[Question #13324] Risk with an escort

 
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10 days ago
Hi experts,

I recently had an encounter with an escort and want to understand my level of risk. She had a vetting process to go through before we could see each other so I know she is at least somewhat selective. During the encounter there was deep kissing, finger in vagina, I briefly received oral sex from her (<1 minute), and then penetrative sex wearing a condom. 

I am married and concerned about possible transmission to my wife if there is a risk. At what point should I feel in the clear to continue having unprotected sex with my wife? Anything in particular to look out for over the next few days/weeks?

Thank you for all you do!
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Edward W. Hook M.D.
10 days ago
Welcome to the Forum and thanks for your questions.  I'll be glad to comment.  Most commercial sex workers do not have STIs and as you might imagine, within the general category of CSWs there is a spectrum of ris, with the sorts of CSWs you might pick up on a street corner or hotel lobby being higher risk than persons with identifiable contact information.  From the sound of things, your casual partner sounds as though she might have been in the latter category.  Her vetting process is reassuring, as is your condom use for vaginal sex.  

FYI, condoms provide a high degree of protection from most STIs so your major risk is from receipt of unprotected oral sex.  There are no known cases of HIV which have been acquired through receipt of oral sex and syphilis and chlamydia are likewise quite rare.  The most common STIs acquired from receipt of oral sex are gonorrhea and non-chlamydial NGU.  Over 90% of gonorrhea becomes symptomatic and is obvious, typically within 3-5 days of exposure.  Non-chlamydial NGU is of little concern as it reflects the introduction of a partner's normal oral bacteria into the urethra and poses little risk for complication of transmission.  

Decisions about testing are a personal choice.  If you have no symptoms within five days of exposure I would have no concerns and personally would not be concerned about having an STI to transmit to others.  Many clients choose to test for the reassurance that a negative test provides.  If you choose to test, the key test is a urine test for gonorrhea (chlamydia testing is typical done on the same specimen) and some point 3 or more days following your exposure.  Certainly at that point there would be little chance that you were infected.

I hope this information and perspective is helpful.  If anything is unclear, please use your up to 2 follow-ups forclarification.  EWH
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10 days ago
Hi Dr. Hook, thank you for your reply! I'll keep an eye out to see if any symptoms develop in the next few days. I know it is probably hard to estimate but what do you think the likelihood is that I contracted gonorrhea or NGU from the brief oral sex? Is this a 1 in 10 type of risk or a 1 in 1,000? Thanks!
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Edward W. Hook M.D.
10 days ago
Certainly less than 1% although, as you point out, it’s difficult to say.  EWH---