RIsk Assessment

[stupidmanatla]

Although it might sound stupid, I need some advice from my exposure due to my forthcoming marriage in summer.  I have an exposure with a escort (from nightclub) in Hong Kong on Mar 12 who is from China.   We have deep kissing (not long, approximately half a minute),  fingering, protected vaginal as well as oral (BJ) but I do unprotected oral on her (ONLY licking her clitoris).  I have asked about her status afterwards, she told me that she's only do it part time and have bodycheck once a year.  The latest is OCT, 2010 and everything is OK.  She even told me to put on condom for BJ otherwise she will refuse such act.  

I have visited a clinician at heathcenter today and she told me that it is a high risk exposure (she told me to search CDC for info).  I have been tested two years ago for STD panel as well as HIV since I am in long time monogamous relationship so my test is done once in 2 years.  I feel so guilty which I haven't involve any sexual activities with my girlfriend.  My questions are:

1)  When we finished, I pulled out and saw my condom cover only 80-90% of my shaft with the thing contained inside the condom.  Although not examine closely and the condom is the same one for oral and vaginal sex, can I assume the condom doesn't break and don't have any pores, so that my protection is regarded as complete?

2)  I am uncircumcised.  What is my risk for this exposure (as the clinician at the health center told me is high risk)?  And do you suggest testing due to this event.

3) What are the risks from other STD (Gonorrhea, Chlamydia, Syphilis, HSV2 etc...) to my penis or my mouth due to this exposure?  I mean does condom also avoid to catch anyone of these?

4) I can't remember whether my penis have touch any vaginal fluids that may be stick on the outside of condom when the time I pulled off the condom.  Is the any chance for any std or hiv?

Thank you.  

[Edward W Hook, MD]

Welcome to the Forum.  There was very, very little risk of acquiring any STD from this and you can be confident that you did not get HIV.  Let's deal with HIV first.  HIV is not spread by oral sex, giving or receiving and for the reciept of oral sex your condom provided an additional degree of protection to what was, as I said, a no risk exposure to begin with.

Similarly, condom use makes your vaginal exposure no risk for STDs as well.   You do not need to worry that your condom may have failed- it did not. When condoms fail, they break wide open leaving no doubt about failure.

Finally, there is the fact that you performed oral sex on her.  Few STDs are transmitted this way. In fact, the only one of consequence is gonorrhea and your risk for this is quite low. If you wanted to be tested for oral gonorrhea this can easily be done with an oral swab.  Personally however, I would not be very worried.  

That your condom may have slipped down during your exposure does not increase risk.,  As long as it covered the hea of your penis, you are protected.  

I hope these comments are helpful to you.  You really have likttle to worry about related to this exposure.  EWH

[stupidmanatla]

Thanks Dr, its such a relieve.  Just 3 quick questions,

1.)  So the circumcision issue I read online is only corresponds to the results of comparing Unprotected intercourse.  The prevention efficiency of condom is the same for circumcised and uncircumcised male is the same, right?

2.)  I remembered I have a slightly to mild sore throat on that night, so the risk regarding hiv for licking her clitoris a couple seconds remain the same.

3.) Since I have no symptoms, no fever, no rash, no swollen glands (I do have a bit feeling today due to frequent examination by myself last night), no discharge on penis for the past 4 weeks.  Do you recommend blood test and urine test regarding this exposure
?  Or just the oral swab is necessary?    

Again, thanks for your kind assistance.

[stupidmanatla]

Do you recommend STD panel test for this exposure

[Edward W Hook, MD]

1.  The circumcision issue related to variation in risk for person who are exposed through potentially infectious sex acts, none of which are operative for you.   the benefits of condoms are the same for men who are and are not circumcised.

2.  No risk, not HIV.

3.  As I said, I think no testing is needed.  If you want to be absolutely sure however, all you need is an oral swab for gonorrhea.  

I see no medical need for an STD panel test related to the activities you described.  EWH