risk of catching STDs from CSWs

[stupidguy88]

Dear Doctor,

I am a 23 year old male from Hong Kong and I am glad I have come across this forum as I have some serious concerns about my STD exposure from four encounters with CSW's during the past 5 months. Please note that I had been a virgin up until my first encounter.  My encounters took place on July 4, Sept 19, Nov 2 and Nov 10.  
In each encounter, I had protected oral sex (for 2 min) and protected vaginal sex (for 5 min).  I had been wearing the same condom for both oral and vaginal sex.

Concern 1: HPV
Over the past few days, I have been reading up on STDs and found out that there’s no test for HPV for men (please let me know if there’s any other STD for which a test isn’t available for men).  Also, I have learned that having HPV would mean that I bear a lifelong higher risk of developing penis and anal cancer.  Now I am very concerned and particularly horrified at the prospect of having to surgically remove my penis in case I am unfortunate enough to develop penis cancer.  The CSWs probably carriers of many strains of HPVs. How likely would I have contracted HPV from my four encounters?

Concern 2: Acne/Pimple in the genital area
During my third encounter, I had what seemed rather like a large acne just a little above and off the base of my penis shaft.  It was at that time about 3 weeks old and didn't hurt anymore.  Would it have increased my chance of catching a STD that could be transmitted by skin-to-skin contact?  Also, three weeks ago, there was a smaller pimple-like lump growing out of my scrotum skin, somewhere near the edge connecting to my left leg.  Occasionally, I would press on it with my fingers just to check it out; sometimes it would hurt and sometimes it wouldn’t. It has largely dissipated now but I can still easily identify a small dark red spot at its original location.  Could these lumps be symptoms of some forms of STDS?

Lastly, may I please ask for your professional opinion on which STDs I should test for at the moment? Thanks.

[Edward W Hook, MD]

1.  Yes
2.  Correct.

EWH

[stupidguy88]

Thank you very much for your responses, they are very helpful.  I just have two follow-up questions that I would like to ask.

1) Does the Hep B vaccine provide life-long protection?
2) Does this mean at the moment I have no reason to test for any STDs?

Thanks a lot!

[Edward W Hook, MD]

Welcome to the Forum.  I am pleased to hear of your commitment to condom protected, safe sex.  This will do much to virtually eliminate your risk for most STDs.  I suspect you are worried more than you need to be.  I will provide brief answers to your questions:

1.  Condoms reduce the risk for HPV by about 50% but not entirely.  For better or worse, at present HPV is a "fact of life" and most people have it or will have it at some point in the future.  Despite this fact, only a tiny minority of persons with HPV get the consequences of infection (primarily women and primarily cancer and pre-cancerous lesions).  HPV is the most commonly acquired STD.  Over 85% of sexually active women will have HPV infection at some time in their lives.  The figure for men is less well studied but similar.   In some HPV will cause genital warts, in others it will not cause warts but may lead to changes in PAP smears.  In nearly everyone who gets HPV, warts or otherwise, the infections will resolve by themselves without therapy in 8-24 months.  In a very small minority of women, HPV infection can persist and lead to the pre-cancerous lesions that PAP smears detect and which can then be treated.  For men there is far less risk of any sort.   there are no tests for HPV in men.  I would not worry about this unless you develop a lesion or sore of some sort.  

2.  this lesion was likely folliculitis.  Folliculitis occurs when the pores in your skin get plugged.  This allows that normal bacteria that are present on just about every-one's skin to grow and cause what is essentially a pimple.  What you describe does not suggest an STD.

3.  These are no risk activities. STDs are not spread on soap, toilet seats, towels, etc. There is nothing to worry about.

4.  Only hepatitis B is commonly spread through sexual activity.  Condom prevent this, as does the Hepatitis B vaccine if you have received it.  

I hope these responses are helpful. It sounds as though you have no reason to be concerned about STDs from the encounters you mention. EWH

[stupidguy88]

Dear Doctor,

I am a 23 year old male from Hong Kong and I am glad I have come across this forum as I have some serious concerns about my STD exposure from four encounters with CSW's during the past 5 months. Please note that I had been a virgin up until my first encounter.  My encounters took place on July 4, Sept 19, Nov 2 and Nov 10.  
In each encounter, I visited a brothel and I had protected oral sex (for 2 min) and protected vaginal sex (for 5 min).  I wore the same condom for both oral and vaginal sex during all four encounters.

Concern 1: HPV
The CSWs probably carriers of many strains of HPVs. How likely would I have contracted HPV from my four encounters? Is it true that I will carry a lifelong risk of developing penis or anal cancer?

Concern 2: Acne/Pimple in the genital area
During my third encounter, I had what seemed rather like a large acne just a little above and off the base of my penis shaft.  It was at that time about 3 weeks old and didn't hurt anymore.  Would it have increased my chance of catching a STD that could be transmitted by skin-to-skin contact?  Also, three weeks ago, there was a smaller pimple-like lump growing out of my scrotum skin, somewhere near the edge connecting to my left leg.  It has largely faded away and is now just a small red spot.  Could these be symptoms of STDs?

Concern 3: STD transmission to family members
I now sometimes masturbate in the bathroom during the day. There is a chance that I had left some residue of my semen on the water tap, hand soap bottle or toilet paper. I am especially worried about the toilet paper as my sister would use it to clean herself after urinating.

Concern 4: Hep B (and possibly A, C, D, E)
As far as I can remember, I have not been vaccinated against Hep A, C, D, E. I have been vaccinated against Hep B at birth, and received an extra booster shot at age 7. About three years ago, a blood test detected I had an antibody level of 110.  Could you please evaluate my chances of catching any one form of Hep?

Lastly, may I please for your professional opinion on what type of STDs should I test for at this moment? Thanks.

P.S. I am terribly sorry for exceeding the word limit.

[Edward W Hook, MD]

The 2000 character limit is there for a reason and clients have been exceeding it regularly.  As a result, we have decided to not answer such questions but to ask you to restate the question within the guidelines.  If you cannot do that, your question is too complex to be addressed on on line.  

Please re-state your question and I will do my best to answer it.  EWH

[stupidguy88]

I have some additional concerns but it exceeded the 2000 character limit.  Thanks.

Concern 3: STD transmission to family members
First and foremost, I realize that there’s a chance I could’ve gotten STDs through any one of these four encounters, my first concern would be that of transmitting any potential STDs I have to other members in my family. Recently, I have been masturbating more to reduce my urge to visit CSWs again, and I now sometimes do in the bathroom during the day. There is a chance that I had left some residue of my semen on the water tap, hand soap bottle or toilet paper. I am especially worried about the toilet paper as my sister would use it to clean herself after urinating.

Concern 4: Hep B (and possibly A, C, D, E)
I am very worried about this one because in case I have contracted one of them, I can transmit the disease to my family members through everyday interactions. As far as I can remember, I have not been vaccinated against Hep A, C, D, E. I have been vaccinated against Hep B at birth, and received an extra booster shot at age 7. About three years ago, a blood test detected I had an antibody level of 110.  I heard that as long as it stays above 10, I would still be protected against Hep B.  So my question is, how likely would it be that my antibody level has dropped below 10 in three years' time, and what are the chances that I have Hep A, C, D or E?