Hi, I wanted to inquire about my supposedly "risk free" behaviors. Due to work stress, I went on a phase that I regret, engaging with some CSWs. In total, I had 3 events to assess the STI risk:

Having seen similar questions (thank you Dr. H for blog post entries), I didn't experience much anxiety due to the absence of HIV risk and limited other STI risk. I, however, want to confirm:

1- Can you confirm if the above is indeed not an HIV risk? Does my interaction with a higher-risk population (CSW) change this? 

2- What's the risk of other STIs, particularly undetected Gonorrhea, Syphilis, and most importantly HSV2. I'm unclear about the risks.

3- Symptoms wise, if I don't experience anything, is there real value in testing after the above, particularly as I pursue more stable relationships. The only symptom that I noticed was "chafing" that took place after my NYC trip, characterized with redness and itch (no blisters) in the area between my testicles and my anus. I saw a dermatologist and diagnosed me for a fungal infection + irritation, treated with Keta and subsided within 2 weeks.

PS: I lumped 3 exposures in one question as the risk profile felt similar. I'm more than happy to buy 3 separate questions if requested.

You were at no significant risk of HIV, HSV2, or any other STI from the exposures describe. You are correct in the understanding shown in the title you chose for your question:  these indeed were very low risk exposure.Without unprotected vaginal or anal intercourse, risks always are low. Going directly to your question:

1. Yes, I confirm you were not at risk for HIV. That's both because the events described do not transmit the virus but also because the chances any of your massage partners have HIV is very low. Contrary to popular belief, in the US and other industrialized countries, HIV is uncommon in female sex workers.

2. I would also rate your risk of gonorrhea, syphilis and HSV2 is near zero.

3. "Chafing" isn't a symptom that suggests any STI and would not have materially increased your risk of infection if exposed. And I'm sure you can rely on the dermatologist's diagnosis of a superficial fungal infection; your symptoms were entirely typical for that.

I see no need for any STI testing at all. However, you certainly could be tested if you would like the additional reassurance of negative test results. Anxious persons often are more reassured by test results than professional opinion, no matter how expert. (We don't take it personally!) If so, you could have a urine gonorrhea/chlamydia test and, 6 weeks after the last exposure. blood tests for HIV and syphilis. I definitely to not recommend any other tests.

It's fine to put all your risk episodes in one question. We definitely do not want separate questions for every exposure of possible concern or about different STIs.

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

HHH, MD