[Question #12768] Safe sex with escorts possible?

5 months ago

I’d like to better understand the potential risks of contracting non-HIV STIs, such as gonorrhea, HPV, syphilis, and chlamydia, when engaging with female escorts, as the internet is rife with anxiety-inducing information that leads me to considering celibacy. If there are no visible symptoms present, what steps can I take to ensure a safer experience for both parties?

Additionally, how do activities like giving or receiving oral stimulation or performing rimming compare in terms of risk if condoms or barriers are not used?

I appreciate your guidance on this matter. Thank you.

Edward W. Hook M.D.

5 months ago

Welcome back to the Forum. I see that this question is a spin-off of your earlier interaction with Dr. Handsfield whose answers partially addressed this more recent question.

As Dr. Handsfield said earlier "it is statistically unlikely your partner has HIV -- in your previous thread, Dr. Hook described the infrequency of HIV in Dubai sex workers. In addition, "escort" usually means expensive female sex workers by appointment, and such women (world wide) are believed to have low frequencies of HIV and STIs. They often are educated, they understand the risks and take steps to protect their health (condoms, regular testing), and their clients generally are themselves unlikely to have HIV (men like you!)." While nothing is 100%, as implied in his response, CSWs, particularly those who work by appointment or charge a bit more, are probably lower risk for STIs than someone who you might pick in a bar for a "one-night stand" and who is less likely to take the precautions that CSWs so. Additional steps to address possible risks with CSWs include condom use throughout encounters and discussion of partners' testing practices (not all will want to disclose this but like the partner you mentioned, many will and when they answer they typically tell the truth).

Regarding types of exposure, in general, unprotected oral sex is a lower risk activity than unprotected ano-genital sex. This is both because oral infections are less common than ano-genital infections and because oral sex is biologically less efficient for STI transmission. The best data are for HIV; there are NO proven cases of HIV acquired from receipt of oral sex and the estimated risk of acquiring HIV by performing oral sex on an HIV infected, untreated partner is estimated to be, on average, less than 1 infection for every 10,000 exposure. Other STIs are less well studied but in general giving or receiving oral sex, including rimming, is relatively low risk.

I hope this information is helpful. EWH

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