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Avatar universal

Help with Risk Assessment

Hi Doctor,

Last night, I had a few drinks at a strip club. A woman performed protected oral sex on me for a while.  Then, she removed the condom and began to masturbate me for a while.  While masturbating me, she spit a lot on the head of my penis.  She spit on the head of my penis like 7 or 8 different times, and there was a lot of saliva that came into contact with my penis head.

Then later on, I went to a massage parlor and had protected vaginal sex.  After having vaginal sex for a few minutes, I lost my erection so the woman removed the condom and gave me unprotected oral sex.  About a minute or so after removing the condom, she put the same condom back on me!  I'm really nervous because I don't know what side of the condom she placed on my penis the second time.  In other words, I have no way of knowing if the condom had gotten turned inside out; and therefore, when she put it back on me, the inside of the condom against my penis was the outside of the condom before and had all of her vaginal fluids on it and consequently came into contact with my penis. We continued to have sex for a few minutes, and then she removed the condom once more and gave me unprotected oral sex.  

When I got home, I noticed that I had two red marks/bruises on the head of my penis head. This was probably from the oral sex.

1.  How much risk did I put myself at for STD's and which ones?

2.  Did the stripper spitting onto my penis head several times increase my risk for any STD's?

3. Because the woman at the massage parlor removed the condom and then put it back on me later, was this essentially the same thing as having unprotected vaginal sex?

4. What is the STD risk for having had deep unprotected oral sex performed on me by the woman at the massage parlor?

5. Do I need to be tested for anything?

6. I know it's not an HIV form, but could you please let me know if I put myself at risk for HIV because of these exposures?

Thanks
11 Responses
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Yes, conclusive and reliable.
Helpful - 0
Avatar universal
Hi Dr. Handsfield,
I just wanted to let you know that I tested negative with a hiv rapid blood test today. I
think it was a clearview test. This has been 7 weeks after the exposures more or less.
I also tested for gonorrhea but won't get the results back for about 10 days they said.
Do you think this 7 week negative hiv test is conclusive and reliable?
Thanks very much again for all your help!
Helpful - 0
Avatar universal
Thanks Dr.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
It is unlikely pour partner's symptoms have anything to do with your non-risky sexual activities last month, and we already discussed the near impossibility you caught anything.  By far the most common cause of vaginal itching is a yeast infection, which is not an STD -- even though many women notice symptoms soon after sex.    
Helpful - 0
Avatar universal
Hi Dr. Handsfield,

I'm sorry for a follow-up post. It's been 30 days since my exposure. I haven't had any symptoms such as burning urination or noticeable discharge. However, I had unprotected with my girlfriend about a week ago without ejaculation. About 2 days after this, she started having vaginal itching that still hasn't gone away. She will be going to her Dr. for a check-up because she said she is still experiencing lots of itching at her vagina.
She has not had any burning during urination or discharge. Does this sound like she could have gotten an STD from me, following my exposure? Would vaginal itching without discharge and burning urination be a symptom of an STD?
Thanks a lot.  
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
I already said that.
Helpful - 0
Avatar universal
Thank you Dr. for your informative response.  

If I can just ask one last question:  in respect to HIV and the lack of data regarding condom usage as you mentioned above, do you think it's pretty safe to say that the odds are stongly in my favor that I wasn't infected with HIV and would not need testing?

Thanks a lot
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
There are no data on the level of STD/HIV risk from reversed/reused condom versus no condom.  In the absence of definitive data, equally qualified experts may have different assumptions.  As I said, this is not ideal and undoubtedly the risk is higher than if a fresh condom were used properly.  However, my judgment is that the risk remains lower than for entirely unprotected sex.  In any case, you don't know that the condom was reversed when your partner put it back on your penis.

Also, remember that at any point in time, most women -- including strippers and commercial sex workers -- don't have any transmissible STD; and when they do, transmission usually doesn't occur.  (Most STDs are inefficiently transmitted.)  Therefore, the large majority of commercial sex exposures don't result in STD, even with entirely unprotected sex.  That's why, in general, STD testing isn't recommended after single exposures except when the partner is known to be infected.  Rather, STD experts recommend that people who are sexually active outside committed relationships have routine testing at regular intervals -- e.g. once a year, or more often if particularly sexually active -- rather than running off to a doctor or clinic after each exposure event.

But of course that's still a reasonable course for people who are nervous and would like the reassurance that a (probably) negative panel of tests would give.
Helpful - 0
Avatar universal
Hi Dr.,

Sorry to post again. I asked a follow-up about this on the community forum, and they seem to think my situaiton was still a no risk situation. I value their opinion but just wondering if you agree?

Thanks a lot
Helpful - 0
Avatar universal
Hi Doctor Handsfield,

Thank you for your response and advice. I just have a follow up question because I saw a similar post regarding condom reuse in the archives where Dr. Hook had a different perception about the condom being reused and was wondering if it is just a difference in opinion.

http://www.medhelp.org/posts/HIV-Prevention/was-i-at-risk-please-help/show/739800

If you can shed some light on this, I'd appreciate your time and advice.


Thanks so much again
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the STD forum.  You had brief but accurate responses from Teak and LizzieLou on the HIV community forum.  The replies are pretty much the same for other STDs.

You had mostly protected sex -- i.e. condom for vaginal and the main oral exposure.  Generally speaking, oral sex is safe sex, even when not condom-protected.  The risk for STDs isn't zero, but it's much lower than for vaginal or anal sex, and there is virtually no risk at all for several STDs, such as HSV-2, chlamydia, hepatitis, and HIV.  Condoms of course are highly protective against STDs from vaginal sex and essentially 100% protective for oral.  Hand-genital exposure is probably zero risk, even when genital secretions or saliva are used for lubrication.  STDs are generally not transmitted by saliva.

To the specific questions:

1,4) Virtually zero risk. Theoretical risks only for herpes (due to HSV-1), nongonococcal urethritis (NGU), gonorrhea, or syphilis from the unprotected oral event.  But not high enough to get tested unless you get symptoms.

2) No risk from saliva.

3) No, a reversed condom is not the same as unprotected sex.  It isn't ideal, but still the chance of transmission of any STD is very low.

5) From a strict risk perspective, no testing is necessary if you don't develop symptoms like penile sores or discharge of pus or mucus from the penis in the next 1-2 weeks.  However, if you remain nervous despite this reassurance, feel free to visit your local health department STD clinic or your private doctor's office for testing.

6) No measurable HIV risk, as you learned on the other forum.

I hope this helps calm your fears.  Best wishes--  HHH, MD
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