i'm currently seeing a female sex worker and I would like to know the risk of getting hepatitis from performing the following 2 activities on her.

-Giving oral sex to her vagina without protection

-Giving oral sex to her anus without protection

The female sexworker get tested every 2 months, she has been vaccinated for hepatitis, and only has vaginal sex with condom and gives blowjobs with condom. She engages in no other activities with clients.

thank you

As Dr. Hook said, viral hepatitis is rarely if ever transmitted by oral sex. You were not at risk by the oral-vaginal exposure (cunnilingus).

Analingus (oral-anal) is risky for viral gastroenteritis and other intestinal infections but low risk for all STDs. The only kind of hepatitis it is likely to transmit is hepatitis A, but there is no carrier state for the hepatitis A virus. And with your partner having been vaccinated, zero risk anyway. 

A couple of basic facts about sexually transmitted hepatitis:  Hep A, only by contact with persons currently with active infection and obviously sick. Hep B, only by unprotected vaginal or anal intercourse, and even then this is very rare -- and zero risk if you have been vaccinated against HBV (as you likely were in childhood). As for hepatitis C, it is commonly sexually transmitted ONLY by potentially traumatic anal sex practices between men; contrary to common belief, it is essentially zero risk in heterosexual relationships, including no measurable risk by vaginal or oral sex.

HHH, MD

-There is no carrier state for hepatitis A. Can a person be infected with hep A with zero symptoms and still transmit? I understand this is a mute point considering the vaccination perhaps.

- I asked my doctor if I had been vaccinated for hepatitis and she couldn't tell me but thought it was nearly certain. I am 33 and live in Belgium, do you think I am vaccinated?

-are any of the intestinal infections through analingus of significant risk for my health? Can i counter this by  an anal douche?

thank you

On rare occasions, analingus could risk pretty serious stuff, like amebic dystentery and serious bacterial infections, like bacterial dystentery (shigellosis) and typhoid fever. In my 50 years in the STD business, I've never seen such a case. Viral gastroenteritis (which usually is pretty uncomfortable a few days but rarely dangerous) is the main risk. Anal douching would have no effect in preventing any of these and there are no vaccines.