Very Concerned - Brief Exposure

[stupid_jm123]

Dear Drs,

I am a white, 38yo hetero male, no IDU, uncircumcised, clear of STD’s. I am married and my wife is pregnant.
I travelled to the States for trip that coincided with Spring Break. Last wednesday, went to an upscale night club and met an attractive 23 year old woman, mixed native american and white (not AA); from Niagara county; appeared fit and healthy. She was not a student but employed by a spring break tour company.

She was with friends - i.e. she didn't appear to be searching for men. Later she accompanied me to my hotel.  During frontage in a hot tub, I momentarily pushed my penis into her vagina. In total, there were approx 3 small thrusts, with no more than 50% penetration. This lasted only a few secs - certainly less than 5 secs before I withdrew. This took place under water.  I then asked her if we could have sex without a condom - she replied ‘no - wait until tmrw’. I asked this to see if she normally practices safe sex; that said, she didn’t freak out when I did penetrate her. I met her again 2 days later and we had unprotected oral both ways and fully protected vaginal sex.

I don't know her STI status, have no reason to believe she was an IDU or HIV+. She said she had not slept with anyone the month she had been there. I did not ask her STD status.
I I am concerned at STD risk from the brief unprotected penetration. I am not sure if her background, the very short duration, or the hot tub are relevant factors to my risk. Am i 1/1000?

5d post I have had a cold (no fever) (caused by climate and travel?)
5d post - very small red marks on the underside of the penis head (caused by masturbation without lube?). Cleared in 24hrs
8d post (now) diarrhoea, stomach cramps, heartburn, no appetite.

I would greatly appreciate your review of my exposure risk and the course of action i should take. While i intend to abstain from intercourse with my wife, I would also appreciate your opinion on the necessity/duration of doing so.

Thankyou.

[Edward W Hook, MD]

Thanks , it did not.  Your brief vaginal exposure is associated with, on average, a 1 in 1000 chance of getting HIV, IF your partner is infected.  Chances that she had HIV however are miniscule.  I would not be worried.  EWH

[stupid_jm123]

Thankyou Dr. Hook.

If I may close this thread on one point of clarification - does your HIV risk  assessment above also take into consideration the brief unprotected vaginal penetration rather than just the oral exposure?

[Edward W Hook, MD]

Typically chlamydia tests are done on the same specimens used for gonorrhea testing so getting the chlamydial test should not be a problem.

The risk for HIV from the exposure you describe is minuscule.  Fewer than 1 in 10,000 American women have HIV, there are no proven cases of men getting HIV from receipt of oral sex, and the risk of you getting HIV from performance of oral sex on your partner is less than 1 in 10,000.  There is no reason to to test if you wish.  Should you do so, I am confident your test will be negative.

EWH

[stupid_jm123]

Thankyou Doctor.

I do appreciate your promote reply and associated advice. I will follow up with the recommended tests. You do not recommend Chlamydia, should I also screen or that? I don't believe it to necessarily be relevant (may be more driven by anxiety), but I am aware of a more regularly urgency to urinate.

Can I also ask for your advice regarding my likely HIV risk from the brief unprotected penetration and your opinion on the need for testing given my symptoms to-date? Or do I need to move this post to the HIV forum to address that request?

Thankyou.

[Edward W Hook, MD]

Welcome to the Forum. I'll try to help. On one hand your partner sounds to be relatively low risk and the assurances she provided you are hopeful.  Certainly your condom protected genital sex was safe sex and not a concern.  You did however have unprotected genital (brief or not) in the hot tub and oral sex (giving and receiving), each of which is associated with some risk for STI although certainly most people are not infected and most exposures do not lead to infection.

Regarding your genital exposure in the hot tub, as you can imagine, there are no studies of this topic.  Logically the presence of the water (perhaps chlorinated), as well as the brevity of your exposure would make it unlikely that you were infected but this was still not no risk

As for your oral exposures, oral sex is an inefficient way to transmit STDs.  Even among persons with many sex partners, oral infections are uncommon and for a number of biological factors too complex to go into here, the efficiency of transmission of infections through oral sex is lower than for penetrative genital-vaginal or –anal sex.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through receipt of oral sex and only oral gonorrhea is acquired through performing oral sex on an infected partner; chlamydia is rare and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.  If you had gotten gonorrhea or NGU you would have most likely developed symptoms of urethritis (penile infection).  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  

While infection is unlikely, the safest approach would be for you to go to your local STD clinic or health care provider to be tested at this time.  Tests should include urine or penile tests for gonorrhea and NGU as well as pharyngeal tests for gonorrhea.  I suspect the tests will be negative if you choose to test.  

I hope these comments are helpful.  EWH