I think I am worrying over nothing but would appreciate your opinion, if for no other reason than to reassure.

Last night I (male) went to a strip club and had the following sexual encounters:

1. A handjob;

2. A blowjob followed by vaginal intercourse, condom used the entire time;

3. Another blowjob followed by vaginal intercourse, condom used the entire time;

4. Another blowjob, condom used the entire time.

Because I was very intoxicated, I wasn't fully rigid and the condoms sometimes moved around on me, but I believe the head of my penis was covered at all times. 

I believe these were all low, or even zero, risk encounters but would appreciate your view. Should I do any testing? Thanks,

-A

Your own judgment is correct -- these were very low risk exposures. Condoms work, and oral sex is quite safe even without condom protection. No STIs ever are transmitted by hand-genital contact, even if genital fluids are involved (e.g. used for lubrication).

That said, there is always at least small risk for vaginal sex, even condom protected -- both because of overt condom failure and because of unrecognized failure of proper condom use; and because there often is risk for transmission of skin-to-skin STIs above the area covered by the condom. And the small risk may be slightly higher when the condom is loose, as might occur with partial erection.

Even with entirely unprotected sex, in general STI testing isn't necessary or recommended after any particular exposure, except in special circumstances (e.g. if one's partner is known to have an active, transmissible STI). But perhaps more important, anxious persons often choose to be tested even when the risk is very low or even zero -- some people are more reassured by negative test results than by expert opinion based on probability and statistics.

If somehow I were in your situation, I would not be tested and would continue unprotected sex with my wife, with no worry of infecting her. But I'm not you, and you'll have to make your own decision. If you decide to be tested, I would recommend only a urine test for gonorrhea and chlamydia (valid any time 3-4 days or more after exposure) and blood tests for syphilis and HIV after 6 weeks. (Or of course sooner if STI symptoms appear in the meantime, such as discharge from the penis, genital sores, etc).

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

HHH, MD

The syphilis and HIV incidence in my jurisdiction (Ontario) is 17/100,000 and 3/100,000 respectively so I'll probably skip that.

However, I did want to take a chlamydia/gonorrhea test, which I did pretty much exactly 3.5 days after exposure (84 hours) just to be sure, which came back negative.

My question is whether I should take a followup at 2 or 3 weeks? I ask because I'm experiencing some itching on the top of my penis lately. I don't know if it's psychosomatic or a yeast infection or what have you. No burning sensation while urinating, no discharge. Thanks again.

Your negative result at 3-5 days is conclusive -- no need for a follow-up testing. And in any case, no STI causes external penile itching. If there is no visible skin abnormality, then an anxiety reaction (psychosomatic, etc) is probably the best bet.

Sorry again for the long delayed reply. I'll leave the thread open another couple of days in case you see this and it prompts any additional thoughts or concerns.

I admit my anxiety got the better of me and I did a urine and blood screen at 4 weeks which came back  negative. Thanks again.