Unprotected oral sex, razor cuts and STDs

[polomarco1974]

Late in 2011 I had 2 separate encounters with 2 different CSW: 1st in September (Australian woman) and the 2nd in November (Asian woman). Earlier this month, I have met again with the same Australian escort. I used a penis pump a few hours before my encounters, which resulted in a rather swollen and slightly sore penis (no bleeding). I also shaved a few hours before I met with these 2 ladies. In 2 cases out of 3, I had a few razor cuts at the base of my penis and in my scrotum. Here is what may have put me at risk (not accounting for protected vaginal/oral sex):
-Uncovered oral sex (receiver): no apparent sores on her mouth, plenty of saliva. This was followed by protected vaginal sex, but after ejaculating (inside condom) I took a shower and had more unprotected oral sex
-Analingus (receiver): it last for no more than 10-15 sec. At the time of exposure I used to suffer from occasional tiny sores in my anus that used to bleed (a few drops) after going to the bathroom. My doctor said that this was probably related to my diet and the sores went away on their own
-Protected vaginal sex with condom not covering completely the base of my penis: I shaved about 3 hours before intercourse and razor cuts were probably exposed to the escort’s vaginal fluids
-Deep french kissing: plenty of saliva, no apparent sores/cuts
Particularly concerned about HEP B (which I am not vaccinated against) and all other STDs (HIV, and HPV included). I am tempted to conclude that you would probably say that I was not at risk (technically speaking that my risk was EXTREMELY low), but I would like to confirm that, if I decide to get tested for STDs, it would be solely for my peace of mind and not for the types of exposures I had. Thanks.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  It seems you have correctly predicted my responses with "I am tempted to conclude that you would probably say that I was not at risk (technically speaking that my risk was EXTREMELY low), but I would like to confirm that, if I decide to get tested for STDs, it would be solely for my peace of mind and not for the types of exposures I had."

That is exactly right.  Congratulations on choosing safe sex for these events.  Oral sex isn't entirely risk free, but it carries much less STD risk than unprotected vaginal or anal sex. There is virtually no risk for some STDs (HIV, the hepatitis viruses, HSV-2, HPV, chlamydia) and low risk for syphilis, gonorrhea, and nongonococcal urethritis (NGU).  And condom protected vaginal sex also is essentially no risk.  Kissing is risk free for STDs and analingus is similar.  The ancillary factors you mention -- penile implant, recent shaving, etc -- do not modify my assessment.

So based on the exposures described, you correctly predict that I would not recommend any STD testing at all.  But if you need the additional reassurance of negative test results, visit your local health department STD clinic, or other STD-knowledgeable provider (e.g. Planned Parenthood) and follow their advice about specific tests.  But if I were in your circumstance, I would not be tested and would continue unprotected sex with my wife without fear of transmitting anything to her.

I hope this has helped.  Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

Yes, same for other STDs.

I don't know what your local PP clinic considers a "complete STD panel", but routine STD testing normally is urine for chlamydia and gonorrhea (conclusive any time more than 3-4 days after the last exposure) and blood tests for syphilis and HIV (reliable at 6 weeks or later, although official advice for HIV antibody tests is 3 months).  In my STD clinic, we would not routinely test you for anything else.

That should end this thread.  Take care and stay safe.

[polomarco1974]

"If a condom appears intact, i.e. no overt breakage, you can be confident there was no significant risk of HIV." Same can be said for all other STDs?
Based on our discussion I decided not to get tested anytime soon, but I will still visit an STD clinic in a few months. I checked with the local Planned Parenthood and the cost of a complete STD panel is very affordable. After how long after my last exposure can the test results be considered conclusive? Thanks again for all of your time and help. This discussion has been very informative and helpful.

Best,  

[H. Hunter Handsfield, M.D.]

You probably would notice if you were asked to use a natural membrane condom; but even they are highly effective.  The theoretical issue of reduced effectiveness is just that, theoretical; any barrier is highly effective.  If a condom appears intact, i.e. no overt breakage, you can be confident there was no significant risk of HIV.

[polomarco1974]

Thank you VERY much! This is VERY helpful and reassuring! Like most people on this forum I have run many "what if" scenarios in my mind, most of which are just unreasonable. However, I have a couple of additional questions, if you do not mind:
-In most cases, the ladies I met provided the condoms. Assuming they used non-latex condoms (I highly doubt it), is it possible that these are not as effective against STDs as latex condoms?
-Condoms can break during vaginal intercourse, but in my experience they either "pop" (i.e. break completely) or they remain intact. What are the chances that small / non visible tears might have formed on the condom's surface during vaginal intercourse (I figured there may be some statistics on this)? Would this increase the risk of contracting any STDs in case of a leak? Note that I always "pulled out" after ejaculation. I quickly inspected the condoms before removing them and they always seemed intact.
Even after considering all of these random variables, would you still advise against testing? Thanks again...or sorry for testing your patience ; )