Protected Oral Sex with Stranger

[OoopsOMG]

Dear Dr.,

I am a married man who a few days ago made the biggest mistake of his life.  Being slightly intoxicated and bicurious I fellated a man I met on the internet.  Besides some brief manual contact with his genitals (my hand, his penis) in order to stimulate an erection, he wore a condom throughout.  The whole act lasted several minutes and I was careful that my mouth only contacted the condom covered area of his penis.  He climaxed into the condom while my mouth was still on him.  I did not notice any kind of sores on the penis, scrotum, or anywhere in the genital region. I was very cautious not to contact any other areas of skin except perhaps for bracing my hands on his thighs for the duration of the act.  After ejacualation I noticed the condom was indeed intact.  I asked his status before the act and he claimed he is clean and gets tested but you never know (I also asked again after and he reiterated that he plays safe and is clean).  I know oral is low risk in general but,

a) What are my risks for various STDs from this singular transgression (herpes, hpv, gonrrhea, chlamydia, etc)? I know chance of HIV is practically zero,right? My only other sexual partner has been my wife and I'm worried sick.

b) What are the dangers this presents to my wife? Is it safe to engaged in deep kissing, cunnilingus, fellatio, and unprotected sex without putting her at risk?

c) Upon arriving home (~30 minutes later) I washed my hands thoroughly and rinsed out my mouth with antiseptic rinse.  Is there any evidence to suggest that these acts offer any benefit in protecting against STD transmission?

d) Does this singular exposure warrant STD testing?

e) I think I've covered everything but just to be sure, short of condom breakage, is there any other detail that I could have failed to provide that would change your assessment of the above questions?  For example, if I find out in the future that he tests positive for something?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.  It's one of those in which all the information required for an accurate response is in the title.  Without even reading the question itself, I can say that a) oral sex carries little or no risk for HIV (especially if the exposure was a partner's mouth with your penis); and b) condoms work and would reduce any risk to truly zero.  So unless I see a surprise in the details when I read your question, you aren't at risk for HIV or other STDs, don't need testing, and can safely continue unprotected sex if you have a regular partner.

Now I have read the question itself.  Guess what?  Since it was your oral cavity that was exposed, the risk would have been a bit higher for some STDs.  However, since the condom was apparently in place for the entire time of your oral exposure, there was no risk.  Potential contact of your hands with genital secretions carries no risk.  The STD bacteria and viruses evolved to require more intimate contact than you had in order for infection to take hold.  If superficial contact with semen etc could transmit STDs, there would be risk from public toilets, sex shops, and (sometimes) shaking hands with people -- but no such STD transmission ever happens.  To your specific questions:

1,2,4) The risk was zero, for practical purposes, for all STDs.  Your wife is not at risk and no testing is recommended.  

3) Washing had no effect one way or the other.  Even without washing, there would have been no measurable risk.

5) No, there are no details I can think of that would change my opinion or advice.  The same applies to any other "what if" scenarios that may come into your mind.

You're obviously distraught about a sexual choice you regret, and you'll have to deal with that aspect of this experience.  But STD risk is not part of the equation and you can dismiss it.

Good luck--  HHH, MD

5)

[H. Hunter Handsfield, M.D.]

Basic conservatism and legal liability indeed explains some of the more cautions health advice you can find, whether on STD/HIV or many other health issues.  The scientific data, however, are clear.  The problem of course is that it is logically impossible to prove a negative: that there has never been known cases of some STDs (e.g. HIV) being transmitted through an intact condom doesn't prove it can't happen someday -- hence risk-averse or conservative resources may have a "take no chances" perspective.

STD clinics like mine have thousands of visits a year, and patient after patient has HIV, gonorrhea, chlamyida, herpes, etc, etc.  And yet we neve- see patients with these infections who didn't have unprotected insertive sex.

So do your best to accept the science, and the reasoned reassurance I have tried to give. And stay off the internet.  Anxious people tend to be drawn to information that inflames their fears and to miss the reassuring bits.

That will end this thread.  Take care.

[OoopsOMG]

Also, I just wanted to point out the source of much of my confusion on this issue.  Of course I did a search before posting in order to try to answer this question myself and I find that a lof the information out there is highly misleading.

For instance, on of the top hits on google states:

"Oral Sex With a Man - If you choose to have oral sex, and your partner is male, use a latex condom. If you or your partner is allergic to latex, plastic (polyurethane) condoms should be used. Research has shown the effectiveness of latex condoms in preventing the transmission of HIV. Condoms are not risk-free, but they greatly reduce your risk of becoming HIV-infected if your partner has the virus."

Based on the way that is worded it certainly sounds to me like an intact condom can still allow the transmission of HIV even though that really wouldn't make sense.  So are statements like the one above made out of purely out of concern for legal liability?

By the way, I am not questioning your medical opinion, which I value highly, but simply trying to understand how so much misinformation is able to persist.

[OoopsOMG]

Thank you, doctor.  Your response is extremely helpful.  Like many other people who post to these forums I find it difficult to think objectively about concerns relating to my own health.  It's a great help to have a resource like this where people can get objective assessments from medical professionals.

I guess the same mechanism that makes us think we can win the lottery when the odds are astronomically against it also makes us think we are likely to catch a disease when the odds are nearly impossible.