[Question #1531] Unprotected Vaginal Sex

44 months ago
Hi Doc I hope all is well. Around 6 months ago Dr Hook answered a question of mine ref#816. I did not log back into say thanks and would like to take the opportunity to do so now. Essentially, i had unprotected sex with a romanian CSW in London on 31st May 2016. It was the first time i had unprotected sex ever. I kept a semi friendly relationship with her, i got tested as per Docs recommendation and was negative on all STDs.  I then stopped contact with the CSW and spoke to her again in October. From Oct-Dec she was contacting me every other day and was insistent that i see her again. On Dec 16th, i met her and we once again had unprotected sex. This time however, she was extremely insistent on having unprotected sex, she literally grabbed my penis and attempted to place in the vagina from behind, despite me initially insisting on condoms and trying to resist insertion (i accept overall responsibility however) but this does worry me a little. I ejaculated inside her and this was only the 2nd time i have had unprotected sex in my life(she knows this). Afterwards, i asked her why she wanted to have unprotected vaginal sex, she didnt answer but sat down next to me and showed me a text from the clinic, saying that she tested negative on Nov 17th ( i am assuming this was for all STDs including HIV).  I am aware that this still remains a low HIV risk but wanted to gauge your experience perhaps for psychological reassurance. I am circumcised, she is technically a high class escort at a price of £190per hour and does not advertise unprotected sex. She does have an inplant in her arm to stop pregnancy. 1) Considering that she tested negative in Nov (assuming HIV was included in the tests) is there any real need for me to get tested?2) Does her insistence on having unprotected sex on this occasion place me in higher risk than usual from your experience? 3) Does my circumcision have a considerable influence in this situation? Thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Welcome back to the forum and thanks for this question. I'll try to help.

This sounds like a dangerous situation. Presumably she has other partners, and if she requests/insists on unprotected sex with you, seems to me she probably does so with others as well. I suppose there's a chance she sees you as particuarly safe, given your limited sexual experience. But that doesn't mean she has been safe. Evidence of recent negative test results is well and good, but what tests? And what risks has she had since November? That said, many escorts (expensive sex workers by appointment) often are very selective in their clients, and she may not be at high risk. But I wouldn't assume that. If you continue to see this lady, please use condoms!

1) In general, I don't ever recommend STD/HIV testing after any single exposure, except in especially high risk circumstances, e.g. a known infected partner. It's usually wiser for sexually active people at potential risk to get tested regularly, e.g. once a year. That said, some people would seek testing after an exposure like this one. The chance you were infected is very low, assuming no symptoms (discharge, genital sores, etc within 2-3 weeks). But I can't say it is zero.

2) As I said above, this seems unusual for upscale sex workers and strikes me as indeed "higher risk than usual".

3) Circumcision status isn't very important. Circumcision makes quite a difference in the "population level" risk of HIV, i.e. double the number of uncircumcised men will become infected over time. But little real difference for any single exposure. If the risk of HIV for an uncircumcised man were, say, 1 chance in 5,000, it would be 1 in 10K for the circumcised guy. Not enough lower to make much difference in whether or not to be tested, for example.

I hope this information is helpful. Let me know if anything isn't clear. 

HHH, MD

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44 months ago
Doc. Thank you for your response.

I of course share your concerns. Her insistence on unprotected sex with me on this occasion was worrying. What is confusing is that she actually doesnt advertise unprotected sex and actually charges extra for unprotected oral. I also paid for 2 hours And she ended up staying for 5 (without extra charge). Plus we are connected on social media etc

I will get tested for stis today and hiv in 4weeks and speak to this lady face to face in the next couple of days to get answers to some key questions. I have had a cold for 3 days 2 days after exposure I assume this not much to worry about.

My last question ( and I understand if you do not wish to answer) if I were a patient of yours in this situation, will you be overly concerned solely from a HIV perspective ?

Thanks 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
I agree she seems to be providing "confusing" information, but I don't have any way to judge her intentions or risks more than I already have.

Would I be "overly" concerned about HIV? Probably not. But I would recommend testing. Better safe than sorry.


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44 months ago
Hi Doc 

Not sure if i have used up my two questions and if you will be allowed to answer my update. Doc, without creating a soap opera here, i will briefly say that i did see her a week after the unprotected encounter. She once again wanted unprotected sex but i insisted on condoms assertively and we had fully PROTECTED! sex. Interestingly, we spoke about STIs and HIV for about an hour and she got pretty emotional, saying shes clean and that she only does this with me and would never take a chance of infecting someone and that she is not seeing me for the money. It was a bit reassuring and i have stayed overnight at hers twice without paying and indulging in  safe sex. I do speak to her 4 - 5 times a week which is also a bit reassuring.

Doc i have just got my results back, on Friday 13th Jan i went into my clinic (exactly 28 days after exposure on 16th Dec), they took a vial full of my blood and sent it to the lab for testing as well as urine samples. They tested for HIV, Syphilis, Chlamydia and Gonorrhoea - I got the results today and all were negative. The lady who saw me at the local clinic mentioned a window period of about 4 weeks for the HIV test. Furthermore, today i had already booked an appointment at a well known central london clinic (aniticipating that my local clinic wont get back to me until end of this week). They tested for exactly the same STDs and the lady at this clinic was adamant that the HIV test at 31 days post exposure would be reliable and there would be no need for further testing. I have got the results back for HIV and Syphilis from the Central London Clinic - All clear (negative). My questions to you while I wait for the C London clinic to provide my Chlamydia and Gonorrhoea results:

1) From your perspective, am I in the all clear now? This particular episode has affected me psychologically a little and i am keen to get focused back onto my career at work. As such, do you think i need a further test at 3 months post exposure? Or can i sleep peacefully knowing I have nothing to worry from an HIV perspective?
2) Are there any other STIs you think i should be tested for other than those which you have already recommended testing - FYI i have had no symptoms post exposure. Just a weird groin pain in my left thigh.

Finally, i would like to thank you sincerely for your time and i hope others can learn from my posts and your responses as i hope they will  influence my lifestyle. I have decided to seek help in terms of my habbit with paying for sex and would like to reassure you that i will not be indulging in unsafe sex with this CSW again. I am very much looking to try and get into a monogamous relationship in 2017 if i can. 

Thanks once more for your time.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Thanks for the additional information. 

1) Assuming your HIV blood test was a 4th generation ("combo" or "duo") test, the results are conclusive any time 4 weeks or more after the last possible exposure. You are in the clear for HIV and all STDs for which you have been tested. 

2) In the absence of symptoms, I don't recommend any other STD testing. Some experts might suggest testing for herpes (i.e. an HSV antibody blood test); but I do not. The chance of herpes isn't zero, but the tests are not perfect and the results often misleading, so in general testing is reserved for people with symptoms that suggest herpes. No tests exist for HPV, overall the most common STD. You should consider getting vaccinated, which will prevent infection with 9 of the HPV types that cause most cancers and genital warts. Also consider vaccination against hepatitis B. 

That completes the two follow-up comments and replies included with each original question, and so concludes this thread. I hope the disucssion has been helpful. Best wishes and stay safe!
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