[Question #12543] Encounter with CSW

7 months ago

I would like your guidance regarding a few encounters with sex workers in Bahrain, as I am concerned about potential risks

1: In October, I fingered a sex worker while having a fresh cut (1–2 hours old) near my nail for couple of minutes. The cut was red and could bleed if squeezed. Afterward, I used a condom on my hand to continue fingering her for 20 minutes without washing my hands first. She also performed oral sex on me with a condom, which slipped off briefly during a handjob but was immediately replaced.

2: In December, a sex worker kissed me deeply a few times. Her lips were dry and possibly cracked and cut. I also have a cavity in one of my teeth, which worries me.

3: Another sex worker gave me a handjob with a condom only NO peneration. She showed me an HIV test in Russian. I saw "Anti-HIV: 1.2," which I read could indicate a reactive result but test result was not highlighted with red , like other random blood test

Assuming the worst-case scenario (all HIV-positive), what are the chances of transmission in these cases? Do I need testing, or am I safe?

H. Hunter Handsfield, MD

7 months ago

Welcome to the forum. I'm happy to help. The bottom line is that you were not at risk for HIV.

HIV is uncommon in sex workers in the Middle East. I have no personal experience with Bahrain, but according to the United Nations AIDS information site (www.unaids.org) under 0.1% of the population has HIV. Of course the frequency undoubtedly is higher in some sex workers, perhaps especially those from Russia, Eastern Europe, etc. But still probably well under 1%. Second, at least one of your sex worker contact showed you an apparently negative recent HIV test. Believe it or not, most sex workers are truthful when discussing their HIV status.

But even we go with your worst case scenario -- that all three of the sex workers you mention have untreated HIV -- you were at no risk of HIV. There has never been a case of HIV known to have been acquired by vaginal fingering or any other hand-genital contact. And since various cuts and wounds on the fingers are extremely common, we can assume there have been billions of fingering events with such wounds. Kissing also does not transmit HIV, partly because HIV is killed by saliva; therefore almost no exposures to infected persons' mouths are risky. Even oral sex has never been known to transmit HIV mouth to penis.

Therefore you really needn't be worried at all and do not need testing, at least not from a medical/risk perspective. Of course you are free to be tested if you would feel better knowing you've had a negative test result. Many nervous persons are more reassured by negative test results than by professional opinion, no matter how expert. (We don't take it personally!) If so, feel free to have an HIV blood test, preferably an antigen-antibody (AgAb) test, also known as "fourth generation". These tests are valid any time 6 weeks or more after exposure. Personally, if somehow I were in your situation, I would not be tested and would continue unprotected sex with my wife without worry.

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

HHH, MD

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7 months ago

Thank you so much, Doctor. That brings me great relief.

I was particularly worried about the cut on my finger because I’ve read online that a cut, especially if it’s bleeding, could potentially transmit the virus. During the encounter, the sex worker even asked me to stop, mentioning something about disease, which added to my anxiety.

What made the situation even more stressful is that, as an expatriate in Saudi Arabia, an STD test could have serious consequences, including the risk of deportation. This would be devastating for me and my family. Additionally, I’ve struggled with health anxiety for a long time, which has made this situation even harder to cope with.

So, to confirm, even if the cut on my finger was bleeding, there’s no need for testing, and I can move forward without anxiety?

Thank you again for your support.

H. Hunter Handsfield, MD

7 months ago

Be careful about online searching. Anybody can say anything they want, and even legitimate professional sources may not distinguish between theoretical risks and the real world situation. Theoretically it is true that an open wound can lead to infection with HIV if exposed. However, as I said above, there has never been a known case in which this happened. So if it can, it is exceedingly rare -- rare enough to disregard.

In my experience, largely on this forum, the business about HIV or STD testing in Saudi Arabia and other Mideast countries is an urban myth. Negative test results have no harmful consequences, at least none I've ever heard believable stories about. Maybe you've heard otherwise? As best I can tell, the risk of deportation for ex-pats is only for positive results -- but if HIV positive you would have to leave the country anyway to get medical care and life extending treatment. In fact, I would judge that the personal impact of being positive, both for you and your family, would be a whole lot worse than deportation. For those reasons, our consistent advice on the forum is that if you really need HIV testing, suck it up and just do it. (Here too I have no experience with Bahrain, but I have been told exactly these things by the director of a clinic that does lots of STD care and HIV testing in Dubai.)

But in this case I see no realistic risk of HIV anyway and truly am not recommending testing. You can cross that bridge if someday you have a real risk. Human temptations being what they are, if you continue to seek sex worker experiences, massage, etc, please have condoms handy so you don't get yourself into serious risk territory.

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7 months ago

Alright, doctor, thank you.

Is there any other STD that these encounters might pose a risk for? So far, I don’t have any symptoms of anything. Also, just to provide more context, the CSWs were in a hotel or a brothel-like setting.

H. Hunter Handsfield, MD

7 months ago

There was no risk for any STD. You cannot get HIV or any STD without insertive sex, i.e. penis in a partner's vagina, rectum or mouth. They call some infections "sexually transmitted" for good reason: they are not simply genital infections that can be transmitted by any exposure; they require sex itself, and your exposures don't count. Such CSW partners might be high risk, but your exposures were not.

That completes the two follow-up questions and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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