[Question #13698] Should I test?

13 hours ago

I recently had a brief encounter with a Trans female escort . She had her HIV status publicly declared as negative and is a “high end” Asian CSW . The encounter involved brief kissing. I then performed oral on her penis without protection off and on for approximately 10 minutes. We then both masturbated . There was no penetration and she never touched my penis . My hand did touch her penis prior to mine . There was no ejaculation during the oral sex . I wiped after and used listerine. I was a little worried so I took doxycycline (PEP) afterwards.

This was a one time encounter. Would you recommend testing if this were you? I know trans csw’s carry higher risk for STDs. Thanks in advance for your guidance

H. Hunter Handsfield, MD

3 hours ago

Greetings. Apologies for the longer than usual delay in this reply.

Most people don't lie about HIV/STI status when asked directly, and female escorts (which is how I would define "high end") are at low risk: typically they understand the risks, take precautions, have mostly low risk clients (men like you), and get tested regularly. Even if she were infected with an active transmissible infection, kissing is no risk, especially if "brief"; and performing oral sex is low risk as well. Hand-genital contact is risk free.

I would have advised against doxyPEP, which is recommended only after much higher risk events. That said, it isn't likely to be harmful. Presumably you took the standard regimen, i.e. a single 200 mg dose, right? If so, you are well protected against gonorrhea and chlamydia, which were near zero risk to begin with; and syphilis, also very low risk. And the chance of HIV in this situation is exceedingly low; HIV is rarely acquired by oral exposure.

For those reasons, from a medical/risk perspective, no testing is needed. If somehow I were in your situation, I wouldn't do it. There's really little point for gonorrhea, chlamydia or syphilis after the doxyPEP; and HIV is too low risk to be a serious consideration. That said, if you'll lose sleep with worry about HIV, feel free to have an HIV AgAb (4th generation) blood test in a few weeks.

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

HHH, MD

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3 hours ago

Thank you. Just making sure you saw this escort was trans . Not sure if that changes anything.

3 hours ago

Also yes the dose was 200 mg single dose approximately 24 hours after exposure

H. Hunter Handsfield, MD

2 hours ago

Yes, I understood her status. You not only said it, but referred to oral contact with her penis. That was a pretty good clue by itself! No change in my assessment or advice.---