[Question #2091] Protected encounter with a CSW. What are my risks and should tests be done?

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83 months ago
Hello,

I recently met up with a lady five days ago who is a high end escort We had very brief unprotected oral sex and then I proceeded to have have protected vaginal sex with her. After the encounter, I checked the condom to see if it broke and it looked fine to the naked eye. The escort looked completely healthy as well with no visable sores on her mouth or around her genitals.  I get yearly STD screening and I previous to this encounter I had no STDs. 

As you can imagine, I am very concerned about this encounter and I stopped by my doctors' office. He suggested that I was fine and do not need any further testing and I do not need to be on PEP.. He also prescribed a single four tablet dose of azithromycin to clean up any potential infection from chlamydia & gonorrhea.

I am currently in a relationship and I really wish this encounter never happened. Here are a few of my questions:

1. Should I be concerned about HIV/Herpes/HPV from this encounter? What STDs should I be concerned about?

2. What are the chances I currently have an STD given the information I relayed in this message? Is there any other information that would be helpful for me to provide that could help you make a more informed decision?

3.  Should I refrain from sex with my current partner until I get a new STD screen? If so what tests should I get done?

4. In your opinion did I practice safe sex? 

Thank you so much for your service and thank your time in helping me out. 

Best, 

Sam
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Edward W. Hook M.D.
83 months ago
Welcome to the Forum.  This was a very low risk encounter and is not something I worry worry about in the least.  Most escorts, particularly high end ones, do not have STIs and are careful about their health.  Your partner was probably less likely to have an STI than someone you might have picked up at a bar.  Further, even if she were infected, even without condoms, most single exposures do not lead to infection and in your case, you used a condom for your vaginal exposure.   The risk for STI acquisition from receipt of oral sex is lower than from vagial sex. Personally, were I you, I would not feel the need for testing.  In answer to your specific questions:

1.  Virtually all of your risk relates to your receipt of unprotected oral sex and the small amount of exposure of your penis which was not covered by the condom. From the oral sex there is a tiny risk of getting Gonorrhea or NGU but that risk is tiny and the azithromycin you took (which I would not have prescribed) would prevent infection.  Similarly, your risk for getting herpes or HPV is very very low for all of the reasons I mentioned,  there is no meaningful risk for HIV.

2.  See above, less than a fraction of 1%.

3.  As I said, I see no need for testing and no need to refrain from sex with your regular part .

4.  This was very close to safe sex.  Your only exposure of any significance was receipt of unprotected oral sex and that risk is very, very low.  I would not worry.

I hope these comments are helpful to you.  EWH
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83 months ago
Hello Dr. Hook,

Thank you so much for your reply. It's a real weight off my mind to hear that I have little to no risk of being infected with HIV or some other STI. I just have one more question:

 Are there any symptoms I should keep a look out for regarding potential herpes or HPV infections or would that just cause more anxiety than is warranted?

Thanks, 

Sam 


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Edward W. Hook M.D.
83 months ago
Your risk for infection is vanishingly low and not something to worry about.  I appreciate your comment about increased vigilance just contributing to your anxiety and agree with it.  Were you to acquire herpes, a rash or lesions would be expected to appear within about 10 days of your exposure.  After 14 days, there is no reason to worry further, if there ever was, about HSV.  For HPV, if you were going to develop warts, this can take, typically three or more months and would be apparent.  Thus, I would suggest that you go forward and not worry further.  In the very unlikely situation that something was caught, you would note it.  EWH. 
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83 months ago
Dr. Hook, 

Ok great. Thank you so much for your time! This was a really great resource for me and I have a much better knowledge and appreciation of potential STI risk. 

Cheers,

Sam