STD transmission & unprotected vaginal sex

[newpartner&nervous]

I have a new sexual partner and am a bit nervous. After using condoms for our first weeks together, yesterday we had several unprotected encounters (vaginal intercourse, I am on my period).

We are just getting to know one another and have discussed our sexual histories - we both get tested every year (my last test with my annual exam just days before we met; his in May).

Seems neither of us has had many sexual partners, and while he's told me he's careful, he was pretty adamant about not wanting to use condoms, which was a red flag. One I stupidly did not heed.

My main question is what are the chances of STD transmission from three separate instances of vaginal intercourse for (1) gonorrhea, (2) chlamydia, (3) HSV, (4) syphilis, and (5) HIV?

Even though there was lots of pre-***, does the fact that he did not ejaculate inside me lessen the risk for any or all of the above?

I have educated myself enough to know that one can have an STD without having any symptoms. So even if I don't have any symptoms, I plan to get tested for all STDs in 3-4 weeks.

Is 3-4 weeks a good time frame to make sure all the above will show up? Would you recommend getting tested earlier to detect at least a few possibilities asap?

I hope until then my only symptom is anxiety - if there's anything you can do help that, I'll be most grateful!

I can see through reading this forum that you help many people - thank you in advance for helping me.

PS. Two things he's told me keep causing worry: during the last year, he had a bad case of conjunctivitis (pink eye) and later a respiratory infection that sent him to the hospital. He explained the circumstances of both and neither had to do with his sexual history; however, I'm researching online and it seems both could be related to STD's. Am I just being paranoid, or is this a possibility? (I understand that what I really want to know is whether or not this man is trustworthy, and of course you can't answer that!)

[H. Hunter Handsfield, M.D.]

No, you should not "overreact".  The red dots don't bother me, but the discharge and abdominal pain definitely do.  Every abnormal vaginal discharge should be medically evaluated, unless the woman is experiencing a recurrent problem and is pretty sure about the cause--and the pain adds urgency.  So it's not an overreaction to get evaluated promptly. Your symptoms are classical for chlamydia, gonorrhea, and other STDs, and perhaps (with the pain) early pelvic inflammatory disease (PID, fallopian tube infection).

Unless these symptoms are normal at the end of your periods, see your gynecologist tomorrow; or your local health department STD clinic or a family planning clinic (e.g., Planned Parenthood) if your own doc isn't available on short notice.

[newpartner&nervous]

Thank you, Dr. I felt so much better after reading your post.

But the last two days, I've had unusual discharge (yellowish and a bit bloody with small clumps of tissue), some mild abdominal pain and mild vaginal itching. All might be just the end of my period? Doesn't feel like menstrual cramps, and usually the end of my period is quite dry.

Perhaps a yeast infection? But I was careful to pee after sex, and I've had many yeast infections before and I think I'd recognize the symptoms, which are usually more immediate and severe than what I am experiencing now.

I also noticed some small red dots along my pubic hairline where I shaved recently. Probably ingrown hairs, but I'm still worried.

Communicated my nervousness to the man I had sex with and asked him about the tests he had in May. He said it was blood test "probably" (?!) only for HIV, said he didn't think I should worry.

Trying not to overreact, but I remain nervous. I'm glad I'm going to my ob-gyn tomorrow.

[H. Hunter Handsfield, M.D.]

Wow--  you seem awfully concerned in an obviously low risk situation.  Regardless of your partner's interest in condom use, someone who is willing to openly and frankly discuss his STD risks, and couples who go into new relationships in this fashion, typically are at low risk for any STD.  Nobody can say it is zero, but you don't describe anything to make me concerned.

However, there are no data to answer your question in the way you ask it--i.e., I cannot even take a stab at the numerical odds you are at risk for any of the specific STDs you mention.  Certainly HIV is zero risk, for practical purposes.  If you remain concerned, you could insist that he be re-tested now.  If so, you should be tested as well; obviously it would be unfair for you to assume he is at more risk than you.  Or just stick to your plan to get tested yourself a few weeks from now.

As to differential risk with and without ejaculation, there are no data.  Logically, the risk might be lower without ejaculation, but if so the difference likely is small.

Finally, is it a "possibility" your partner's conjunctivitis was due to an STD?  Sure.  Is it likely?  No.  Over 99% of such infections are due to garden variety cold viruses.

Best wishes for a healthy, rewarding relationship. Don't screw it up by overreacting to the STD risks.  Of course there are no guarantees, but the risks seem low.

HHH, MD