First of all please receive my full gratitude for the services you provide I am trully trully thankful.

Background: 37 year old heterosexual male, married for many years now and with an almost 2 year old son.

Risk situation: visited a FSW in a brothel in South America. No vaginal sex, only protected oral sex (no breakage of condom, since I was completely hammered I took the condom with me back to the hotel and checked it again before throwing it away).  The oral sex was short (possibly 4-6 mins) and then she continued to give me a hand job still with the condom on and she put some kind of lubricant on it, since I was so wasted she did not make me cum so I had to masturbate to completion while she was fingering her self. I do not think that she touched my bare penis with her hands (which potentially had vaginal fluids on them) after I removed the condom. Other than that I just touched her breasts and squeezed a bit her nipples (not sure if there was breast milk coming out) and also touched her buttocks.

I am experiencing a great deal of anxiety and guilt for this. Therefore I wanted to hear from your expert opinion what is my risk for HIV or any other STI for that matter from the exposure above. I have a very active sexual life with my wife and I will not be able to refuse her for long but I am just terrified of thinking that I might have caught something and could potentially give it to her.

Two additional things: 1)my encounter was pretty late so I am sure that the CSW had several clients before me that night, does that increase my risk? 2) the "bed" where I was lying during the act did not look the best. What id there was some semen or blood from previous clients and I accidentally laid on potentially fresh fluids on the towel.

Thank you so very much doctors!

As you undoubtedly know, HIV is quite common in sex workers in that part of the world, perhaps especially in brothel workers -- and particularly high risk if she is a black African. (Not a racist perspective, just an epidemiologic fact.) Still, it is most likely she doesn't have HIV; my guess is around a 10-20% chance she is infected, hence 80-90% she is not.

That said, you went about this event with wisdom, with a condom for oral sex (which actually wasn't necessary for HIV prevention) and otherwise no penetrative sex-- all good moves! HIV is not transmitted by any kind of sexual or skin-to-skin contact without body orifice penetration:  no risk at all from kissing, hand-genital contact, and so on. In regard to your concerns about her other partners earlier that night, nobody has ever been known to be infected with HIV is his direct sex partner didn't have it -- i.e. no known transmission by exposure to other men's genital fluids. And in any case, still no penetration. The cleanliness of the sheets or overall hygiene in this situation also make no known difference.

All those comments were for HIV. For other STDs, really no worry about those transmitted through genital fluids (gonorrhea, chlamydia, hepatitis B). In theory, there could be some risk for those transmitted by skin-skin contact (syphilis, herpes, HPV). However, even these are rare without direct genital-genital contact, i.e. rare if ever transmitted by hand-genital contact even when genital fluids might contaminate the hands. Such indirect contact rarely carries enough infectious agent for transmission to be likely.

Of course there are no guarantees here, and you might be reassured by having syphilis and HIV blood tests in a few weeks, and even a urine test for gonorrhea and chlamydia, even though the chances of these are exceedingly low if not truly zero. I suggest testing primarily for reassurance; from a strict risk standpoint, there's really no need, and the chance you were infected is low enough that if I were in your situation, I would continue unprotected sex with my wife.

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

HHH, MD