I am a 45-year-old heterosexual man!

Last night, that is, Tuesday night, I called an escort to my place and had sex (both genital and oral)

In the 2:30 hours that she stayed with me, there were 4 vaginal penetrations protected by a condom and 4 times he gave me oral sex (fellatio) All the exposures were protected by a condom and each time a new one( condom).

I do my best to have only protected sex   it doesn't matter if is vaginally or orally. Just protected!

Overwhelmed by a feeling of guilt and anxiety, I try to clarify which sexually transmitted diseases I can get infected with???!

I read that certain diseases can be caught with a condom, those that require direct contact with a lesion.

My mind is working and it takes me thinking about HIV, syphilis, hepatitis B, herpes and so on..Gonorrhea….

I didn't notice any odors, leaking lesions at her. She claimed  she was clean!?!?

As a man, I did not give her oral sex (cunnilingus) and there was no French kiss!!!

Dear gentlemen, can you assess my situation and do I need to do something specific or get tested for something?

Thank you in advance and I look forward to your assessment !

You describe a very low risk exposure. I wouldn't recommend testing for anything. First, female escorts -- expensive sex workers by appointment -- are generally believed to have low STI rates. Most know the score, use condoms, and get tested frequently -- and typically their clients are low risk as well (men like you!). And condoms work. While not perfect, as you already know, when properly used and with no obvious breakage, they are highly effective in preventing all STIs, including those transmitted skin to skin (herpes, syphilis, HPV). Yes the possibility of skin-skin infection is higher than for STIs transmitted by fluids (like HIV, gonorrhea and chlamydia), but still very low.

The condom "water test" has a long history but is nonsense and truly unnecessary. There is no such thing as microscopic leaks large enough to cause infection. If a condom doesn't break wide open, protection is complete. Don't waste your time on such testing in event of future exposures like this one.

So if somehow I were in your situation, I would not be tested for anything and would continue unprotected sex with my wife without worry about infecting her. That said, of course you are free to be tested if you wish; for some nervous folks, negative test results are more reassuring than professional opinion, no matter how expert. (We don't take it personally!) If that the case for you, feel free to have a urine gonorrhea/chlamydia test, valid any time 4-5 days of more after exposure; and blood tests for syphilis and HIV after six weeks. For sure your risk for anything else is too low, and all other tests (like those commonly included in labs' "comprehensive" test panels have high potential for misleading results.

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

HHH, MD

Thank you very much dear doctor!

This sentence: "So if somehow I were in your situation, I would not be tested..." it is very reassuring for me and I thank you from the bottom of my heart!

Thank you doc! 

Thanks a lot dear doc.!

2. No data available, but the chance such a person has syphilis also is near zero.

3. Gonorrhea symptoms typically start 2-5 days after exposure, chlamydia 1-2 weeks.

4. Also near zero risk for hep B; maybe higher for herpes, but still low enough to disregard.

The HIV AgAb (4th gen) tests detect ~98% of infections at 4 weeks. RPR for syphilis probably 80-90%.

Your exposure was far too low a risk to warrant doxycycline post-exposure prophylaxis (doxy-PEP). If you had come to our clinic and requested it, we would not have done it. When taken within 72 hr of exposure, it eliminates any risk of syphilis and chlamydia, and reduced the gonorrhea risk by about 50%. However, its efficacy taken weeks later probably is less. It was pointless at the time you took it.

Thank you very much for the reassuring answers!

1. For HIV assessment I think 1 in 6 mil is 0 for all practical purposes !!!

2. I read on your forum that condoms reduce the risk of syphilis infection by 60%. I understood well? And the fact that I took doxycycline reduces that risk to almost 0? and for chilamydia? Is my rating correct?

3. For Hepatitis B, is it necessary for bodily fluids to come into contact, and if I used a condom for all exposures, is there a possibility of these fluids coming into contact?  Or can hepatitis B be transmitted in another way?

4. For genital herpes, what is the incubation period and what is the maximum time until it should appear? I also read on the forum that it is somewhere around 10 days. Correct? and what should I pay attention to?

I know that after the first question you answered that if you were in my place you wouldn't take any test, and at the risk of asking one more time and please don't be angry with me, do you still think that no test is necessary?

Thank you dear doctor for your expertise!

“ However, its efficacy taken weeks later probably is less. It was pointless at the time you took ”….

Do not seek gonorrhea treatment. But 400 mg (or better, 800 mg) cefixime would be preferred over azithromycin. Here too, the contribution to antibiotic resistance is a consideration.

That concludes this thread. Best wishes and stay safe.