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Risk Assessment
Well I am recently single and have decided to play around more than usual. In the past, I have been ridden with guilt after every sexual exposure and I am not nearly as bad anymore after good CBT. However, I want to discuss a few situations to see if my thinking is clear.
I have had sexual intercourse and oral sex always protected with a condom (not provided by me) with CSW's. The condoms appeared to remain in tact. Unfortunately I realized after one encounter that I had recently shaved my pubic region only hours prior and it left visible razor burn. I am worried that vaginal secretions would get into that area which would make my chances of infection the same if I had not worn a condom as both the urethra and razor burn would serve as a point of entry. Is this correct? If not, how come? She and I connected and she did admit that she is an IV heroin user who has been in and out of rehab. She denied sharing needles but I am aware that 50% acquire HCV within a year and HIV is still a real risk amongst the injection drug users.
If I practice safe sex is there ever any real reason to test outside of annual health exams? I have no moral problems with sleeping with a CSW and it is rather no strings which is fine for me at the moment. However I don't want to worry over every detail. For the most part, I haven't as I have had about 4 encounters but this one I am describing does have me concerned. Regards.
I have had sexual intercourse and oral sex always protected with a condom (not provided by me) with CSW's. The condoms appeared to remain in tact. Unfortunately I realized after one encounter that I had recently shaved my pubic region only hours prior and it left visible razor burn. I am worried that vaginal secretions would get into that area which would make my chances of infection the same if I had not worn a condom as both the urethra and razor burn would serve as a point of entry. Is this correct? If not, how come? She and I connected and she did admit that she is an IV heroin user who has been in and out of rehab. She denied sharing needles but I am aware that 50% acquire HCV within a year and HIV is still a real risk amongst the injection drug users.
If I practice safe sex is there ever any real reason to test outside of annual health exams? I have no moral problems with sleeping with a CSW and it is rather no strings which is fine for me at the moment. However I don't want to worry over every detail. For the most part, I haven't as I have had about 4 encounters but this one I am describing does have me concerned. Regards.
MEDICAL PROFESSIONAL
Trust your condom. When condoms break they do break wide open. Please stop worrying and move forward rather than welling in the past.
PEP- no way.
EWH
PEP- no way.
EWH
Thank you for the reply. Just one follow up please. I have read that condom failure will completely break and therefore I wasn't worried at the time. However can they leak? The reason I ask is because that night when I pulled out I saw a thick white field of fluid just under her genitals. We examined the condom and everything seemed intact. My fluid was in the Trojan and she pinched the tip. She seemed to think it could be from her spit and the lubricant from the Trojan. But it looked like semen? Do you think I should get pep or is there any test that can tell very soon for HIV? I didn't think leaks were possible but some people think I should be very concerned? Thank you Dr.
MEDICAL PROFESSIONAL
Welcome to our Forum. Congratulations on your mature and forward looking approach to sexual activity and STD/HIV prevention. I'll be happy to comment.
Condoms are far and away the best mechanism for STD/HIV prevention should a person be exposed to a partner with an STD. They effectively prevent the exchange of secretions at mucosal surfaces which is where most transmission of infection occurs. Mucosal surfaces are epithelial surfaces(skin) but the composition of skin/epithelium varies from location to location on the body. The surfaces of the urethra inside the male penis and at the cervix at the mouth of the female uterus are the sites which are most vulnerable to infection. At other surfaces the skin has different characteristics which make them thicker and less vulnerable to establishment of infection. In addition, another element which contributes to risk for transmission of infection, if exposed, is whether the surface is exposed to direct rubbing/friction which tend to help establish infection by "working" the infection bacteria or virus into the skin surface. Thus in men the skin of the penis itself is more likely to get infected, if exposed than the skin at the base of the penis, the leg, etc. For all of these reasons, despite the fact that it is common for sexually active couples to get each others' genital secretions on one another during condom protected sex, transmission of STDs in this situation is VERY, VERY rare and for some STDs does not happen at all (sorry, not going to go into a STD by STD breakdown here). Thus that you got some of a partner's genital secretions on your pubic area does not put you at risk for STD. Having recently shaved and having a "razor burn" does not change this.
If you do not have signs or symptoms of an STD and you are practicing condom protected sex as you mention, there is no reason to worry about being evaluated for possible STD more than your annual exam. When you have your annual exam however, please be sure that you know what tests your doctor is, and is not doing. Sometimes clients think they are being tested when that is not the case.
I hope these comments are helpful. Again, congratulations to your commitment to safe, condom protected sex. It will keep you healthy EWH
Condoms are far and away the best mechanism for STD/HIV prevention should a person be exposed to a partner with an STD. They effectively prevent the exchange of secretions at mucosal surfaces which is where most transmission of infection occurs. Mucosal surfaces are epithelial surfaces(skin) but the composition of skin/epithelium varies from location to location on the body. The surfaces of the urethra inside the male penis and at the cervix at the mouth of the female uterus are the sites which are most vulnerable to infection. At other surfaces the skin has different characteristics which make them thicker and less vulnerable to establishment of infection. In addition, another element which contributes to risk for transmission of infection, if exposed, is whether the surface is exposed to direct rubbing/friction which tend to help establish infection by "working" the infection bacteria or virus into the skin surface. Thus in men the skin of the penis itself is more likely to get infected, if exposed than the skin at the base of the penis, the leg, etc. For all of these reasons, despite the fact that it is common for sexually active couples to get each others' genital secretions on one another during condom protected sex, transmission of STDs in this situation is VERY, VERY rare and for some STDs does not happen at all (sorry, not going to go into a STD by STD breakdown here). Thus that you got some of a partner's genital secretions on your pubic area does not put you at risk for STD. Having recently shaved and having a "razor burn" does not change this.
If you do not have signs or symptoms of an STD and you are practicing condom protected sex as you mention, there is no reason to worry about being evaluated for possible STD more than your annual exam. When you have your annual exam however, please be sure that you know what tests your doctor is, and is not doing. Sometimes clients think they are being tested when that is not the case.
I hope these comments are helpful. Again, congratulations to your commitment to safe, condom protected sex. It will keep you healthy EWH
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