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Possible STD and HEP C Exposure
Hello Doctor. Thank you very much for your consideration of the following. Two questions based on these facts.
Part 1: Seven days ago I had a brief encounter with a professional FSW. Very drunk. I couldn't get an erection at all. With a condom over my flacid little penis she attempted to stimulate me orally and using spit/saliva. These efforts lasted maybe 10-15 seconds to no avail. Also with the condom and my flacid penis, tried stimulating around her outer vagina - tapping it here and there, trying to insert. Crotch to crotch contact. Again very short duration - probably less than a minute altogether. Also to no avail. Totally flacid. No penetratation. I did not notice any sores on her vagina or mouth. No symptoms other than high anxiety. Please assess risk of exposure to STDs, do you recommend testing and, if so, when?
Part 2: Same encounter. She offered me 3-4 small snorts of cocaine off the pointed end of a Bic-type pen cap, which we both did (first time for me in 20+ years). The pen cap was hers and I'm sure she'd used it before. I don't think that there was much physical contact between the pen cap and my nostrils and I didn't notice any blood on it or her, but I wasn't looking. I don't believe that I've got any open sores in my nose, no bloody noses recently etc. Nonetheless, I'm very anxious about possible exposure to Hepatitis C, which I've read may be connected to sharing coke straws (she had a couple of obviously cheap tattoos). Here again, please assess risk of exposure to Hep-C, do you recommend testing and, if so, when?
Thank you so much.
Part 1: Seven days ago I had a brief encounter with a professional FSW. Very drunk. I couldn't get an erection at all. With a condom over my flacid little penis she attempted to stimulate me orally and using spit/saliva. These efforts lasted maybe 10-15 seconds to no avail. Also with the condom and my flacid penis, tried stimulating around her outer vagina - tapping it here and there, trying to insert. Crotch to crotch contact. Again very short duration - probably less than a minute altogether. Also to no avail. Totally flacid. No penetratation. I did not notice any sores on her vagina or mouth. No symptoms other than high anxiety. Please assess risk of exposure to STDs, do you recommend testing and, if so, when?
Part 2: Same encounter. She offered me 3-4 small snorts of cocaine off the pointed end of a Bic-type pen cap, which we both did (first time for me in 20+ years). The pen cap was hers and I'm sure she'd used it before. I don't think that there was much physical contact between the pen cap and my nostrils and I didn't notice any blood on it or her, but I wasn't looking. I don't believe that I've got any open sores in my nose, no bloody noses recently etc. Nonetheless, I'm very anxious about possible exposure to Hepatitis C, which I've read may be connected to sharing coke straws (she had a couple of obviously cheap tattoos). Here again, please assess risk of exposure to Hep-C, do you recommend testing and, if so, when?
Thank you so much.
MEDICAL PROFESSIONAL
I don't think the coincidence is suprising at all. You had an encounter which raised concerns for you, causing you to pay far more attention to your genitalia than you have pre-event. As a result, you have noticed what are mild symptoms. Occasionally, uncircumcised men can acquire fungal (yeast) infections from partners but this is quite uncommon and when it does, it still does not "count" as an STD. I have little to add to the nurse paractioner's assessment. EWH
Dr. Hook,
I know that you and your colleagues have a limit to your patience with repetitive threads after you've given a post due consideration, but I'd appreciate your indulgence for an additional follow up.
I'm now 23 days post the encounter described in my initial post. 3 days ago I consulted with an experienced STD nurse practitioner at the local Planned Parenthood clinic and reviewed your assessment with her. She generally concurred. I complained about the continued penis and scrotum itching and tingling (onset 3 or 4 day after the initial encounter). On exam she noted that my scrotum is red and the lower ridge of my glans may be a bit dry and little bumpy, but still no obvious lesions, discharge, painful urination, distinct rash, swelling, etc. Her diagnosis was tinnea cruris - jock itch - although no real groin or inner-thigh presentation, limited to itchy tingly penis and scrotum. She suggested OTC anti-fungal cream for a week. I'm 3 days into twice daily applications of Lamisil (terbinafine hydrochloride) after washing. I've definitely noticed some relief, and I know I have to give it at least a few more days - but it's driving me nutty (pardon the bad pun). The onset of the condition just seems too proximate to the initial encounter. I'm having a hard time accepting the coincidence. Of course, I'm also conjuring other intermittent symptoms - a low grade fever in the afternoon, a little sweat outbreak in the morning after my shower, etc., etc.
Does this add anything to your analysis or can you think of anything else I could have picked up from the encounter - thrush, candida (can you tell I've scoured the internet), do these symptoms fit in the not-so-obvious category of any STDs you would consider? Thank you for your patience and consideration - I promise I'll leave you alone after this.
I know that you and your colleagues have a limit to your patience with repetitive threads after you've given a post due consideration, but I'd appreciate your indulgence for an additional follow up.
