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STD (Herpes) Prevention

I am a 46 y/o male headed to Amsterdam's Red Light District for two weeks for adult hi-jinx and fun.  I am planning on using a condom during oral/vaginal intercourse, but I still am VERY concerned about the risk of contracting HSV-1/HSV-2.  When engaging in these activities, is it wise to only allow penetration up top the base of the condom?  I'm aware that herpes is not a fluid based disease, and can be passed simply by skin to skin contact (which scares me).  What types of preventative steps can you suggest (beyond condoms) to prevent to a high degree the likelihood of catching herpes?  Finger cots when touching?  No direct skin to skin contact?  Thank you!
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Do not use male and female condoms together.  That would increase the risk that either or both might break.

Your level of worry about the most minor genital skin contact is misplaced. If you're that worried, you need to rethink this whole business and probably not do it.  Probably it isn't possible to have genital sex without some skin contact.

HSV doesn't infect skin surfaces so easily anyway.  Most infections result from the virus being massaged vigorously into the skin, which is why almost all initial genital herpes infections first appear at the sites of maximum friction during sex (penis, labia, vaginal opening) and almost never on the scrotum, pubic area, etc.  Scrotum contact with a partner's genital area carries little or no STD risk.

Oral sex is virtually zero risk for HIV and lower than vaginal sex for most STDs, but not zero, and genital herpes due to HSV-1 is one of the risks.  In general, condoms are considered optional for oral sex, but given your heightened concern, you probably should do it

Bottom line:  If you go ahead with this plan, just plan on using a male condom for both vaginal (or anal) and oral sex.  With that, the risks will be sufficiently low that you shouldn't worry about it.  If that level of safety doesn't satisfy you, I suggest dropping the entire plan -- or stick to mutual masturbation.

That's all for this thread.
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Avatar universal
Thanks again!
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Avatar universal
One more question...is the risk of catching anything receiving oral with a condom on extremely low as well?  Could I expect a sex worker to be familiar with the usage of a female condom, given that male condoms are widely used?  Thanks again.
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Avatar universal
Thanks for your response doctor.  I live in the US (CA).  I was tested for herpes within the past 6 months and came back negative for both types.  

"However, the risk of catching HSV-2 for any single episode of entirely unprotected vaginal intercourse probably is once in every few thousand encounters."

Is that assuming the female is HSV-2 positive? or the female population as a whole?

Are you suggesting the possibility of using both male and female condoms?  Would a female condom provide greater protection from direct vaginal contact to the testicles.  I asked my doctor about the risk of transmission from direct vagina to testical contact (due to condoms not protecting that area), and have received a blank look.  Is that a possibility.  Sorry if I sound paranoid, but I just want to consider all the possibilities.  Thanks again.
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Condoms are highly effective in preventing herpes.  Not perfect, for the reason you state, i.e. the potential for skin-skin contact above the condom.  However, the risk of catching HSV-2 for any single episode of entirely unprotected vaginal intercourse probably is once in every few thousand encounters.  Assuming 90% protection by condoms, the chance is vanishingly small.  As for orals sex, there is a slight chance of acquiring genital HSV-1, but all in all it's probably even lower risk than for genital HSV-2.  Fingering is no risk; the chance of herpes or any other STD by such contact is too low to worry about.

There are no data to estimate how much safer it might or might not be to have less deep sex, i.e. trying to reduce skin-skin contact above the condom.  However, skin-skin contact probably is quite a bit less with the female condom.  There is no research on this, just common sense based on the structure and function of male versus female condoms -- but most likely the risk of herpes is lower.  So you might want to phone the establishment ahead of time to see if the ladies use female condoms or have them available; or take some along yourself.

Another approach is to have a blood test before your travels.  You don't say where you live, but in the US there's at least a 20% chance you already have HSV-2 and around 50% chance for HSV-1.  The probabilities vary around the world, but almost everywhere there is a substantial likelihood of already having one or the other infection.  You are immune to catching a new infection (or at least highly resistant) with the same HSV type.  For example, if already positive for HSV-1, like half the population, you have no worries of catching herpes by oral sex, with or without condoms.

Finally, my general advice is this:  By deciding ahead of time that you're going to have sexual exposure of this sort, for all practical purposes, you are making a decision to accept some risk of an STD.  You can minimize the risk, and within the limits of the basic decision, you are going about it responsibly.  But you cannot reduce the risk to zero, unless you decide to limit yourself to mutual masturbation and not much else.

Bottom line:  Herpes really isn't much of a risk anyway.  But there you have some ideas abour reducing -- but probably not eliminating -- the small risk that exists.

HHH, MD
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