Unprotected Oral and risk of exposure for myself and my partner

Dr,

I am a married white male (38) and have been married and monogamous for 14 years. Recently I made a couple of bad choices that I regret deeply and would like to understand risks for both me and my family's health.

10/6- Met a woman from online (she is married, white and 38 as well).  and I fingered her and then she performed unprotected oral on me. We used the same towel to wipe up with each time.

10/7- I had unprotected sex with my wife

10/9- I noticed red spots under the head of my penis, these were more like raised irritation spots (they never pussed or oozed). I contacted the woman I had the unprotected oral with and she said she was clean and was due for her yearly test (health worker) and said she would share the results with me

10/13- The spots on my penis were dry and started to peel (I have psoriasis so is it possible this was an episode?)

10/19- She said her results came back and all negative (I did not see the results)

10/20- I met with the woman again and fingered her, I also started to have sex (put my penis in  but immediatly pulled out and said no, I didnt want to do that), she then performed unprotected oral.

10/27- My wife told me she had a "strong smelling urine" , she has never complained of such a thing to me in 14 years. My heart sank and I have not slept much since. I did not have sex with my wife since the day after my first exposure.

1) What is the risk I picked up something, transmistted it to my wife and did not have any sympomes myself? I have been checking and have not noticed any discharge etc. I do notice a sensation or itch about inside my penis but cant tell if its hypersensitivity due to my stress

2) What STDs could case a stong smelling urine?online data confsing some say trich? Is it possible I passed that on?

3) If I would have a standard STD panel of tests run would it pick up on trich?

4) I am freaking out and looking for medical suggestions on next steps. I am very concerned about my wife!

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help.  The exposures you describe are low risk for stds.  Our knowledge of STDs suggests that your partner, on the basis of her age is rather low risk for STDs.  The most common STDs- gonorrhea, chlamydia,etc. are most common in younger persons.  Her marital status also makes STDs somewhat less likely as well, as do her recent negative STD tests.  Finally the sorts of exposures you report are also unlikely to lead to STDs.  STDs are not transmitted/acquired through masturbation (fingering) and following oral sex STDs are uncommon.  The most common STDs following receipt of oral sex are gonorrhea and nongonococcal urethritis and these are most often symptomatic in persons who get them.

With this background, let's deal with your specific questions.
1. The chance that you have an STD is quite low,for all of the reasons that I mentioned above.  The rash you describe is not typical of STD and may well have been your psoriasis.  I suspect your itching represents the power of suggestion and perhaps your increased vigilance.

2.  There are no STDs that are associated with "strong smelling urine".  This was likely a coincidence.

3.  Trich testing is typically not performed I men however there is no risk for trick from oral sex or masturbation.

4.  My advice is to try to relax.  You may wish to visit your local STD clinic to be checked out and for the peace of mind it might provide.  Such an evaluation would most probably be negative given the nature of your exposures.

I hope these comments are helpful.  EWH

[NH1974]

Dr. Hook,

Thank you for your quick reply. I have a couple of follow up questions

1) Since my last exposure was only 9 days ago, is that too early to get tested?

2) I did have penis to vaginal exposure for a brief moment. Since I was dumb enough to do that, how much extra risk did I subject myself and wife to or do you believe the risk is still minimal?

3) Is it possible that I somehow my doings kicked off my wife to have BV or something of that sort to create the "strong smelling urine?". What forum do you suggest I post question about causes of this condition (urine odor)

4) In your opinion, if you were me, would you get tested? also should I hold off any sex with my wife at this point until I get tested?

Thanks again,  I appreciate the straight forward answers you post here. I tried researching online and the information and recommendations are not consistent and quite frankly due to that I was always jumping to worst case scenarios.

[Edward W Hook, MD]

1.  No, testing at this time will be fine.

2.  The penile contact does increase risk but only slightly, particularly given the brevity of of the exposure.

3.  It seems unlikely that this would have caused BV.

4.  The main reason for testing is for the reassurance it would provide.  The risk that you have an infection is low but not zero.  If you choose to seek evaluation, the sooner the better for the answers it will provide.  EWH

[NH1974]

Dr. Hook

On your advice I visited a local STD clinic on 10/31 and they only recommended gonorrhea, chlamydia and herpes testing.  Its interesting because the timing wise I am not sure herpes testing would provide accurate results (25 days from 1st pos exposure, 11 days after 2nd pos exposure). They said results will be in Thursday/Friday.

Also the clinic recommended against syphilis testing as the counselor said "if I had it I would know it" and "they haven't seen it much in the northeast"
Also recommended against HIV testing as it was "no risk" she said.
I asked about others and she said "no risk". Her answers were so fast I feel she was too confident in the answer. I know the risk is higher than zero and would have been re-assuring to tell me real numbers rather than a quick "no risk"

1) Is the statement about syphilis, HIV and others an accurate medical statement? I am regretting not pushing to have more testing for an extra couple of bucks just for the piece of mind now. Is it unusual to advise against such testing? I am reading for example syphilis can be asymptomatic, is this true or internet misinformation?

2) Will the herpes test tell me anything 25/11 days after possible exposures?

3) If I do go back for syphilis testing, are there any other tests I should request to be run?

4) If the original tests come in negative, do you believe I am blowing this out of proportion continuing on with syphilis testing?

Thanks again.. this is a great resource here and I am glad to have found a place to get clear answers.  I will report the results when they come in.

[Edward W Hook, MD]

Straight to your questions:
1.  Indeed syphilis is most often an infection transmitted between men who have sex with men and your partner was quite low risk.  Typically if you acquired syphilis you would develop a painless sore at the site of exposure.

2.  If your HSV test is positive, you may have already had the infection and not known it.  Further, if you acquired HSV (unlikely as I said above) there is no guarantee that the blood test would be positive.  I would not have recommended a HSV test.

3.  No.

4.  Your risk of syphilis is low.  I do not feel strongly that it is needed.

Feel free to follow-up if any of your tests are positive and you have questions. EWH

[NH1974]

I received a call this evening from the clinic. They informed me I was negative for gonorrhea, chlamydia and HSV2 but positive for HSV1.

Not what I wanted to hear but then again after all the reading I have been doing lately I was not completely surprised.

Now I am unsure if I had HSV1 prior or not.. I do not ever recall having cold sores in the past however I remember my wife has had cold sores on her lower lip once or twice.

Is it possible I have had HSV1 and never shown symptoms? also now I am not sure if I have it oral or genital..  

If you recall I did have that irritation 3 days after the first event, however these red raised spots have never hurt, blistered or oozed. The color fades and they dry/peel slightly an then become more red again.. I do not believe this would be a sign of herpes right? (way too long and no pain/blisters?).

So if the spots are not a sign of the herpes (I know you cannot diagnose it), there is no way for me to tell if I have oral or genital HSV1 correct?

Since my wife has had cold sores in the past, should I just move on or is there a chance I could cause greater infection to her (Example, spread it genitally). We have never brought up HSV before and since she has had cold sores she must have HSV1. We have had unprotected oral and vaginal sex for 14+ years.?

Thanks again for all the help

[Edward W Hook, MD]

Your experience is just the reason that I would not have ordered a herpes blood test.  The fact is that about 60% of Americans, on average, have HSV-1, of whom only about 80% know it.  The vast majority of these infections are oral in location.  In your own case, since your wife already gets cold sore, your likelyhood of having HSV is higher than average.

There is no way to tell the location of a HSV infection from blood test.

Finally, there is no reason for your HSV-1 infection to change your interactions with your wife or family.  Persons who already have HSV cannot get it again.

I hope these comments are helpful. EWH