I'm now 23 days post the encounter described in my initial post. 3 days ago I consulted with an experienced STD nurse practitioner at the local Planned Parenthood clinic and reviewed your assessment with her. She generally concurred. I complained about the continued penis and scrotum itching and tingling (onset 3 or 4 day after the initial encounter). On exam she noted that my scrotum is red and the lower ridge of my glans may be a bit dry and little bumpy, but still no obvious lesions, discharge, painful urination, distinct rash, swelling, etc. Her diagnosis was tinnea cruris - jock itch - although no real groin or inner-thigh presentation, limited to itchy tingly penis and scrotum. She suggested OTC anti-fungal cream for a week. I'm 3 days into twice daily applications of Lamisil (terbinafine hydrochloride) after washing. I've definitely noticed some relief, and I know I have to give it at least a few more days - but it's driving me nutty (pardon the bad pun). The onset of the condition just seems too proximate to the initial encounter. I'm having a hard time accepting the coincidence. Of course, I'm also conjuring other intermittent symptoms - a low grade fever in the afternoon, a little sweat outbreak in the morning after my shower, etc., etc.
Does this add anything to your analysis or can you think of anything else I could have picked up from the encounter - thrush, candida (can you tell I've scoured the internet), do these symptoms fit in the not-so-obvious category of any STDs you would consider? Thank you for your patience and consideration - I promise I'll leave you alone after this.
I know. Thank you so much for your advice and patience. I appreciate your time and the service you provide here. Take care.
MEDICAL PROFESSIONAL
Itches of this sort are not at all uncommon on those occasions when persons have cause to reflect on whether things "feel OK" in their gential region following a potential exposure. (I am not saying you're are crazy. Rather your sensitivities are heightened). If there is nothing to see, I suspect your doctor would say the same thing. I see no reason to seek medical evaluation at this time. Should a rash or lesion develop (I doubt they will), then getting seen might be a good idea. EWH
Dr. Hook,
Thank you very much for your response to my concerns. I have a follow up that I'd appreciate your thoughts on. Even though intellectually I trust your advice above, I have been experiencing a rather constant localized little itch in the margin between the glans and the shaft on the right side - just a persistant itch in the same spot. But I don't see anything for certain, maybe there's a small bump, but I really can't distinguish anything different from the rest of my penis, i.e., inflammation, rash, lesion, etc. It's pretty irritating, though. It feels external, a burning little pinpoint itch, as opposed to anything internal. No noticable other typical STD symptoms like discharge, burning urination etc. My anatomy appears normal. It's been two weeks. Should I go see a doctor, your thoughts please? Thank you very much.
Thank you very much for your response to my concerns. I have a follow up that I'd appreciate your thoughts on. Even though intellectually I trust your advice above, I have been experiencing a rather constant localized little itch in the margin between the glans and the shaft on the right side - just a persistant itch in the same spot. But I don't see anything for certain, maybe there's a small bump, but I really can't distinguish anything different from the rest of my penis, i.e., inflammation, rash, lesion, etc. It's pretty irritating, though. It feels external, a burning little pinpoint itch, as opposed to anything internal. No noticable other typical STD symptoms like discharge, burning urination etc. My anatomy appears normal. It's been two weeks. Should I go see a doctor, your thoughts please? Thank you very much.
MEDICAL PROFESSIONAL
Straight to your questions:
Part 1. No risk. Your exposure was essentially protected oral. Oral sex in and of itself is rather low risk sex, protected oral, even with a flaccid penis is likewise very, very low risk (that's about as close as I get to saying "no risk") sex. It take penetration to get an STD, you didn't penetrate her vagina and when your penis was in her mouth, it was protected. No testing needed - no concern
2. Could you get hepatitis C through a shred cocaine straw. Theoretically, yes. Practically, very unlikely. the reasons I say this are several. First, as you point out, you were cautious is the use of the "straw". Second, hepatitis C is primarily a parenterally transmitted virus, meaning that her blood needs to get into your blood. You are clear that you had no obvious lesions, bloody noses, etc to increase your vulnerability and you state that you did not notice any of these sorts of lesions on her part. Thus your risk, if she was hepatitis C infected is low. The reports of hepatitis C transmission through shared cocaine straws have occurred in persons with repeated exposures and blood sharing in the context of shared straws.
Finally, your concerns are based on the idea that she was infected with hepatitis C. In fact, even as a commercial sex worker with "cheap tattoos", odds are that she did not have hepatitis C.
When you put all of these factors together, my assessment is that your risk is again, very, very low. I would not bother getting tested at this time.
Hope this helps. EWH
Part 1. No risk. Your exposure was essentially protected oral. Oral sex in and of itself is rather low risk sex, protected oral, even with a flaccid penis is likewise very, very low risk (that's about as close as I get to saying "no risk") sex. It take penetration to get an STD, you didn't penetrate her vagina and when your penis was in her mouth, it was protected. No testing needed - no concern
2. Could you get hepatitis C through a shred cocaine straw. Theoretically, yes. Practically, very unlikely. the reasons I say this are several. First, as you point out, you were cautious is the use of the "straw". Second, hepatitis C is primarily a parenterally transmitted virus, meaning that her blood needs to get into your blood. You are clear that you had no obvious lesions, bloody noses, etc to increase your vulnerability and you state that you did not notice any of these sorts of lesions on her part. Thus your risk, if she was hepatitis C infected is low. The reports of hepatitis C transmission through shared cocaine straws have occurred in persons with repeated exposures and blood sharing in the context of shared straws.
Finally, your concerns are based on the idea that she was infected with hepatitis C. In fact, even as a commercial sex worker with "cheap tattoos", odds are that she did not have hepatitis C.
When you put all of these factors together, my assessment is that your risk is again, very, very low. I would not bother getting tested at this time.
Hope this helps. EWH
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
