[Question #13400] Very worried and hated myself.

1 days ago

Hi doctor(s)

I just did a crazy thing just now. There is an escort I see regularly, she seems clean but nonetheless she is an escort which means she sees many men. I was having sex with her and the condom completely slipped off! I ended up finishing inside of her. I feel so disgusted with myself! I asked her nicely if she will take a birth control and if she going to be tested. She said she will take plan b today and she will get tested early next week. She told me she regularly tests but condom slippage have happened with her, even though not a lot!

I am very sad and angry with myself and just booked an appointment with a doctor so they can prescribe me PEP. My questions are:

1. Do you recommend me take the PEP?

2. What are the side effects especially long term risks?

3. How likely is getting HIV or other STI from unprotected sex with this escort?

4. Other ideas or advices are appreciated.

Thanks

1 days ago

Please I want your answer before I start taking the PEP today

Edward W. Hook M.D.

23 hours ago

Welcome back to the Forum. Thanks for your question. I'll be glad to comment.

If I were in your situation, I would not start PEP. Let me tell you why. You have had good communications with your CSW partner who had told you that she tests regularly and had s not been infected to date - most people do tell the truth in these situations. She apparently uses condoms with many of not all partners making it unlikely that she had untreated HIV. Assuming that you are in North America the likelihood that she has HIV is less than 1% and if she did, your risk for infection would be less than 1 in 2000. Thus statistically there is a 99.99% chance you were not infected. Finally, should you start PEP, that would delay the time when you could reliable test for HIV for more than a month. Considering all of these facts, as I said above, if I were you, I would not be starting PEP.

I hope this perspective is helpful. EWH

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23 hours ago

Thanks for your educated reply. What are the other greater STI risks besides HIV risk?

Edward W. Hook M.D.

23 hours ago

Th risks for other STIs such as gonorrhea or chlamydia are higher but still relative low, perhaps in the range of 1% or less (remember. even if she were infected, there is only a 20% chance that you would become infected. The risk for syphilis is lower still.

In your situation I would ask her to share her test results and get tested myself but not would be overly worried.

One reply remining. EWH

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22 hours ago

I have asked her, hopefully she will comply. I also read one research that states HIV rate among sex workers is about 17%. That worries me. Do you believe that research is accurate?

Edward W. Hook M.D.

22 hours ago

I'm skeptical about that figure, particularly in North America Western Europe. There are many types of CSWs - rates of STI and HIV are higher among those who might be found on street corners working to support drug habits. OTOH, those who work by appointment or other most stable environments have HIV rates far, far lower. I presume from what you say, your partner is more like that latter group than someone you hired off of a street corner.

This completes this thread. EWH

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21 hours ago

Thank you. I am considering not taking PEP actually.

1 hours ago

Hi Dr, last follow up if thats ok. What if she has an acute hiv infection meaning she got it recently and did not know. I read that risk is 20 fold. We also had rough sex where she was on top.

Edward W. Hook M.D.

1 hours ago

Final response

The likelihood that she has recently acquired HIV is very low. Further, the 20-fold increase in transmission is an exaggeration. She’s not been infected yet. The odds of you having been exposed remain very, very low. My assessment is unchanged.

Closing the thread now. EWH

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