[Question #7206] STI risks (mainly oral)

8 months ago

I was twice with CSWs last year (Oct.+Nov.). I am in a lifelong relationship (my wife and I had no other sex partners). The contact in Oct. was prot. intercourse and orally unprot. (giving and receiving). In Nov. there was prot. intercourse and unprot. cunilingus. I panicked about HIV after the contact in November, because I imagined that the condom was slightly slipped at the end. The HIV test in Jan. was negative. Only now did I become aware of the oral risks. Shortly after the contact in Oct. I had tonsillitis with streptococci a and was prescribed cefuroxime for 7 days (twice daily). I was not tested for oral gono because I did not see any connection at that time. I started taking the antibiotic 5 days after that. The sex with my wife did not take place in the weeks after that. it started again more than a week after stopping the tablets. Also the genital sex with my wife is always with a condom. Only now I have had a lot of testing – all negative: Hep A/B/C, Chlamydia, Syphilis and I even had a HPV smear. A gono test was not recommended to me because I never had any penile symptoms. The antibiotic is also a medicine that could be used for this (oral and genital). But I am afraid of HPV (might be gone for me by now) but still be present in my wife who never had any other contact. I could have got Chlamydia through fellatio (by now healed by itself) and despite condom use I could have passed it on to my wife (one time it slipped having sex with her). Is it just anxiety?

H. Hunter Handsfield, MD

8 months ago

Welcome to the forum. Thanks for your question.

You really needn't be at all worried. You were at very low risk for any and all STDs. Although the unprotected oral exposures are the main thing on your mind, oral sex is actually quite low risk for all STDs and zero risk for some. (It's extremely low risk for chlamydia, despite what you may have read about that possibilty.) In fact, the condom protected vaginal sex exposures carried more STD risk than the unprotected oral -- although those events too were very low risk. Second, you'ave had all those negative tests. Third, the antibiotics used for strep throat would cure most bacterial STDs if you happened to have been exposed.

Could you have acquired HPV? Conceivably yes -- that's the main STD that would not have been entirely protected by the events described. However, even that is very low risk from the exposures described. In addition, there's a good chance you and your wife have or have had HPV before, despite your lack of sex partners other than your wife. HPV sometimes appears in persons with true lifelong monogamy. The sources of those infections aren't understood. But in the unlikely event that evidence of HPV appears in you (e.g. warts) or your wife (warts, abnormal pap smear), it will not necessarily have anything to do with the sexual events you are concerned about. And most HPV infections remain asymptomatic and never show up on testing anyway. Between the low risk you caught HIV plus its usual asymptomatic nature, the chance HPV will ever make an appearance in you or your wife is exceedingly low. I really wouldn't worry about it.

I'm not sure how to interpret your last brief question ("Is it just anxiety?"). Is what just anxiety? You don't describe any symptoms. Obviously you have been worried -- but I hope these comments help you stop worry and reduce your anxiety. You really have nothing to worry about in terms of STDs. Don't confuse your regret about your sexual decisions with STD risk; they aren't the same. Deal with the former as you need to (perhaps even including discussion with your wife?), but you can put STD risk out of your mind.

Let me know if anything isn't clear. Best wishes.

HHH, MD

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8 months ago

Thanks a lot! You can't imagine how much this has kept me busy over the last few months...I cannot sleep, I cannot eat, I browse the internet for several hours a day - but in the meantime I have sought psychological help. My "Anxiety" question was also related to this! I’m afraid of losing everything my wife and me are in a over 25 years relationship. what a fool i was risking everything..!

Some thoughs/questions:

- Why had the condom protected sex more risks? You mean HPV?

- Antibiotic: Which STDs would be cured by this, except Gono?

- Chlamydia: I’ve heard about the very low oral risks, but you’ve recently referred to studies that it is not as rare as assumed in the past. tests are negative yes, but I just did them now. Something constructed maybe, but I could have gotten it from fellatio (unlikely), could not have had any symptoms (possible), now cured (possible) and despite condom use with my wife (during a one time slipped condom) I could have passed it on to her.

- HPV: would an intimate shave several hours before one encounter change your assessment? Do I have to live in lifelong fear that my wife will get something and only I can be to blame and be the trigger and thus be convicted of cheating? I couldn't live with myself having done anything to her. In germany for women over 35: every three years pap test + optional hpv test.

- You wrote "caugt HIV" - I assume you mean HPV?

