[Question #964] Nervous & disappointed in self after exposure

50 months ago
Dear Dr. -

I am a 41-year-old married male who has recently had two exposures with sex workers. 

The first one (6/25), I had intercourse and wore A condom and used it properly. I feel there is little risk for that encounter with the exception of HPV to this to the scrotal area.  

In Second one I received unprotected oral sex and ejaculated in her mouth (7/14). My sense is that this was a higher risk scenario with the fact that this individual didn't seem concerned about having a client ejaculate in her mouth and seemed not to understand the risks associated with it.

Based on what I've described, do you have any thoughts on how I would risk I am for STDs. My biggest concern is infecting my wife with something. My plan at this point is to refrain from sexual activity with her till I can get tested. But, I know I'm going to make myself crazy with worry about HPV and potentially he having exposed myself to gonorrhea, syphilis, herpes or something else I'm not even aware of.

Also I've read that sometimes people can be exposed to STDs and have no symptoms. How likely is that scenario?

Over the course of my life I've had unprotected oral sex with sex workers without protection and have never gotten anything. Is that just luck or is that just because it's very difficult to get something that way?

I should say that I am not proud of any of this and I view it as a problem that I need to address.

Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago

Welcome to our Forum. I hope I can provide a few comments that you will find helpful.  I agree with you that your June exposures were effectively no risk and would extend that to HPV (see below).  As for your more recent exposure, this too was low, but not no risk.  First, most persons, including commercial sex workers do not have STIs, particularly oral STIs.  Second, transmission of STIs from oral infections in not a biologically efficient process and few persons get STIs from receipt of oral sex. 

The STIs that are sometimes acquired from receipt of oral sex are gonorrhea, non-gonococcal urethritis and rarely chlamydial infection. there are no documented instances in which persons have acquired HIV from receipt of oral sex and syphilis is incredibly rare from this sort of exposure.  There is a very, very small risk of getting genital herpes simplex type-1 (the virus that causes cold sores) if you do not already have it but most people do have it, whether they know it or not.  Testing for gonorrhea and a chlamydial infection is reasonable but I doubt that you have these since most persons who get these STIs become symptomatic with penile discharge or burning within a few days of exposure.     

Once you have been tested, I see no reason related to the exposure you describe to abstain from sex with your regular sex partner.

Finally, with regard to HPV- HPV infections are rarely acquired from oral sex, most people (over 85% of adults) already have HPV whether they know it or not, and most exposures do not lead to infection.  for all of these reasons, I would not worry about HPV.

I hope you find these comments helpful.  EWH

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50 months ago
Hello Dr -

Thank you for your response. 

With regard to HPV...  I have had genital warts removed over the years and my wife once had a pap that was irregular which led to a Leep procedure to remove the cells (15 years ago). 

I assume that we can be infected with new strains that our bodies are not accustomed too and have new outbreaks.  Would this be the case? Or, does the body build immunity to HPV in general, and keep all strains under control?   Also, does HPV only affect an area of skin to skin contact or can you get it in the scrotal area and transmit to the inner area of a woman?

Interested to learn more here. 

Thank you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago
Immunity to HPV is strain specific so that persons who have had one type of HPV can be infected with another type in the future.  Most adults have had multiple HPV infections, whether they know it or not which is part of the reason that few older persons get HPV.

HPV infections are local processes, trans tired through direct contact.  They do not spread through the body without direct contact and they are not effectively spread fro. Person to person through transfer on a person's hands to other parts of the body either.

The ASHA web site has a very good kink to HPV information.  EWH
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50 months ago
Thanks Dr for your replies!

Last thoughts/inquiry on this matter...

Last night I engaged in safe sex with my partner.  Today I feel a little soreness, and a minor sensation of having urinate.  No discharge or significant pain.  Just awareness of my private area in the form of sensations (tingling at the head, feeling like I have to urinate)

I know short of getting a test no one can say I "don't" have an infection..., however,  would symptoms of an infection be very clear and obvious? And, does what I'm describing sound like a guilty person being hyper sensitive? 

Sorry to ask you to go over this further. 

Thank you!!!
Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago
The symptoms of the STIs I mentioned to you in my original response can be mild and, as I told you, the can even occur without symptoms.  That you had condom protected sex last night has no bearing on whether or not you have an STI or impact on the development of symptoms.    What you describe sounds most like anxiety-related hyper vigilance and heightened awareness of what are most likely normal genital sensations.

No change in my assessment or advice.  Testing is reasonable and, on you case, might help you in dealing with your guilt and anxiety,

As you know, Forum policy is up to three responses to clients per question.  As this is my third response to you, this thread will be closed later today.  EWH
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