protected sex with high risk partners - chances of std?

[klnxprpy]

Plese help me Doc,

8 years ago I was tested for all stds, had a clean bill of health, and have been in a monogomous relationship with a tested disease-free partner (my wife) since.

To my never-ending regret, during a business trip to an ex-soviet block country, I had an encounter with 2 Russian prostitutes. One performed oral sex on me with a condom on. Then I had protected vaginal sex with the other (different condom). Both condoms seemed intact to me afterwards - although I was pretty drunk. THis is the only time I've ever strayed in 8 years.

I know protected sex is much safer than unprotected but what I'm particularly worried about with this encounter is that: a) the prostitutes seemed like (and told me) they had been extremely active over a number of years in a country that's a well-known destination for men seeking sex b) the 1st prostitute put the condom on with her mouth - meaning her mouth or saliva probably made at least brief contact with my unprotected penis and/or genital area (penis was flaccid when she started) c) during the vaginal sex, the base of the condom slipped half way up my penis meaning only the tip and half the shaft were covered - so part of my unprotected penis may have made contact with her vagina or  genital region d) during the vaginal sex, the genital area directly around my penis made contact with the prostitutes bum and inner thighs e) at various times during the encounter the prostitutes probably touched my unprotected penis with their bare hands.

Now that I'm back (it's a week since the encounter), my primary concern is the health of my wife (we have unprotected sex, though not since the incident). I'm terrified I may have something but even more terrified I could give something to her - a completely innocent person. Naturally she expects us to have sex again soon, but I couldn't knowing she'd be in danger. If I told her what happened, that would pretty much mean a divorce and the end of my life - we have 3 kids, one of them an infant in the cradle. Even still, I'm so desparate to protect her health I would tell her if that helped keep her safe in any way.

My questions:

1) what the heck do I do now? Do i tell my wife (a pretty safe bet my marriage and life as i know it would end instantly) then get tested for any stds i may have gotten? do i put her off (sex-wise) for a few months then get tested when anything I could've contracted would've manifested itself?

2) given the specific circumstances of my encounter (protected oral and vaginal sex, but: skin-to-skin contact between me and the prostitutes genital regions, possible direct contact between prostitute's mouth/saliva and my unprotected penis, condom on  during vaginal sex but not extended all the way to base of penis) what are my chances of contracting stds including hiv?

3) what's the next medical step i should take? should i get tested? for which stds? when?

Help!

Anxiously awaiting your reply...

-a moron

[H. Hunter Handsfield, M.D.]

I won't try to respond to the marital counseling aspects of your questions, such as whether and what to say to your wife.  I limit myself to the medical and epidemiological aspects of STDs; that information may help you decide, but that's as far as I can go.

Condoms are close to 100% effective against HIV as long as the meatus (penile opening) is covered; unless you had open sores of the penile skin, there was no route for HIV penetration.  Same for gonorrhea, chlamydial infection, and the hepatitis viruses.  HPV, herpes and syphilis are transmitted skin-to-skin, so there might have been come risk, but I have no way to estimate it numerically.  Syphilis is epidemic in eastern Europe and Russia; and herpes and HPV are common everywhere.  But the risk of catching those from any single episode of sex, even if entirely unprotected, is pretty low; and you had a high degree of protection even if not perfect.

Don't worry about the saliva business, penile skin-to-thigh contact, or hand-to-genital contact; none of those exposures carries any measurable risk of STD/HIV transmission.

1) Tell wife?  See above.  The answer depends as much on your relationship with your wife and her personality as on the medical issues.  Perhaps other STD forum users will have advice for you.

2) The statistical likelihood you caught anything is low, but I can't say it is zero.

3) If you develop no symptoms, especially of genital bumps (warts) or sores (syphilis, herpes), you're probably home free.  However, it takes time for symptoms to appear, up to 2-3 weeks for herpes, 6 weeks for syphilis, 3 months (or more) for warts.  You'll probably want to test for HIV, just to reduce your anxiety; the negative result will be reliable 4-6 weeks after exposure.  Syphilis blood tests are positive within ~6 weeks, herpes within 3 months.  There is no test for HPV.

Good luck--  HHH, MD

[Imdumb]

Chances you have HIV are zero. The chnaces you have HPV, Herpes, or syphilis is very low.  You were protetced, I don't think the slipage was a big deal.  

I think the chances you have anything are so low that I wouldn't ruin my life over it.  Do you drive your wife in a car or let her fly in a plane?  Those carry multiple times the risks that you caught anything that you will pass on.

It might help for you to get tested for piece of mind, but I think (and please dr. correct this if not valid) if after 10 -14 days of no symptoms you have nothing to worry.  If you see no sores, have no discharge or it doen't burn to pee.  

Unless you need to tell your wife to take away your guilt, then say nothing.  You mention she is an innocent party, so why bring her the pain by taking your guilt and transfering that luggage to her.  If you can get past the guilt and then really to some soul searching to figure out why you did it and how you will keep from doing it in the future, your life will be free of this and your famliy can remain intact, which would be the best for everyone.  But you truley need to do the work to keep yourself in control.  You might want to look into sexual addiction and see if there are books, counselors or groups that can help you stay clean.

