Took a risk

[whitelily123]

I had no idea that so many people with STD's don't even know they have it (80%?) until I recently read up on STD's.

My concern is that a couple of days ago I had unprotected sex with a guy who I've been dating for a couple of months.  He says he hasn't had a partner in a year, and I believe him.  I should have had him use a condom anyway but I didn't.  We only had sex once and he withdrew before he came.  My question is: If he has an STD, how likely is it that I would get it with only having sex once (and him withdrawing)?  I'm guessing that since I already had sex with him, if he has something- I already got it.  Or is it less likely since he withdrew before he ejaculated.  I'm not sure if STDs are transmitted via semen or any type of discharge.  

So now when I have sex with him again I feel I may as well go without a condom since I've already taken the risk and either he has something or not (thinking if he has it I got it already).  Is that irrational reasoning?  I only have sex with one person at a time so if we stop dating I could get a routine check for STDs (even if I have no symptoms) to make sure that I didn't get anything.  

Do I really need to use a condom since I've already taken the risk?

Thanks in advance for sharing your expertise with me,
whitelily123

[H. Hunter Handsfield, M.D.]

Safe sex isn't synonymous with condoms, as if that were the only strategy.  It strikes me that your own sexual lifestyle is safe, and probably your new partner's is as well.  Statistically, the longer a couple takes to get to know each other, the lower the STD risk.  Obviously there can be individual exceptions, but when considering the population as a whole, care in partner selection and limiting sex to people who "seem safe" after you get to know them is probably just as important as condom use, maybe more so.  In settings like yours, having sex--even first sex--without a condom isn't necessarily unsafe.

To answer your specific questions:  IF he has an STD, you likely already are exposed.  But the likelihood he is infected is low.  Gonorrhea and chlamydia rarely last as long as a year anyway; and the risks for herpes, HIV, hepatitis, etc seem very low.  At this juncture, I see no particular reason to start using condoms.

Finally, although couples counseling is not my thing, I suggest you have this same conversation with your partner.  It's a good bet he is thinking the same way you are.  You might even consider going together for STD evaluation from the same provider.  The odds are everything will be negative; you might find it a relation-strengthening experience.

Congratulations on a sensible, level-headed approach to your sexual safety!  Best wishes-- HHH, MD

[Imdumb]

Since you don't know his sexual history, it would be prudent to use protection until you can both get a full STD panel.  If at that time you are both clean..Go for it!!!

Having sex unprotected with the thinking "if he has anything I already have it" is not good logic.  Although  it is doubtful he has anything like gonnorrea or chlamydia given that he has no symptoms and has not been sexual active for a year, there are other things to think about.  Like HIV, HPV and HSV.  There is no way to tell if he has these without tests and there is a low chance you would get HIV or HSV (herpes) from a single unprotected encounter. But the odds go up quite a lot if you have repeat exposures.  

Bottom line, both go get tested and then you can make an informed decision whether or not to go unprotected.

[tanner203]

Doctors, this a statement you said to someone on 2/20/06 - I felt I had to respond.


"And or course you need to consider your sexual safety. Using condoms for anal sex is good, but not perfect; you need to also know, ask, and share your HIV status with anybody you have sex with, even if condoms or other safe sex is planned. If you don't, it's a pretty good bet you'll have HIV someday. Don't take the risk"

I really don't understand this statement.  Why the hell should we even were condoms at all if there is a pretty good bet we will get HIV with protected anal sex?  I know condoms can break, is that what you are referring to?  Also, people lie all the time about their status, especially in the "gay" world. I agree with sharing folks status, however, there are a lot of people who don't know (25% to be exact) their status or, as mentioned above, lie.  I think you should rephrase what you say to something a little more realistic "If you going to have sex, always, always assume your partner is positive, even if they say they are not."   I just think by saying even if you use condoms for anal sex and not know your partners status (since a quarter doesn't know their status) there is a good bet you'll get infected someday sends the wrong message to gay men about the importance of continuing safer sex practices.

[whitelily123]

By the way I am a female.....have been in a 10 year monogomous relationship (married).  I just got divorced.  I know I shouldn't have had unprotected sex....I had a few drinks that night and wasn't really thinking, plus I trust this guy and believe he hasn't been with anyone in a year and hasn't had any symptoms.  I don't know a lot about STDs and started getting worried... that is why I posted the question.

