[Question #2666] MSM Trans Oral Sex risks, testing

43 months ago

Thank you for an amazing website and service.

Please consider: Approx 3 to 5 times per year, a person having oral-only sexual experiences with TS/TV CSWs. Kissing, oral sex, that’s it. Experience is that condom is worn by the client, generally not the Transgender SW, unless client known as regular client, then maybe both are unprotected.

STI screening done once or twice per year.

Never any adverse results or diagnosis of an STI, so wonder how safe is the described sexual behaviour.

Has the same, usual anxiety as everybody else, and sometimes gets a little anxious if for example, a mouth ulcer develops, when tired, overworked, etc - main concern would be passing something on to another person.

The status of the escort is usually requested, though sometimes unclear due to language barrier. The TS escorts in the area work out of clean, upscale apartments via the internet and charge around €150 dollars equivalent. There isn’t any on-street transgender prostitution. Private testing is expensive.

Last test in May this year, all normal, all negative. Has been with two TS CSW since. The question is, based on the above, is this behaviour safe, and should testing be more or less often, or even post each encounter? Thank you.

Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Welcome to the Forum.  Thank you for your detailed question and thoughtful question.  I will try to provide an equally thoughtful response.  There are several variables here, including the routes of exposure, that your partners are transsexual, and that they are commercial sex workers.  Here are the data to consider, realizing that the information I provide represents statistics which are, where possible informed by data but if there is a 1 in a thousand chance and you are the 1, you are affected. 

1.  HIV rates, in particular, tend to be a bit higher amongst transsexual women than other at risk groups- in the 10-12% range in the U.S.  CSWs tend to be a somewhat higher risk group within this subset of people.
2.  Kissing is a no risk event, irrespective of the sort of kissing (deep or otherwise) or the partner's dental hygiene- cavities and gum disease are not known to change the risk.
3.  Oral sex has to be considered in terms of whether a person is receiving oral sex or providing it.  The US CDC estimates that both acts have a risk of infection of 1 infection per 10,000 sex acts however, neither of us on the Forum has EVER heard of a person who acquired HIV from receiving oral sex but are aware of a small number of persons who have apparently acquired HIV from performing oral sex (fellatio) on an infected sex partner.  Oral sex of either type is the lowest risk sort of exposure that a person can have for insertive sexual contact if a partner is infected with HIV.
4.  Asking partners if they have been checked, how long ago, and there test results is a good idea.  Most people do tell the truth.  Obviously, persons who have not been tested are a bit more likely to be infected. 

I hope that this information will help you in reflecting on your degree of risk.  In my opinion, since you limit yourself to oral sex and kissing your risk is low but not necessarily zero.  I applaud your regular check ups and testing.  In the unlikely event that you were to become infected, this would permit early diagnosis and therapy.  EWH
43 months ago
Dr Hook, thank you. I will limit myself to the two follow-up questions, then consider the Q&A concluded, with thanks and best wishes to you and your colleagues.
Given the specific variables and routes of transmission, and the data you are aware of;

1) Do you think there is a greater or lesser risk of STIs other than HIV, or is it the same 1 per 10,000?

And, given the frequency of exposures per year, 3 to 5;

2) Could you comment on the need around frequency of STI screening?

I hope that makes sense, what I'm really considering is, is annual testing enough, or do you think greater frequency? I think the duration of exposure per encounter is actually quite brief, if that is relevant.
I try to aim for harm reduction rather than abstinence, but don't want to be over-confident as to safety. 

Again, thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Straight to your questions:
1.  Other STIs. specifically gonorrhea, are probably both more common and more easily transmitted that HIV.  TIs such as chlamydia or oral syphilis are less common.

2.  The frequency of screening varies from person to person and is effected by the number of exposures, the risk of partners, resources (time and money for testing), and the level of concern.  For you, I think that twice yearly screening should be fine and depending on your level of comfort and assuming that you are not particularly worried, even once a year should be sufficient to detect otherwise asymptomatic infections, if present.  As a harm reduction strategy in the situations you describe, I would be comfortable with once yearly screening.  EWH