[Question #8924] Protected but not fully covered

38 months ago

Dear Doctors,

I am a married man that has done the worst mistake of his life. 4 days ago I received protected oral and vaginal sex from a sex worker in Madrid. Vaginal was very brief (1min) and not especially vigorous. I need to admit I am under a lot of anxiety. I am barely able to eat or sleep.

My worry is the following: the condom was covering 75-80% of the penis. Around 3cm from the base were not protected. Hence, I have the worry about having caught syphilis. I did some research and the cases of syphilis in Madrid are around 13.29/100,000. However, the official health ministry points out that 88.7% of these cases are men, so 12% only are women and the ratio for women is 3/100,000.

I have taken the determination to test in 4 weeks but in the meantime, I'd want to ask you some questions. Potentially your answers will help me move from my anxiety to a better and more rational estate of mind.

My questions are:

1. If you were in my situation, would you ignore the event and continue with your normal life with your wife?

2. How many cases have you seen with syphilis due to uncovered part? If she had a rush, can that be infectious? It was so dark that I could see anything.

3. What is the overall probability you give to this event?

Thanks a lot, Doctor. I have a lot of respect for your work.

Regards,

Edward W. Hook M.D.

38 months ago

Welcome to our forum. Thanks for your question. Thanks as well for your confidence in our service. I’ll be glad to comment.

By and large, the encounter you describe was a close to no risk event. Condoms remain amongst the most effective means preventing all sexually transmitted infections including HIV. The important thing for the condom to do its job is to cover the tip of the penis. The fact that the condom did not cover the base of your penile shaft does not reduce its efficacy. I’ll comment a bit more on your risk of syphilis below. Regarding your specific questions:

1. If I were in your situation, I would not worry about having unprotected sex with your wife. Please remember, even in Mexico most commercial sex workers do not have STI’s and, when they do, even with unprotected exposures, most solitary exposures do not lead to transmission of infection. In your case you had the added benefit of a condom which reduces your risk for infection to close to zero as long as it was worn throughout the encounter and did not break ( FYI, when condoms break, they break wide open - they do not leak a little bit. If your condom appeared intact, it was and did its job).

2. You are correct that most syphilis currently occurs amongst men, however it occurs primarily in men who have other men as their sex partners. It is not how does it is rare for syphilis to be acquired through heterosexual contact.

3. If I were in your situation, I would not worry about this encounter. You mentioned that you were very anxious and thus, the reassurance provided by negative tests may be helpful. You can test for the most common STIs, gonorrhea and chlamydia, using a urine test at this time and anticipate conclusive results. Testing for other STIs such as syphilis and HIV would not be conclusive until six weeks after the exposure however those STI‘s are far, far rarer than gonorrhea and chlamydia. I anticipate should you choose to test your test will be negative.

I hope this information is helpful to you. EWH

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38 months ago

Thanks a lot, doctor. You are helping me a lot. Sorry for sounding like the classic anxious person but, could you help me validate the statistical risk of this encounter for syphilis? I will help me rationalize the real risk as at this moment I am in a loop of negative thinking. Would the below be correct?

3/100,000 women have syphilis cases in the region per annum, which is 1 every 33,000. Even if infected, 50% chance of getting it if exposure had been unprotected (I saw it in some std clinics web), and let's add a 50% efficacy (my own figure) of the condom as it was only covering a part. That gives around 1 change every 133,000 (or 0.008%). That sounds rather small.

In your vast experience, how many cases per year do you see of heterosexual syphilis in the uncovered part of the penis.

Thanks a lot. I promise that after this we can close the question and I will try to move on mentally. I just have a lot to lose in my personal life due to my stupidity.

Regards,

Albert.

Edward W. Hook M.D.

38 months ago

If anything, the figures you use for your estimate of risk are conservative. Most experts would tell you that the risk of acquiring syphilis following unprotected exposure to a person with active syphilis is about 33%. Further, they would probably estimate the efficacy of condoms for prevention of syphilis transmission at greater than 50%. Personally, I have never seen acquisition of syphilis from a person who used a condom at the side of exposure. Please don’t worry. EWH---

38 months ago

Thanks a lot doctor. I am less stressed. It seems I have more chances of getting hit by truck than syphilis. I will try to move on (even if it takes time).

This service you provide is outstanding.

Regards

Edward W. Hook M.D.

38 months ago

Thanks for your thanks. I’m pleased that you found my comments helpful. We’ll close this thread now. EWH ---