I was in San Francisco alone for business and I stupidly (and drunkenly) ordered an asian escort to my hotel approx. 36 hours ago (Monday morning 12:30 am). Encounter was protected oral and vaginal sex (as well as kissing) using a latex condom, lasted maybe 20 minute entirely. I think the condom was properly used and on until I pulled it off to masturbate to completion, however at times it may have been loose/not covering the base as due to my drunk condition I could not maintain an erection the entire time. I took a shower afterward. Is there any risk in terms of the condom and not maintaining a full erection etc? The condom did not break (water test). I am married and extremely worried about passing something to my wife. 

This is the first time I have done something like this and I am worried sick, can barely eat/sleep thinking about how I may have screwed everything up with this stupid drunken act. Is it safe to resume unprotected sex? I called the escort back and she assured me that she is tested every 3 months and clean. I plan on visiting my local general practitioner doctor and getting tested for chlamydia / gonorrhea this Thursday and HIV/syphilis at 6 weeks but it is not realistic to not have sex with my wife and she will know something happened if I insist on using a condom. Everything I've read online at medhelp etc suggests I have minimal need to worry, and should only be concerned about HPV/HSV and syphilis. Please help!

Thank you.

You can relax. While I understand your concerns, this was a very low risk encounter. You can safely assume the condom was intact. In fact, "water testing" is based on the urban myth of small or microscopic leaks, which are extremely rare if they occur at all. If a condom doesn't burst wide open, it is safe to conclude protection was complete. Looseness like you had doesn't appear to be an important reason for condom failure. As long as the head of your penis was covered during penetration, which sounds likely, protection is complete against all STDs transmitted by sexual fluids (gonorrhea, chlamydia, trichomonas, nongonococcal urethritis, HIV, viral hepatitis). There is slight risk for those transmitted skin-to-skin, like herpes and syphilis, but even for these, the risk for any single encounter is in the range of one in many thousand. HPV is probably more likely, but the vast majority of HPV infections cannot be traced to any particular encounter, and it is equally likely you and/or your regular are already carrying one or more HPV strains as it is that you acquired a new infection from this event. (In other words, your final statement about HPV, HSV is correct. Syphilis is almost nonexistant in women like your escort partner.)

Beyond all this, I would add that it seems unlikely your escort partner is infected. In general, escorts (expensive female sex workers by appointment, as opposed to brothel workers, bar pick-ups, etc) are at low STD/HIV risk: most use condoms consistently, have low risk partners (mostly men like you, primarily monogamous or otherwise not sexually active) and, like your escort partner, get tested regularly.

Should you be tested? It's optional, more important for reassurance from the expected negative results than because of any significant risk. Assuming you go ahead with testing, you might move your gonorrhea/chlamydia plans to Friday; 3 days is cutting it close for a reliable chlamydia result (it's fine for gonorrhea); and also 6 weeks for HIV and syphilis. However, I don't think you need to abstain with your wife -- certainly not for the entire time until the blood tests are done. If somehow I were in your shoes, I would either not abstain at all, or might wait until the gonorrhea/chlamydia results were known to be negative, whic probably would also take you to the 10 day window in which any sympotms would likely show up.

I hope this has helped. Let me know if anything isn't clear.

HHH, MD

It has now been 1 week and several hours since the incident in question, awaiting test result from Friday which should come in today.

This morning I noticed a single, very small hard bump on the underside of the shaft of my penis, which looks possibly like folliculitis or a pimple of some kind, however I am concerned about syphilis. Would it be possible for symptoms of syphilis to show up at this time and would they look at all like this? Am I overanalyzing/obsessing and is it still safe to resume unprotected sex with my SO given this development? I have been abstaining until now (was planning to resume after negative gon/chlamydia). No other symptoms at this time.

Thank you.

This is further to my previous question regarding the bump.

It's now been about a month and 2 days since the incident. The bump I previously mentioned started out  about halfway up the shaft about a week after, very small, looking/feeling like a harder hair follicle and continued to be the same until about 3 days ago, at which point it began to expand and seems to have become slightly more red. It is somewhat firm and not painful at all, and definitely more noticeable than it was before. I've resumed unprotected sex with my spouse and am now extremely nervous that this is syphilis and I could have passed it along to her. Is it possible that when I contacted you last it was the earlier macular / papular stage of infection at which point most people do not notice, and it is now transitioning into a chancre? How long would syphilis typically take to go through these stages to become what would obviously be a chancre? It has not ulcerated at this time but I am dying of anxiety. 

I would go to the doctor however my GP is out of town and we're still about 2 weeks from the definitive testing point anyway. Separately, the chlamydia / gonorrhea tests came back negative.

Thank you.

A syphitic sore (chancre) can start as a red bump, but always ulcerates within a few days. This sounds like an infected hair follicle or sebaceous cyst, unrelated to the sexual exposure. I'm sure it's safe to wait a couple of weeks, except that with the lesion turning red, it might soon rupture and drain. Once that happens, it will be harder to diagnose accurately. So I would recommend seeing somebody now, without waiting for your GP to return. Probably someone is covering for her; or you could visit an urgent care clinic.

5 week HIV ag/ab (duo) came back negative, as did 6 week RPR (syphilis) and hepatitis tests. The lesion ended up bursting similarly to a pimple, which combined with the negative RPR leads me to believe that it was unrelated to the 'exposure' and syphilis is not a possibility.

Is it safe to say I can rest assured and move on with my life?

Thank you very much.

Best wishes and stay safe!