[Lutheran122]

You can't really trust anyone when asking if they have any std's as there are a few of them that can hide in your body for years and show no signs they are there like Hiv and Herpes. So definitely do not have unprotected sex with him again and also you need to go make sure you didn't get anything from him so just go get a full std panel with hiv testing. It will ease your mind and also everyone should know their status if they are sexually active.

[H. Hunter Handsfield, M.D.]

WL123:  Since this conversation followed my response to your question, I will repeat for everyone to see:  You strike me as a level-headed, caring person who is taking a rational and inherently safe approach to your sex life.  Condoms are good but not the only story.  Most STDs would more or less disappear if all sexually active singles took your approach, even if condoms didn't exist.  Lutheran122 recommends a more conservative course than seems necessary in your case.

Tanner203 criticizes me for stating facts that are not subject to debate.  There are several safe sex strategies.  They include knowing your partner; avoiding partners at obvious high risk; sharing STD/HIV infection information; use of condoms; selective sexual practices (oral safer than anal or vaginal); and avoiding sex in settings and environments that impair judgment (drugs, alcohol, bath houses).  None is 100% effective by itself, but since when is 100% efficacy a criterion for recommending a prevention strategy?  We advise seat belts even though people die in auto accidents while wearing them.  Some strategies work best or are more important in selected settings than others, and some people will find some of them easier than others, and one size does not fit all.  Therefore everybody should know and consider using all of them.  However, among gay men, knowing and sharing HIV status - and avoiding sex with HIV positive partners (or with partners who do not know or refuse to divulge their HIV infections) - is by far the most important single strategy.  The argument against knowing and routinely disclosing HIV status before having sex is ethically and pragmatically bankrupt; most people who make it, in my opinion, are self-serving and looking for ways to shirk their personal responsibilities.

HHH, MD

[Lutheran122]

Doc you replied after most of us did ( check the dates ) , I just am pointing that out so you don't think I was disagreeing with your reply to lily. This new guy she met is most probably a stand up guy and probably doesn't have any STD's at all.Then again , the only true way to know is by testing ( if by some off chance he is positive he may not even know ) so the only reason I mentioned to her to test is because she seemed to be saying that she might as well continue not using a condom since if he has any diseases she already has been infected from their first unprotected session. That is just not true. But doc you bring up an interesting point , wise choosing of partners is very important. I wish I followed that advice at all times but sometimes the wrong choice of partners seem to be the most exciting choices  :(

[H. Hunter Handsfield, M.D.]

I was aware of the timing and that you were not responding to my statement and didn't intend criticism.  Just a somewhat different perspective.

HHH, MD

[siobhan_d]

You are providing an invaluable service in this forum by making sense out of the often confusing information surrounding sexual health. But I am puzzled at your response to this woman. I'm not sure how dating someone for a few months constitutes "knowing your partner", which is part of your recommended safer sex strategy. Furthermore, you go on to commend her "rational, levelheadedness" even though she admitted to using alcohol prior to her encounter which seemed to impair her judgement. Like me, and a lot of others, this young woman didn't seem to have all the facts until after the act. How does she know her partner was not as equally in the dark about STD's as she was? Although her risk for contracting anything seems low, based on the numerous threads I've read in this forum, it is contradictory to advice given to many a concerned individual. Since abstinence is the only 100% guaranteed safe method, shouldn't we all just err on the side of caution and use all the preventative measures available to us until we know 100% for sure? If you care at all about yourself and your partner, you would!

[monkeyflower]

I don't know Dr. Handsfield's reasoning for his advice (which sounds reasonable to me), but I think she clearly engages in what I'd consider very low risk behavior. For one thing, she's serially monogamous - but even more, she's evidently only now becoming sexual with her bf after dating for *months*. I guess I think that people who are willing to wait for months to have partner sex HAVE to be awfully safe, lol.

[H. Hunter Handsfield, M.D.]

Monkeyflower has it right (as usual).  There are no absolutes in sexual safety, and anyone who demands near-absolute protection would take the conservative approach advocated by siobhan_d.  It's a personal decision--but from her description of her own risks and her partner's, whitelily123's decision to have sex without a condom seems reasonable.

HHH, MD