45 yr old M in the US. For the past 4+ years I've been only having sex with asian commercial sex workers in the US. Most have been protected but in the moment I've probably gone unprotected 20% of the time - oral and full sex. I like to think of myself pretty healthy as I don't get sick much. I get test regularly with the bacterial STI's (Chlam/Gon/Trich/Mgen) frequently and been clean. I've decided that I'm going to quit that lifestyle and maybe find someone to settle down with. I'm talking to a girl right now, but haven't done anything, until I know I'm good. 4 weeks past (which would cover all the past 4 years) my last encounter I got the full STI panel (HIV HSV1/2 HepB/C plus all bacterials) and that was negative. I took another full test 5 weeks later (9 weeks total after my last exposure) and that came out clean too. I say I dodged a bullet. Whew.

Is 9 weeks conclusive enough to be considered clear on all those STI's? If I were to pursue a relationship, would it be safe to engage in full sexual activities with any future partners? Should I get another full test just to be safe? My research says I should be okay but maybe I need confirmation from doctors.

I think the only other thing would be HPV which I know could be symptomless (besides having GW) and there's no tests for men, that I know of, and I could have it or not have it. Should I reveal my unknown HPV status to a new partner? Also, what is the likelihood of transmission of HPV given any sex act with an asian sex worker? I'm not sure if they are knowledgeable on sex education in their country of origin. I'm assuming not, but who knows. 

Thank you!

Congratulations for a rational and highly safe attitude and practices in your sexual choices. I don't really agree you have "dodged a bullet." That phrase implies a high risk and that you were lucky. In fact, you describe a low risk sexual lifestyle. You didn't dodge a bullet; it's more like you're the speedy driver who was never likely to have a wreck but wore your seat belt anyway. Good moves.

Yes, 9 weeks is fine for your STI test results. Actually not long enough for HSV, but the blood tests aren't all that reliable anyway; and absence of symptoms also makes it unlikely you have genital herpes.

As for HPV, of course you have been at risk but so is everybody. I cannot judge the chance of infection from any single sexual exposure (whether with sex workers or persons of Asian or any other ethnicity), but it doesn't matter. All sexually active people acquire HPV, and you can assume it has happened to you. It's unavoidable, expected, and a normal aspect of human sexuality. The large majority of infections cause no health problems; and any partner with whom you strike up a committed relationship also has been infected. Neither her nor your past sexual lifestyles will elevate your risks for a new HPV infection. 

From an STI standpoint, I see nothing at all to be worried about in seeking a committed relationship or the sexual health of yourself or your potential future partner(s).

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

HHH, MD

The HSV 1/2 testing, you said it could be unreliable & too soon. What is the more appropriate timeline to be tested for it? The test was being done by QuestHealth which used the HSV 1/2 IGG W/REFL HSV2 INHIBITION and said it was over 90% accurate post 6 weeks exposure. I'm just reading it off a website, but just wanted a quick follow up on that?
Was my test really too soon? My 1st test was 4 weeks after sex & shouldn't it have covered the last 4 years, so that could be accurate right? and then my 2nd full panel test was done at 9 weeks total? I'm probably just overthinking it. 

Is there any statistical data about the transmission of all the sti's per one sexual act? I'm curious b/c you mentioned my lifestyle was "low risk sexual lifestyle" but on other forums some might say it was highly risky like playing with fire. It seems like there isn't any one consistent source of material on this throughout the internet. Especially on Reddit, which seems like a large part of it is misinformation & fear mongering especially about HPV.

is it true that you can acquire it from years and maybe decades ago and it just lays dormant and then one day you're in a committed relationship, it reactivates and it just appears randomly as maybe genital warts in men, or shows up positive it a pap smear or HPV test for women? On a men's penis, where does HPV usually live or get acquired on? and are there really no symptoms at all? Not even subtle hints of infection? I know there's no test for men, but if a test were to become available for men in the future, do you have any ideas if it would be a blood, urine, swab, etc test?

Thank you again for your answers! Extremely helpful!

The large majority of HPV infections indeed remain silent -- no symptoms, no bad outcomes. Some labs offer HPV tests, but these assays are not FDA certified; probably miss most infections; and there's nothing to be done about positive results. A positive result in a male should not affect his sexual choices, no need to inform partners, etc. The important HPV prevention strategies are vaccination to prevent infection with the 9 HPV types (there are over 100 of them) that cause 90% of genital warts and HPV-related cancers -- but not advised at your age (since you've likely been infected with most of those types anyway). And, in women, Pap smears to detect pre-cancer of the cervix before it becomes dangerous.