8 months ago

I have to post again due to the limitation of characters. even if I have no comment left after that:

HPV

To my neg. HPV test: The hpv smear was taken from my penis. However, this area was only at risk during oral sex. Vaginally protected, the area outside the condom was a possible entry point. Here, however, no smear was taken. Is the area outside of the condom around the penis only an entry point and an HPV infection would/could still "migrate" to the penis? Or does an HPV infection also remain there?

OTHER

I have no symptoms, that is correct. In the last few weeks I've had pain in my groin area, which I also had over a year ago. A hernia was operated on with a net (minimally invasive) once over 10 years ago and both last year and this year I have developed pain (post-operative?) that both times occurred after physical exertion (long walks while on vacation with wrong shoes) and lasted several weeks. Nothing was visible on the net in the ultrasound last year. The pain is permanent and even if I press on the spot it is there. It is on the right side and the surgery was also on the right side. the pain is clearly located in the groin (right above the pubic area), but sometimes radiates from there into the right testicle. the testicle itself is not sensitive to pain. This cannot have anything to do with a STD, can it? Ascending chlamydia infection despite negative test? or can such a thing also be psychological - keyword pelvic pain syndrome?

H. Hunter Handsfield, MD

8 months ago

Wow -- you're off in the deep end on this. It's clear than aswering your questions factually is not going to resolve your fears and stress over this. You're going to need in person professonal counseling. Even complete and sseemingly final answers are going to trigger "yes but" or "could I be the exception" thoughts. In addition to counseling, you need to entirely stay off the internet. You're selectively seeing information that inflames your concerns and missing the reassuring stuff that also is present.

Very brief replies to these additional quesitons:

"Why had the condom protected sex more risks? You mean HPV?" All skin to skin infections (HPV, herpes, syphilis), plus unrecognized condom failures for others. People with compulsive and careful condom use sometiems get gonorrhea or chlamydia.

"Antibiotic: Which STDs would be cured by this, except Gono?" Depending on the specific antibiotics, probably chlamydia, syphilis, and NGU.

"Chlamydia: I’ve heard about the very low oral risks, but you’ve recently referred to studies that it is not as rare as assumed in the past. tests are negative yes, but I just did them now. Something constructed maybe, but I could have gotten it from fellatio (unlikely), could not have had any symptoms (possible), now cured (possible) and despite condom use with my wife (during a one time slipped condom) I could have passed it on to her." Serious overthinking. In my 40+ years in the STD business, I have never had a patient with chlamydia that appeared to have been acquired by oral sex.

" HPV: would an intimate shave several hours before one encounter change your assessment? Do I have to live in lifelong fear that my wife will get something and only I can be to blame and be the trigger and thus be convicted of cheating? I couldn't live with myself having done anything to her. In germany for women over 35: every three years pap test + optional hpv test. More overthinking. You have nothing from these events and your wife is not at risk.

"You wrote "caugt HIV" - I assume you mean HPV? Correct; sorry for the typo.

HPV testing: You should not have had an HPV test. They are not approved by FDA or recommended for use in this situation. Had the result been psoitive, it would not hve been reliable; and (although I hate to say this), neither is a negative result. There is NO useful test for use in males.

"OTHER": More overthinking. Yes, such symptoms almost certainly have a psychological origin. No STD causes such things.

Please heed my comments above about staying offline and professional counseling. Your thought processes on these issues are not normal in view of the scientific facts and the repeated science based reassurance you have had, probably from your own doctor(s) as well as my comments. I suggest it from compassion, not criticism.

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8 months ago

Thank you, doctor. I think you are so right. Your message yesterday also had me very reassured. But this morning the pointless brooding started all over again.

I wasted a lot of time and money on pointless tests. By the way: I know very well that the HPV test was not very conclusive. And it was not cheap either. And it could not calm me down either. A small correction: Cefuroxime has no effect on chlamydia and syphilis as far as I know.

Anyway, I hope that a psychologist can help me as soon as possible. The rethink/OCD has always been my problem. And here comes the bad conscience and the fear in addition. Not a good mixture and in the long run also unhealthy.

But you have really helped me a lot. Thanks a lot!

8 months ago

Do you actually know how much help you offer concerned men and of course women? This is really very important and I can't say thank you enough!

You can close this thread and I will stay of the Internet!

H. Hunter Handsfield, MD

8 months ago

Thanks for your kind comments. I'm very glad my comments were helpful. Best wishes and stay safe.---