[Question #2997] FKK experience in Germany

40 months ago
Hi doctors!  Once again, I would appreciate to get  some risk assessment.

Background: heterosexual healthy 37 yo male from Germany, with an intense sexual life (dating non-exclusively, one-night stands, average one every week) practicing "safer sex" as a good child of the 80s:  always fully protected vaginal/anal but unprotected oral.  I test regularly for STDs (like once a year, and sometimes more) and I have never been diagnosed with an STD.

So, a few days ago I went with a friend to a well-known and prestigious FKK establishment near Frankfurt.  The FKK clubs are 100% legal, and are a sort of a mix between a wellness/gentlemen's club and a high-stand brothel.  Even if that wasn't my intention initially (just wanted to have a massage, eat something, relax) I ended having sexual interaction with two of the girls:  in both cases, I received unprotected oral sex for a long time, body massage, cuddling, etc.  Protected intercourse was offered, but I didn't feel like doing  it because of potential condom breakage, that would turn a pleasant experience into a hell of worries afterwards.  I didn't deep kiss them, nor I gave oral sex to them.  Just very brief fingering.

My concern is that in this kind of establishments the "standard" service always includes unprotected oral and protected intercourse, and of course I can assume these girls had serviced several/many men before me.  They also offer "upsells" for ejaculating in mouth, and it is certainly an option many people choose (I didn't).

The thing is, I had a full STD battery test (including HIV) only a week ago due to a weird encounter I had 8 weeks ago (all negative) and I would rather avoid testing again until my next regular appointment next year.  In absence of obvious STD symptoms, would you say this is a reasonable approach?  I don't want to put anyone else in danger.  Thanks in advance for your answer.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome back to the forum. Thanks for describing FKK clubs -- I'm not familiar with the term. Is it German? What does it mean?

Given your description of the services provided by the club's sex workers, they are potentially at at least moderate risk. However, the actual risk level depends just as much on the likelihood their male clients are infected. If they are mostly heterosexual and mostly monogamous, e.g. just occasional forays by men who have few other partners, the overall risk level may be fairly low for the main serious STDs (HIV, syphilis, chlamydia, gonorrhea). Another factor is that it's not all that rare for sex workers to be susceptible to requests for unsafe (especially condomless) exposures for increased remuneration. Do you have any way to know how common this is? But even with consistent condom use for vaginal or anal sex, the risks definitely are high for herpes and HPV, which are prevalent even in sexually conservative populations.

Ejaculation in the mouth may raise the risk of some STDs for the oral partner, but there is no reason to believe if has any influence on risk for the penile partner. Why would ejaculation in the mouth increase transmission risk to the ejaculator?

The frequency of STD testing for clients of such clubs in general, or you in particular, is not firmly established. But as long as you have no symptoms, I suggest you more or less disregard any particular exposure event as a trigger of testing. Even in the highest risk situations, such as unprotected vaginal or anal sex with a known infected partner, the efficiency of STD transmission is low -- i.e. most exposures don't result in transmission. A smarter approach is to plan on testing at regular intervals. Given your description of FKK clubs and what you have said otherwise about your sexual lifestyle, I probably would recommend testing more often than once a year. Maybe very 6 months? Or perhaps every 3 months if you want to be especially careful.

By routine testing in this situation, I'm referring to urine for gonorrhe and chlamydia and blood tests for HIV and syphilis. Other STD tests are not generally recommended routinely in any people, regardless of risk -- i.e. no routine testing for HSV or hepatitis B.

Of course, it's a different story if you develop symptoms to suggest any of these, in which case you need not only testing, but prompt in person evaluation by a knowledgeable doctor or clinic. Also, testing sometimes may be indicated after particular exposures if you learn a partner definitely was infected.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
  
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40 months ago
Hi Dr. Handsfield.

FKK is an acronym for the German Freik├Ârper-Kultur, which basically means "nudism".  FKK clubs became popular shortly after the legalization of prostitution in Germany, and are considered the higher-end of the sex-working industry here.  They are supposed to provide a clean, safe and controlled environment, and all the girls are supposed to be selected/interviewed before they are allowed to work there.  Different clubs have different policies/control regarding STD checking, and in some of them they run periodic checks and even have their own doctors in designated days.  Dunno about this specific club I visited though, but it is one of the most renowed.

Regarding the male clients, I suppose we can expect most/all of them to be heterosexual.  No idea if they have many other partners or not, but regulars have forums in Internet and they discuss about this and that club, even referring to girls by name and the kind of service they provide, etc.  Some girls even have their "fan club", believe it or not :D  Many of the regulars (and some girls) have been in that environment for many many years.   Judging from what I read in these forums, STDs are not that common, and when it happens, news spread fast, the club is informed, etc.

Unprotected intercourse in exchange of additional money... that's known to happen.  That's one of the reasons why I decided to _not_ have intercourse with these girls, even protected, just in case.  However, it is not done on the open, and there are other sort of clubs in Germany devoted to unprotected commercial sex: AO clubs (Alles Ohne).

I mentioned the ejaculation in mouth because it may be a factor to consider in assessing my risk receiving unprotected oral: if men ejaculated in the mouths of the girls that later gave me oral, that would (indirectly) increase my own risk right?

This is the first time I visit a FKK club and most probably the last, as I am not really into using CSWs services (last and only time was like 6 years ago).  Considering this, and the fact I _always_ use condoms for vaginal/anal sex with the girls I meet (but not for oral) would you still recommend STD tests every 6 months instead of every year?  I'm asking because even without high-risk situations testing always implies a toll in terms of emotional stress, at least for me (yes, I know it is unavoidable when one is sexually active out of a committed monogamous relationship.)  I just want to do the right thing and enjoy sex responsibly without having to think about STDs all the time.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Thanks for the detailed information. But as I think you realize, it doesn't change my advice:  you're certainly doing the right thing in your sexual choices, and periodic testing (every 3 months? 6 months?) should be part of that, along with prompt evaluation if you develop symptoms.

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40 months ago
All right, all very clear.  I will follow your advice and double my testing frequency.  Thank you (and dr. hook and dr. terry) for your invaluable service to society.  You docs rock!
40 months ago
Oh, I almost forgot, a side quick question if I may... would a negative Gonorrhea PCR test on urine be reliable 3 days after exposure? (exposure as receiving oral Sunday night, testing next Thursday morning.)  Turns out I have to go to the clinic for some papers tomorrow and I can just test.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Yes, the gonorrhea DNA tests probably are fully sensitive within 2-3 days of infection. (It may take a bit longer, e.g. 4-5 days, for chlamydia.)

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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