1) What do you think about the multiplied risk and my idea to get tested?

2) I cannot talk to my wife about it (she is deeply religious), but she would be suspicious if I totally resist sex. Can I responsibly have sex with her?

3) I am actually head of a big German organisation, responsible for many people. At the moment I cannot properly function and make mistakes.. I know it is somehow beyond the scope of this forum but from your vast experience, can you give me some advice how to get through the "window period" without a breakdown?

Thank you very much. Keep up this important work!

Karl  

1) With your corporate responsibilities, you're obviously able to think objectively about these risks. Let's speculate there is some extremely low risk of transmission. Let's say one chance in a million. (Even this might be too high.) If so, 2 exposures raises the risk to 1 chance in 500,000. Ten exposures would bring the risk to 1 in 100,000. And 20 exposures, perhaps an approximation of your experience with 16 CSWs, still leaves the odds overwhelmingly in your favor at 1 chance in 50,000. Still far too low to be tested for anything. Further, your risk is lower still, since you have had no symptoms to suggest any infection. The risk of a false positive test result is far higher than the chance you were infected with any STD.

As this implies, I recommend against any STD testing at all. What were you planning to be tested for anyway? Syphilis? No chance. HPV? No test available, and we all have it anyway. Herpes? Unlikely in the absence of symptoms; the tests sometimes give false results; and 10-50% of the population has a positive result due to past infection. (Data from the US, but I imagine Germany isn't much different.) Even if positive for HSV, it would not implicate your recent exposures. That said, if you simply must be tested for its increased reassurance value, have blood tests only for HIV and syphilis, expecting negative results -- but with risk of confusing and upsetting positive results that would have nothing to do with your recent exposures.

2) You can and should continue sex with your wife. If I were in your circumstances, that's what I would do.

3) As you have predicted, this is beyond the scope of our services. We can offer facts and probabilities, but the rest is up to you. Still, try to separate your guilt and shame over some sexual decisions you regret from the medical consequences of those decisions. They aren't the same. Deal with the former as you need to, but you truly can disregard the latter. Finally, schedule a lovely dinner with your wife, bring flowers, and have a very fine bottle of wine. (I highly recommend a 2000 Bordeaux.)

Thanks for your kind words about the forum. Best wishes--

HHH, MD