Transexual Exposure Concern

[Potato1972]

I am a married man and recently made a big mistake and am worried. One week ago, I had sex with a transexual sex worker.  The encounter included me masturbating his penis with no protection and then performing oral sex on him after he had  put on a condom.  He did not ejaculate. He masturbated me without a condom and then performed oral sex on me after putting on a condom.  In addition, he sucked fairly hard on my testicles and used saliva to insert the tip of his finger into my anus.  I am worried about passing something on to my wife and our relationship ending.  I have read many of your responses to other posters regsrding similar situations, but just want to ask specifically. My questions are as follows:
1. Am I at any risk of contracting any STDs, STIs, HSV, HPV, NGU, syphilis, genital warts or other diseases from these activities?
2. Is there a risk from sucking/licking my scrotum?
3. Is there a risk to the finger in my anus with saliva as a lubricant?
4. My testicles feel a bit sore.  Is this likely due to him sucking a bit hard and a bit of a bruise or strain?
5. Should I abstain from unprotected sex with my wife?
6. Do I need to have any kind of testing?
Thank you.

[Edward W Hook, MD]

I agree with all that you say.  It is important to also remember that even with contact most exposures do not lead to infection and that skin other than mucosal surfaces is less susceptible to infection than mucosal surfaces such as the mouth, the urethra or the vagina.  EWH

[Potato1972]

Dear Doctor - I wasn't trying to think about "what if's".  Regarding question #2 above, I was just trying to clarify the points regarding skin-to-skin transmission that I've read across a number of posts.  Basically, my understanding (paraphrase) is as follows. Transmission is possible only when an infected person’s mucous membranes, bodily fluids, open lesions, or infected shedding skin cells come into contact with an uninfected person’s mucous membranes or open lesions. STIs spread by skin-to-skin contact include oral and genital herpes, HPV, and syphilis. Skin-to-skin contact occurs when an infected site of one individual’s skin (for example, the genitals of an individual with HPV) come into direct contact with a mucous membrane or lesion on an uninfected person’s body. For example, if an syphilis or HPV-infected cell were to touch an uninfected person’s cut-and-scratch-free scrotum, the HPV virus would have no route of transmission — the scrotum is not a mucous membrane, nor does it have any open lesions. However, let’s say that the infected sore or cell were to make contact with the mouth of an uninfected person (or any other mucous membrane or lesion on her or his body), transmission would be possible in that case. I think that is why there is only a theoretical possibility in my case.  Many thanks for your patience, responsiveness and reassurance.

[Edward W Hook, MD]

If your partne had infectious lesions on his mouth, I anticipate that you would have seen them.  Be cautions about getting too far into "...but what if..." scenarios.  It's easy to do when one is a bit anxious about an exposure.

I would not worry, as I said earlier. EWH

[Potato1972]

Thank you for the response. A few clarifications if you don't mind regarding #2 above, sucking/licking of the scrotum.  I did not notice any oral lesions, but was not looking for them.  What STI/STD exposure might I have if there were sores that I didn't see.  From other posts, I think it was said that I would need to have a cut/scratch for a sore to have direct contact with, or other means for entry, as skin is an excellent barrier.  Thank you.

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.  The exposures you describe are virtually no risk for STIs of any sort.  Condom protected sex is safe sex and there is no meaningful risk for STIs from masturbation, even when a partner uses saliva for lubrication or when partners get each other's genital secretions on one another. Certainly there is no meaningful risk for HIV.
While some would argue that there is a theoretical risk for HPV, HSV and syphilis because they can be transmitted with direct lesion contact, the fact is that such transmissions are vanishingly rare- so rare that neither of us has seen a case of such transmission in our combined over 70 years of STI focused practice.   It is not something I would worry about.

1. Am I at any risk of contracting any STDs, STIs, HSV, HPV, NGU, syphilis, genital warts or other diseases from these activities?
see above. This is not something I would worry at all about.

2. Is there a risk from sucking/licking my scrotum?
No, not unless your partner had oral lesions which I presume you would have seen.

3. Is there a risk to the finger in my anus with saliva as a lubricant?
no.

4. My testicles feel a bit sore.  Is this likely due to him sucking a bit hard and a bit of a bruise or strain?
Yes that is a more likely explanation.  It does not suggest an STI.

5. Should I abstain from unprotected sex with my wife?
I would not worry about having sex with your wife related to this exposure.  

6. Do I need to have any kind of testing?
I see no need for testing of any sort.

I hope these comments are helpful to you.  EWH