I’m sorry for my English. I’m thinking of a trip to a European brothel in the future. All girls are required to have health checks to work there and there certificates are good for 6 weeks. They check for vaginal infections and HIV and syphilis by law. Safe sex is the norm. I would like to have unprotected oral sex and protected vaginal sex while there. I do not want to put my partner at risk though. I have seen articles on Doxypep and have doxycycline for an unrelated skin condition. I also have azithromycin. If I took 2g azithromycin + Doxypep after a night at this brothel would this prevent infections? I have had the HPV vaccine. Thanks you

You've obviously done your research on the particular brothel you plan to visit. Other information also would be useful, however -- like the particular city, which in turn may have implications for STI prevalence locally and the quality of local or regional public health programs. Conceivably there could even be local data on the specific geographic area or even the prevalence of STIs in the particular brothel you are considering. Whether or not you would like to provide that information here, contacting local, provincial or national public health authorities might lead to better information and advice than mine. For example, that might include whether local experts would advise doxy-PEP, azithromycin, both, or neither. And I imagine you might like to know more about the frequency of HIV in such women, which I cannot estimate.

Having said all that, the information you provide suggests the facility is a relative safe one and it seems likely your partner(s) will not be infected, at least not with a bacterial STI like gonorrhea, chlamydia, or syphils -- or with HIV. Properly used condoms are highly effective in preventing transmission by vaginal sex, and oral sex is inherently low risk even without condom protection. Assuming local or regional public health authorities or data agree with these assumptions, I would be inclined not to advise doxy-PEP, azithromycin, or any other antibiotic treatment following the event. But if they advise such prophylactic treatment, feel free. (Such treatment would be equally or maybe even more effective if taken a few hours before exposure rather than afterward.)

I'm glad you mention HPV and being immunized. You are completely protected for the types covered by the vaccine. You still will be at risk for one of the 20-30 other sexually transmitted HPV types not covered by the vaccine, but any of these likely would be without any health impact on either you or your wife.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Also, would 2-1-1 PrEp be advised in this situation? I realize from other posts the risk is low

Thank you again for your expertise!

With the overall low frequency of HIV in sexually active women in most of western Europe plus the efficacy of condoms, I doubt HIV is sufficiently likely to warrant PrEP.