[Question #2388] Unprotected oral sex with sex worker

45 months ago
Dear Doctor, 

Last night I went to a brothel and paid for 2 hours with a sex worker. During this time I received unprotected oral sex from them. I was quite drunk and not fully hard, but I did end up ejaculating twice (not in her mouth). 

Brothels are legal in my state of Australia. I understand the sex workers are required/encouraged to have regular STI screenings. In saying that, this venue was not a high class place. The sex workers seemed to be risky, she looked like she may have been a drug user. I didn't see any track marks or anything but she seemed a bit speedy. Speed and meth are popular in Australia so this may have been what she was using (if anything). She did have condoms with her but we didn't have vaginal sex so it wasn't used. She did have a look at my genitals before commencing as a 'health check' but it seemed token. 

I want to know if you think I should bother being tested for STIs and if I can resume sex with my wife, who is pregnant. 

I understand the risks are really only for gonorrhea, UTI and herpes.  Also, the risk is low, but not zero. I have seen similar comments on the forum saying that in similar circumstances, it's been recommended not to worry and to recommence sex with the wife, because the risk is so low. I guess I'm wondering if the fact that the woman may have been a drug user would change that. 

Thanks doctor, I am worried. I don't know how long I can avoid sex with my wife. I don't want to destroy my family over something so stupid. 






H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thanks for your question.

Oral sex is safe sex -- not completely risk free, but with much lower chance of infection than vaginal or anal sex. The risk is low for all STDs and zero risk for some, including HIV. Whether or not you ejaculated in her mouth makes no difference in your risk. Your risk is low enough risk that I do not recommend any testing. In other words, I agree exactly with your own statment:  "it's been recommended not to worry and to recommence sex with the wife, because the risk is so low." That the sex worker may have been a drug user doesn't change this advice.

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

HHH, MD

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45 months ago
Thank you so much, Doc. I really appreciate it. 

I was wondering if you think engaging in unprotected oral on a regular basis with sex workers is low risk. Would it be safe to continue to do this while married? Ethical dilemmas aside, wouldn't the small risk be counterweighed by the seriousness of possibly infecting others? 

If STIs can be transmitted by oral sex, is it just that it's so unlikely that it happens? Like 1/100? Or is it more the fact that they are rare these days, or both? 

Sorry for the additional question. I just would like to know how risky it is, which will help me decide if I should engage in such practices in the future. Would you do so if you were that way inclined? 

All the other info online seems to be overly conservative. 

Thanks


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
You are correct in your assumption that even a very low risk for a particular exposure rises in proportion to the number of such exposures. However, for HIV there are no proved oral to penile transnmissions (some claims, but no confirmed cases); and one estimate by CDC was that the risk might be 1 chance in 20,000. That's equivalent to receiving BJs by infected partners once daily for 55 years before transmission might be expected. And even this applies only if the oral partner has HIV -- and statistically, it is unlikely your partners would be infected (assuming they are women, not men who have sex with men). In other words, I would still consider your chance of HIV from repeatedly receiving oral sex to be virtually zero.

The three infections most common from fellatio are herpes due to HSV1 (the usual cause of oral herpes), gonorrhea, and nongonococcal urethritis (NGU). The first two usually cause obvious symptoms, so testing in absence of symptoms is rarely needed. NGU can be mild, but it's probably usually harmless:  some (many? most? all?) cases from oral exposure are believed to be due to normal oral bacteria that are harmless for both affected men and probably their sex partners. Chlamydia is uncommon in the oral cavity and not easily transmitted by oral sex. HPV and syphilis are theoretical riks but very small.

Why are STDs uncommon from oral sex? The STD bacteria and viruses evolved to infect the genital area and do not take hold as readily in the oral cavity, so that even in persons at very high STD risk in general terms, oral infections are much less common than genital or anal. Also, the mechanics of oral sex are inefficient for transmission. Your guess about a 1% chance of transmission, for any single exposure, may be about right for gonorrhea -- probably too high for others.

If you continue with the sexual lifestyle you have outlines, you could reduce the already low risk for your wife by not having sex with her for about 10 days after each non-marital even, within which time most infections would cause obvious symptoms; and consider periodic (e.g. once yearly) testing for gonorrhea, chlamydia (a urine specimen) and blood tests for HIV and syphilis. The risks will always be low, but I imagine you might be more reassured by occasional negative tests than by my reassurance based on probabilities and statistics.

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45 months ago
Thanks so much, Doctor. That helps put things in perspective. All the best.