[klnxprpy]

much thanks to both of you for your advice and comments. i find them extremely helpful.

one more follow-up question for you though, doc:

when you say risk of std is low, is there anything you can say to  
explain exactly what you have in mind by this? i realize applying hard statistical probablity on this type of risk is impossible. but do you mean low as in getting hit by lightining, winning the lottery kind of low - or is the risk higher than that?

thanks again for your help and advice.

[H. Hunter Handsfield, M.D.]

I wish I could help further, but it's awfully hard to quantitate; too much missing information.  For HIV, your risk of being infected is so close to zero that your chances are greater of winning big in the lottery.  But I just have no way of guesstimating the likelihood that the women to whom you were exposed--especially the vaginal partner--were infected with anything.  I don't know enough about STD prevalence in their country, their city, or similar commercial sex workers in that environment; whether they might also be injection drug users; how much they know about STDs and how to protect themselves (but it's a good sign that they use condoms); whether they get tested regularly for HIV and common STDs; etc, etc.

Having said all that, the only STDs of any measurable risk are HPV (esp. genital warts) and HSV.  My guess is that the risk of either of these is under 1 in 100, probably a lot lower than that.  But I just can't say more, and I'm not all that confident about that number.  It's really just a semi-educated guess.

HHH, MD

[shadowknos]

i am always amazed at the comments some people make whenever the origal poster mentions "straying outside the marriage" or something simular.
the poor guy said he strayed once within 8 years and imdumb suggest he goes to consuling for "sexual addiction" .  thats insane.
   we are dealing with the medical aspect . the values or morals are not in our purview. once in 8 years as an "addiction" Please...

[bluebird05]

I'm with "imdumb"...use protection with your wife while you get tested to "be sure"...including a HSV-2 HerpeSelect test...then get on with your life and forget about it...but don't do it again and let this be a learning experience....it will be far worse if you tell her.......good luck.

[nimixer]

Sexual addiction counseling is appropriate if the straying was an escallation of other behaviors. (i.e. porn to strip clubs to prostitutes.)
The anxiety might be a way of dealing with your guilt. You may be punishing yourself for your misdeeds. And you recorgnize the possible dangers you may have exposed your family to. You should seek counseling to deal with your self imposed guilt and punishment and try to get at the root cause of the problem.

[susannak]

I'm a wife, and here's my opinion:

If this was truly a one time thing (I'm having a bit of a problem believing that, incidently) and things were exactly as you said, I WOULDN'T probably be better off knowing what happened.  
It would indeed shatter the marriage (though I'd probably stay giving you this one chance) but there would be no trust-forever.  

You say your wife would leave, your finaces would be ruined, your childrens lives altered forever.  I say the very, very low chance you "got something" is higher than the chance you would ruin all those lives.  
I WOULD however, not want to have relations until you test clean.  So come up with some reason not to have sex with her (bad back, pulled groin muscle or something), get tested and get on with your life of being a good boy.

But--I don't really think that your debut incident of straying included 2 hookers at the same time in a foreign country.  I don't think that's first time behavior.  Just my belief, that's all.  Could be wrong.  If it isn't your first time, do your poor wife and kids a favor and get help or leave gracefully with a minimum of upheaval.

[susannak]

darn it---"the chance you got something is LOWER than the chance you would ruin all those lives"...I hate typos when I'm on my soapbox!

[shadowknos]

If you are under the impression that porn and strip clubs/prostitutes are sexual obsessions that need addictive counseling--- its going to be a long line. As the Dr. has comment many times most do not need to offer apologies for their behavior as basic primal desires do not essentially change.
most men have a porn collection( see Chris Rocks comedy act)
  marriage as some sage /or cynic put it is simply "legal prostitution" .  
most men like  a variety of sexual experiences with  different women. married or single. this is simply the unabashed truth.

[shadowknos]

If you are under the impression that porn and strip clubs/prostitutes are sexual obsessions that need addictive counseling--- its going to be a long line. As the Dr. has comment many times most do not need to offer apologies for their behavior as basic primal desires do not essentially change.
most men have a porn collection( see Chris Rocks comedy act)
  marriage as some sage /or cynic put it is simply "legal prostitution" .  
most men like  a variety of sexual experiences with  different women. married or single. this is simply the unabashed truth.

[The Tulips]

I am a Westernized male from a developing country living in N.Ameria. I have been struggling all my life between my own horniness and opportunties availble to me out side of my marriage. This is not to say either I am unfaithful or want to be unfaithful to my wife recognizing it as a stuggle between male physiology and male psychology. My wife will wipe off my fling like baby wipe and will get on her with life, rather than taking me to a diverse court. It is nothing but male urge, not a moral betray to our loved ones.

[shadowknos]

most men (not all) either in their minds /values/moral view etc are able to seperate "sex" from love.  sex is a physical pleasure that centers on the body .  love is more.
love is a chemistry that while it well may include sex, it  far exceeds it. it involves the mind, the spirit and the body.
   when you berate someone here for  stepping outside the marriage for physical pleasure  with another person you are simply assuming  value judgements .
  most men in their hearts crave sex. they lust if you will after more than one women. (wife , girl friend, neighbor's wife)
   we are "wired " in that way. you well may get a STD. you might get hit by lightning standing in the rain.
you might get hit with a sunami wading in the ocean.  
  

[radian]

A related discussion, HPV was started.

[mrmoshy]

A related discussion, protected sex with an escort was started.