[Question #1418] STD Risk with Escort

46 months ago
Hello Doctor,

First off, I would like to thank you in advance for your valuable opinion and service. The work you do here helps many people put their minds at ease. 

About 2 days ago, I went to see a Thai escort that was working in Switzerland.

The whole encounter lasted no more than 10-15 minutes and she didn't appear to have any cold sores, lesions or anything like that on her mouth or body.  There was also no time where I wasn't wearing a condom during the intercourse. 

However, I went down on her for some time (around 3-5 minutes) and this has gotten me a little worried. I have read on the internet that STD's like Herpes, HPV and Gonorrhea are very easily transmittable through unprotected oral sex, which in my case was cunnilingus. As far as I'm aware, she did not have any sores around her genital area, but assuming the worst case scenario, I am presuming she had sores inside her vagina which I didn't notice.

This has caused quite some paranoia inside my head Doc. For a person in my situation, what are the odds that one acquires the said STD's (Herpes, HPV, Gonorrhea etc.) through cunnilingus with a sex worker/escort? Could you give me some statistics or percentages?

Also, correct me if I'm wrong Doctor but as far as I am aware, sex workers in Switzerland are required to have STD checks periodically, so can we consider sex workers as low risk in terms of STD's in Switzerland?

Should I get tested and if so, when would be the best time to test in order to have maximum accuracy?

Additionally, is it safe to assume that I don't have herpes/HPV if I do not develop any cold sores in the next week or so?

Again, thank you in advance for your answer.

Best Regards,

Eames



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome back to the forum.

Oral sex, especially cunnilingus, can be considered safe sex. The risk of any and all STDs is very low, and it's zero for some. Among other things, oral tissues and throat are less susceptible to STDs than genital tissues. I don't think I've ever seen a case of oral warts or herpes, for example, that was apparently acquired by oral sex. There would a slight chance of gonorrhea, but not much else. All in all, you probably were at higher risk for most STDs from the condom protected vaginal sex than from unprotected cunnilingus. From either exposure, I would guess the odds (for either oral sex or condom protected vaginal) for gonorrhea, chlamydia, herpes, and syphilis at under one chance in many thousand; and zero for HIV.

In general, I never recommend any STD testing in such low risk situations as this one. If condom unprotected, maybe -- but even then, the main indication would be if your partner had a known STD. A wiser approach is to just plan on regluar timed testing for common STDs, e.g. once a year. At any point in time, most sex workers aren't infected. However, if you want to be tested anyway for reassurance, I would suggest culture for gonorrhea (requires a throat swab); and blood tests for syphilis and HIV in a few weeks. Nothing more.

It is also true that most escorts (upscale, expensive female SWs by appointment, as opposed to bar pickups, etc) know the score, use condoms consistently, and get tested frequently. However, I don't know policies in Switzerland -- but if there is a regulatory system that requires testing, of course it can only apply for practial purposes to those women who register as CSWs, and my guess is that most do not do so except perhaps those in licensed brothels.

As for oral symptoms, absence of oral blisters sores and sore throat within 10 days will be good evidence you didn't catch oral herpes.

HPV is a different story. It is present in up to 50% of sexually active people at any time and probably efficiently transmitted, at least genital to genital; less so for oral sex, in either dierction. So you could well have been exposed. When HPV causes visible abnormalities (e.g. warts) they typically appear 2-12 months later, average probably around 4-6 months. Of course as a sexually active person, you undoubtedly have been infected with HPV perhaps several times, and will have more infections. It happens to all of us, almost no exceptions. Fortunatley, only a minority cause symptoms or any potential health problem. And this particular exposure does not materially raise your chance of HPV any more than it was before the event. So it's nothing to worry about or be tested for.

I hope this has been helpful. Best wishes and stay safe--  HHH, MD

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46 months ago
Doctor Handsfield,

Thank you very much for your reply. I am a lot more comfortable than I was before reading your reply. 

So my understanding from your detailed answer is that I can assume I am at very low risk for STD's such as Herpes, Gonorrhea, HIV etc. and thus, should not get tested.  

As you also recommended, I will start getting tested regularly once ever year for all STD's.

As for your answer regarding HPV. Although HPV doesn't usually cause any health issues like you said, it still has me quite worried. Especially the fact that it only starts showing symptoms after a minimum of 2 months or so. Doctor, If I was to get tested for HPV, which test would I go for? Especially in a case of not having any warts or visible symptoms, since I am aware that there is no specific blood test for HPV.

Is it also true that the body will clear itself of the HPV virus completely within 1-2 years? And if so, what factors would this depend on (e.g. weight, age etc.)? Would a person with a strong immune system that regularly works out and eats healthy be able to clear the HPV virus in a shorter time than 1 year?

Thank you for your help.

Kind Regards,

Eames


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
I encourage you to try to better understand HPV. Having HPV is like carrying staph or strep bacteria on our skin and having E. coli in our intestines:  all are normal and most harmless, even though all can occasionally cause serious health problems. HPV is no different just because it mostly involves the genital area and is sexually acquired. Look around among your friends and acquaintances age 20-30:  half of them current have active HPV infections (mostly wihtout symptoms). There is no valid test for asymptomatic HPV in men, and even if you find an online service that offers one, you should not do it. A negative result won't prove you aren't infected, and a positive one would not mean you will have a problem from HPV.

It is true that most HPV infections are cleared entirely within 1-2 years, although in at least some cases, HPV DNA may persist indefinitely in formerly infected tissues, with a potential for recurrence in later years. While it's a good thing to stay in good physical condition and have a normal diet, these things do not significantly "boost" the immune system and have no known effect on the rate at which HPV is cleared. The only external factor that's well documented to alter HPV clearance time is tobacco:  clearance is slower in smokers.

In other words, having HPV is a normal, unavoidable consequence of being a sexually active human being. What you can do, though, is get immunized with Gardasil, which is highly effective in preventing infection with the 9 HPV strains that cause 90% of genital warts and 90% of HPV-related cancers. There are 90+ other sexually transmitted HPV strains, but almost all remain asymptomatic and do not increase the chance of warts or cancer.

So aside from vaccination, and for women to follow standard pap smear guidelines, the proper approach to HPV is be aware you could be infected, since most of us are at one time or another, but then to more or less forget it, knowing that in the chance of warts or cancer, the symptoms are easily recognized and treated many years before they cause important health problems. Also, you should not inform partners when you think you might have been exposed, only if you are known to have an active infection.

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