throughout the acts without visible breakage. Each lasted about 20 mins. After returning home, I continued unprotected sex with my wife. About 3 weeks post exposure, my wife complained about vaginal bleeding after sex and an abnormal period cycle. Her period has been very consistent in the past. More recently, she mentioned about some abnormal vaginal discharge of brown/yellowish color. Based on my reading, these are all common symptoms of STDs such as chlamydia, gonorrhea, or trich, due to vaginal inflammation. For the entire time, I experienced no obvious symptoms of any kind for these STIs. Needless to say, I'm extremely worried and regretful that I may have acquired something and passed onto her. As far as I know, both of us have been free from any STD before these exposures. Here are my questions:

(1) How likely her symptoms are due to chlamydia, gonorrhea or trich infection?

(2) What other STDs can cause these symptoms? Either from skin-to-skin or otherwise.

(3) What are the chances of HIV infection from these exposures?

(4) Do you recommend testing for both my wife and myself based on these observations?

(5) Are there concerns with normal interaction with kids at home if these were indeed STDs?

Thanks!

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

As I think you understand, your non-marital sexual events 3 months ago were very safe, with low risk of infection -- with further reassurance that you had no symptoms yourself in the next couple of weeks. While asymptomatic infection can occur, it is uncommon for the STDs that might cause symptoms like your wife's (gonorrhea, chlamydia, maybe Mycoplasma genitalium -- but not trichomonas, which usually is asymptomatic in men. That said, your wife's symptoms are concerning and are consistent with an STD. However, other non-STD problems certainly can cause them. If I understand the timing, it must be a few weeks since onset of her symptoms. Have they continued all this time? Has she seen a doctor? If so, I would expect she might have had STD testing herself.

Those comments partly address your questions, but to be explicit:

1) As I said, her symptoms are consistent with STDs but other causes are possible.

2) Gonorrhea, chlamydia, M. genitalilum, and trichomonas are the main STDs that might explain such symptoms.

3) HIV risk was very low. On the other hand, if there was an unrecognized condom failure that resulted in an STD, then HIV is at least a possiblity. But extremely unlikely and not a serious concern, and not a possible cause of your wife's symptoms.

4) As implied above, it would make sense for your wife to have STD testing, especially if her symptoms are continuing. It would make sense for you to be tested as well, although at this point even negative results would not completely rule out the possibility you were infected. Within 3 months, most gonorrhea and some chlamydia would be resolved by the immune system. (We don't know how long M gen or trich may last, maybe longer.)

5) No STDs are ever transmitted to children or other household members. They would be at risk only in event of sexual abuse.

My final comment is that when one person in a committed relationship finds a need for outside sexual experience, often the other has done so as well. Only you can judge the likelihood that your wife has had other sexual exposures; obviously I haven't a clue. But it's at least something you should think about.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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9 months ago

Thank you so much for the thorough reply doctor! I have not heard about M. Genitalilum before and just did a brief research, and if I understood correctly, sounds like this is something should have been protected by condom as the bacteria will need to enter through my urethra, and not through skin-to-skin.

From what I have on this forum, I did feel my exposure risk was relatively low, but the fact that these symptoms still showed up for my wife is changing how I see these risks and perhaps I was not as safe as I thought. It really worries and scares me as it seems that condom may not be as effective even if it was used throughout and didn't break. I’m curious if it is possible that these bacteria or virus could have been transmitted to my penis while the CSW was putting on the condom or can it be that her vaginal fluid has entered the condom through the opening at the bottom of my penis during intercourse? If that was the case, what are my chances of catching these STDs? How concerned are you with this possibility?

Regarding to HIV, if none of us have experienced any flu like symptom or fever during this time, is it safe to assume we are safe from that?

To answer your questions, I don't know when the vaginal discharge started, I heard my wife mentioning this recently and I would imagine this probably started around the time when other symptoms appeared. I will try ask and confirm. She did go through a pap appointment about 2.5 weeks post my initial exposure, which is after she noticed the vaginal bleeding, the exam included HPV screen and did not report anything abnormal at the time. No other STD testing was done as far I know.

Again, thanks for your response!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
The risk of urethral infection with any STD, including chlamydia, gonorrhea, trichomonas and M. genitalium, probably is truly zero for a properly used condom (no penile-genital contact before or after condom use) that doesn't break wide open. If you're confident in such proper use, I think there is no chance you were infected from that event. Should your wife happen to have an STD, there would have to be another explantion.

This was virtually a zero risk event in regard to HIV, but not because of your lack of symptoms, which are basically useless in jdging the likelihood of infection. Absence of symptoms is slightly reassuring but really makes no significant difference. The chance such women as you describe, in the Pacific NW, have HIV is extremely low anyway. That said, anyone having non-monogamous sexual exposures should be tested for HIV and other STDs more or less routinely from time to time, like perhaps once a year. So maybe this would be a good time for you to be tested, since it's on your mind. 

Mosty gyns doing pap smears would ask about symptoms and at least make a superficial assessment of abnormal vaginal discharge or other evidence of infection. With a normal pap and no other comment from her doctor, it's a good bet nothing was amiss. However, the only way to be completely certain she isn't infected, given the overall circumstances, would be for her to be tested.
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9 months ago

Thanks again Dr. Handsfield for the through response. I tried to recollect all the details and I’m quite certain that the condom was intact in both events as it would have been very noticeable to see it being torn wide open and my penis visibly exposed had that happened. While thinking though that, one thing came to mind. It is my understanding that all condoms have pores on them, and some viruses are much smaller than those pores, which in theory would allow them to pass through under the right conditions, especially when condom was stretched either at the time of application or insertion when things were not well lubricated. In one of the events, the CSW did stretch the top part of the condom to make sure it fully covered the head of my penis before rolling it down, which I found odd at the time but didn't think much since it didn't cause it break. Would this have enlarged the pores for virus or bacteria to pass through more easily. Is this even a possibility or a concern based on how condoms are made these days?

I will find an opportunity soon to go through a test. Looking at nearby testing facilities, looks like STDCheck.com is likely best choice for me, but it does not look like they cover trichomonas and M. Genitalium. Are these not commonly tested items? I prefer urine test at this time if possible so I don’t have to explain the needle marks to my wife at this time, and will do a full panel during my next annual check up that’s still months later. I will also encourage my wife to see her doctor if her symptoms continue or get worse.

Thanks again for all the help so far!


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
Sorry, you're wrong about condoms. Both lab research and clinical experience show that no bacteria or viruses can leak through "pores" (which do not exist) in latex or polyurethane condoms. It dosn't happen. And the details of how your partner handled and applied the condom doesn't make any difference; there are no pores to enlarge! So these additional comments do not change my professional opinions about your situation or my advice.

If you are tested at all, the only ones I would recommend are urine for gonorrhea and chlamydia and blood tests (6 weeks after the event) for HIV and syphilis. All others are either no risk at all; of unnecessary importance; or the tests themselves (esp. herpes) are not sufficiently reliable to recommend for people without symptoms.

Given the overall situation, it is more important for your wife to consider STD testing than for you to do it yourself. Now that you're three months out, negative results for chlamydia or gonorrhea (or M. gen or trichomonas, for that matter) will not assure you were not infected and now resolved by your immune system -- and therefore will not exclude the possibility that you ifnected your wife. Don't get me wrong:  this is exceedingly unlikely. But it still takes a slightly greater chance of missing an infection if you're the only one tested.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful.
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