[Question #7424] General risk after minor testing

3 months ago
Hi doctors, thanks for hosting this forum.

Some time ago I had regular unprotected oral (giving/receiving) sex and protected vaginal/anal sex with a female who is generally known to me, I’ve no reason to believe she behaves or has behaved irresponsibly and I don’t consider myself to do so either. This went on for 3 months or so. 

After about 2 months we agreed to get tested and were each only screened for chlamydia and gonorrhea (vaginal/penile sites respectively) and we were both negative. Some time after this during vaginal intercourse, I felt a condom break and pulled out probably within the minute. We didn’t get retested for anything after that, as we didn’t really think we’d be at risk for some of the more sinister infections, eg HIV or syphillis and because incidences of these diseases in our country and demographic are quite low (straight; white; middle class; Australia). 

Would you recommend further testing based on the above? I’m not clear why this has suddenly presented me with anxiety - to my
knowledge, neither of us have had any symptoms or anything - but just want to understand if I should have undertaken more tests or if we were naive/mis-informed in assessing risk when the condom broke.

Thank you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome and thanks for your confidence in our services.

You have pretty well described the very low risk for STDs in this situation. You and your partner were wise to be tested for common STDs before beginning your relationship:  many infections and much grief and regret would be prevented if more people were so careful!

I would urge you not to focus on the single condom failure. You don't say how many sexual encounters you have had. But if it were say 10 times, your overall STD risk would be low, but higher from those 10 events than from a single condom failure. Perhaps it would be good to have (another?) conversation with your partner, to reconfirm with one another that you're not having sex with  other partners or otherwise at risk, outside your own relationship. Assuming your expectations are confirmed, I see no need for further testing or any health-related reasons not to continue your relationship.

The main risk probably is from HPV, which is equally common in people with high-risk and low-risk sexual lifestyles, and equally common in regular condom users versus nonusers. Australia has had the world's highest success in approaching universal HPV vaccination, and depending on your and your partner's age, you may have been vaccinated -- in which case even lower worries about HPV. In any case, the large majority of HPV infections remain asymptomatic and cause no health problems at all.

So I don't recommend any testing xcept that your partner should follow standard guidelines for routine pap smears, as should all women.

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

HHH, MD
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3 months ago
Doctor Handsfield,

Thanks for your comprehensive response.  A few additional details, as per your reply:

  • Number of sexual encounters - I assume you mean with this partner. It was probably more like 50 or so over a three month period, but I understand the basis of your reasoning; that this number of instances unprotected oral sex are higher risk than the single broken condom. I should say that I was overwhelmingly in receipt of the unprotected oral sex, and only reciprocated on a few occasions and very briefly. 
  • Partners background. I did ask again; the response was that there is “nothing to tell.” To be honest, I know that she takes reproductive health very seriously for future endeavours (ie children), and was the one to purchase and advocate for condom usage, so I would expect the risk of exposure to something more serious is low (unprotected oral aside). 
  • I’ve never been overly concerned by HPV; not out of a disregard for safety, but on the basis that it seems unavoidable to some degree and I likely already have it, having had cold sores as a child. I didn’t see any sores anywhere on her body, either. 
Let me know if this changes your assessment - but on the basis of your response, I was not considering being tested at this time and prior to commencing anything new and hopefully you agree with this! 

Thanks again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Nope -- none of this changes my assessment and advice. I'm glad to hear you understand HPV and have a realistic perspective on it. And yes, I was referring only to this partner in discussing the risks of multiple sexual encounters.---
3 months ago
Thanks again, doctor Handsfield. One final thing (and I appreciate this is my last available response). Is there any risk of syphilis from this encounter or unprotected oral sex in general? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Syphilis can be transmitted by oral sex, but infrequently. And the chance a partner like your would have syphilis is virtually zero. In Australia most syphilis is currently occurring in men having sex with men, and is rare in women, even in sex workers. Syphilis is just as low risk as HIV in your siuation, i.e. virtually zero risk. That said, you're obviously going through some anxiety about these issues. Perhaps you and your partner should have anohter round of STD testing (gonorrrhea, chlamydia, HIV and syphilis) -- the negative results might be more reassuring than anything I can say. And maybe you'll find she's having the same anxieties as well.

You're right:  two follow-up exchanges included with each question, so that ends this thread. I hope the discussion has been helpful.
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