I’m a happily married man.  My wife, has HPV Vaccine, and I have talked and agree that seeing a CSW from time to time for some fun is okay for me.

I’m looking to receive unprotected oral sex and kiss, with no vaginal or anal sex. 

I’m trying to gauge the overall risk here.  From my reading on the forum here unprotected oral is low, almost no risk and I shouldn’t worry too much.  Should I even bother testing after every encounter if I do it 4-6 times a year? What should I be doing to limit my wife's exposure risks?

Should I get the HPV vaccine to help further mitigate risk? 

I’ve read about DoxyPEP as an after-exposure treatment, what are your thoughts on me getting and taking that after my encounters? This seems like a slam dunk, but I worry about the antibiotic resistance, and I’m not in the demographic that is currently recommended to use it.

With only oral sex (even unprotected), you will be at low risk for all STIs and virtually no risk for HPV. And if such events are planned only with escorts -- i.e. expensive female CSWs by appointment -- the risks will be even lower. Such CSWs generally are at low risk for STIs. I see no need for HPV immunization, or for testing after every exposure -- maybe once a year if such events occur 4-6 times annually. "What should I be doing to limit my wife's exposure risks?" The main risk would arise if temptations get the better of you and you end up having vaginal or anal sex, especially unprotected. I would suggest you have condoms handy -- or assure CSW has them -- just in case.

DoxyPEP is advised primarily for men having high risk sex (no condom) with other men. And certainly you should not do it for the kinds of exposure in your plans. I would even advised it after unprotected vaginal or anal sex, unless you have a strong reason to believe your CSW partner(s) might have chlamydia or syphilis (the only STIs reliably prevented with doxyPEP).

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

HHH, MD

Just to read that back to make sure I got it.  Assuming visiting professional CSWs This is not a high risk activity and is reasonable to pursue, I should not get the HPV vaccine, I should not take DoxyPEP, I should test yearly if desired, or test if I notice symptoms.  

On the DoxyPEP front I thought it was reasonably good at treating Gonorrhea and Chlamydia from what I read, especially in  US testing, but I will defer to your expertise not to take it. Is the reason NOT to take it the potential antibiotic resistance? 

Lastly I'm curious if your advise holds for other countries.  I travel for work (Germany, Thailand, LATAM, etc.) and assuming CSWs again I assume all advice holds true?

Thanks again!

DoxyPEP is definitely not reliable in preventing gonorrhea -- roughly 50% reduced infection. It's virtually 100% protective against chlamydia and syphilis, but chlamydia is never a serious risk from oral sex, and syphilis is very rare in the circumstances you describe. And potential antibiotic resistance is indeed an important reason not to take if unnecessarily. All this applies equally in the US and Western Europe -- and probably for male-female sex in most of SE Asia and Latin America.

So for my last follow up... I'd still like to understand, just for my own education, why not on the DoxyPEP.  From my readings of this forum gonorrhea is the most likely STI I'd get from receiving unprotected oral.  If I can reduce my risk by 50% if I am exposed to someone who carries it seems like a slam dunk.

That concludes this thread. Best wishes and stay safe.