I was in NYC for business this week and made a stupid error while attending a nude strip club.  Of course I was intoxicated and when having a private dance with one of the ladies things went further than they should and we ended up having vaginal intercourse without protection and I ejaculated inside her (nuts I know !!).  It lasted about 10 minutes total.  There was no oral sex.  This is something I’ve never done before and I’ve been in  state of blind panic since last night.  The lady was in her early 20’s and from the US.  She was at pains to tell me she was clean but it didn’t and shouldn’t have reassured me!  My brain was mush.  In any event it happened so I need to deal with the consequences.  I’ve been good about my sexual health up to now and regularly test.  My last full STD screen came back clear on all counts and that was only 4 weeks ago.  I plan on getting tested for all the usual STDs on my return home once appropriate incubation periods have elapsed.  My two questions are as follows: 1. Should I test for all STDs at once in say 2 weeks time and that should be sufficient or should I go for further testing in 4 weeks to rule everything out instead?  2.  The lady in the club was adamant she was clean but the fact she allowed me to have sex without protection has naturally worried me as who else has she been with since she was last tested?  I’d welcome your general observations as to how much of a risk I have incurred here given the facts outlined above.  I know using protection is the only way to stay safe.  This was a one time encounter with a sex worker in NYC working in a strip club. She was also new to the establishment and relatively inexperienced. Just trying to gauge my risk and help calm my anxiety.  Thanks so much for your help. 

You needn't be nearly as worried as you seem to be. Even among the most sexually active women, at any point in time most do not have active infection with the STDs that matter most -- HIV, syphilis, gonorrhea, chlamydia or herpes. And most people don't lie about STD status and testing when asked directly, so there's really no reason to doubt her reassurance that she is unlikely to be infected. And even if she were, these infections usually are not efficiently transmitted -- that is, most exposures don't result in infection. All things considered, the chance of HIV or syphilis in this situation is under one chance in thousands if not millions. Your risk for gonorrhea or chlamydia is higher, but still probably under one chance in a thousand.

Given your concerns, it is reasonable to be tested. I don't know what you consider "all the usual STDs", but the only tests I would advise are urine tests for gonorrhea and chlamydia now -- they're good any time more than 4-5 days after exposure -- and blood tests for syphilis and HIV. You could have these at 3-4 weeks (two weeks is too soon), and final confirmatory tests at 6 weeks. I would advise against the typical "comprehensive" test panels offered by many labs. Aside from the ones already mentioned, all infections are a) too rare for testing to make sense; b) include organisms that don't matter anyway (like Ureaplasma and Mycoplasma hominis); and c) the tests for HSV too unreliable. We never advise HSV testing except in people at far higher risk, such as symptoms that suggest herpes or regular sex with a known infected partner.

I think those comments cover both your numbered questions, but let me know if anything isn't clear.

HHH, MD