[Question #3035] Risk or Anxiety?

38 months ago
I have posted a question exactly a week ago and I received very helpful information from Dr Handsfield. I apologise if you inform me again what has already been disclosed. So I engaged in protected vaginal and oral sex with a verified Escort here in the UK (Birmingham) however I did perform unprotected anilingus and cunnilingus on her. Just to confirm she was of Brazilian background and claimed to reside in the UK for over 10 years. She also resides within Central London and normally works there. I was informed from a risk perspective this is very low and testing would not be recommended. However, I may be completely overthinking but I have some other questions.

1) The sex was protected and lube was used and I do not have a reason to believe the condom failed.  I did ejaculate within the condom during penetration. How can I be sure the condom was 100% effective? The reason I ask the condom did slightly slip due to the lube, the head of my penis was still covered and most my penis was still covered, it was literally not covering the whole penis. Is there any risk based on this for HIV or other STD's?

 2) I had 2 bouts of diarrhoea yesterday, 1 week after this encounter. Could this be related to the episode above? I did eat out twice the day before so I was assuming this could of been due to this, It was not like gastroenteritis, I also noticed a ulcer on my tongue which has seemed to have disappeared now. 

3) Do you have a percentage based on your experience of how many sex workers have HIV and STD's?

4) Can I continue unprotected sex with my ex with 100% confidence of been STD free? I could not live with myself knowing I have placed her at risk. I know you stated in my previous post 'yes of course, but no guarantees' this did worry me.

When I messaged the Escort and asked if she is clear of all STD's, she simply messaged back and stated 'Yes, no worries'. 

Kind regards,

Jason

Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Welcome back to the Forum.  On this occasion I happened to pick up your question and will be providing a reply.  I did review your interaction with dr. Handsfield from last week and agree with all that he has said.  The exposure you describe was very low risk, probably lower risk that had you had sex with someone you met in a pub or other casual location since CSWs are aware of their risks and therefore take appropriate precautions, use condoms expertly, and get themselves checked on a regular basis.  On to your questions:

1.  As long as the tip of the condom covered the head of your penis, it was doing its job in terms of risk for STIs including HIV.  Slippage of the sort you describe should not be a problem.

2.  Your diarrhea is unlikely to be related to the encounter you describe although there is a slight risk that you could have picked up something when you rimmed your partner.  Most diarrhea comes from ingestion of tiny amount of feces such as occurs when you eat contaminated food, drink fecally contaminated water or, perform rimming on an infected partner.  It is far more likely however that what you experienced is unrelated to the encounter you describe.  If the diarrhea persists more than 3-4 days or progresses in terms of severity, I would seek evaluation. FYI, for the reasons above, when diarrhea follows rimming, it is typically not due to classical STI organisms such as gonorrhea or chlamydia but its caused by the same sort of pathogens that cause diarrhea when infected by other routes (such as ingestion)

3.  The data for London suggest that the rate is low- less than 2% and depend in part on the sort of CSW you were involved with  Higher class, more expensive CSWs have far lower HIV rates- less than 1%

4.  I would give the same answer as Dr. Handsfield.  Your risk for having an STI from the exposure you describe is very, very low and should not worry you. 

Hope this helps. EWH
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38 months ago
Thank you Dr Hook for taking the time to answer my questions. 

I believe everything should be ok, however there seems to be so much conflicting on other websites regarding oral sex and the transmission of STD's including HIV.

I really want to enjoy Christmas and leave this episode in the past. 

1) Do you believe testing is not needed with the absence of symptoms?  

2) Typically speaking what symptoms would be alarming?

3) Out of interest, in your experience in this field over the many years. Have you seen somebody contract HIV off a one time exposure? Or does it generally occur after numerous repeated unprotected encounters? I ask from a heterosexual stand point. 

4) Should I forgot about this event and move on with my life? As you put the risk as low enough not to worry? I suppose my anxiety tells me low isn't zero. 

I suppose I am looking for clarification that all is ok and I should forget about contracting anything on this occasion :(

Thank you again Doctor. 

Jason. 







Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Much of the advice we provide here is an effort to correct misstatements and incorrect information taken out of context which can be found on the internet.  One step towards enjoying your holidays would be to stay off the internet.  In answer to your follow-up questions:

1) Do you believe testing is not needed with the absence of symptoms?  
Symptoms are just one indicator of the presence or absence of STIs, including HIV.  Over half of persons who acquire HIV do not develop symptoms of the ARS soon after acquiring the infection.  For this reason we suggest that all sexually active persons with multiple partners or whose partners may have other partners periodically get a sexual health evaluation which would include testing (screening) for STIs, including HIV.  The risk for infection, and particularly HIV from the events you have described are very, very low and would not worry me.  Testing, and when to do it is a personal choice.

2) Typically speaking what symptoms would be alarming?
See above.  As for HV, the ARS which occurs soon after acquisition of HIV includes high fever, sore throat (not just a scratchy throat), severe muscle and/or joint aches, and in some a rash or loose stools, all occurring at about the same time.

3) Out of interest, in your experience in this field over the many years. Have you seen somebody contract HIV off a one time exposure? Or does it generally occur after numerous repeated unprotected encounters? I ask from a heterosexual stand point. 
This is a "what if" question, asked of someone who sees many unusual cases.  So yes, I have seen persons acquire HIV following a single exposure although I have never seen this occur following oral sex.

4) Should I forgot about this event and move on with my life? As you put the risk as low enough not to worry? I suppose my anxiety tells me low isn't zero. 
My sense is that testing might give you peace of mind.  There is no reason not to test if you have not already tested and if that would allow you to put your anxieties aside, that might be a good idea.  If you have tested before, I see no reason for further testing.  If you test, I suggest that you should be tested for other STIs as well as HIV, including throat tests.  EWH
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38 months ago
Thank you Doctor. 

I plan to get tested at the 6 week mark for all STD's and HIV purely for piece of mind.

I am guessing I should expect a negative for eberything based on the advice given? 

I find it hard engaging in anything sexual with my ex partner without knowing i'm 100% clean so I guess testing will be my only way of putting this to rest. 

For now, I don't have any further questions. I just take comfort in yours and Dr Handsfield expert opinion. Hopefully it proves right as I find myself very anxious regarding the whole situation. 

All the best and kind regards. 

Jason.





Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Thanks for your confidence in our advice.  Yes, based on your history, I would anticipate that all of your tests, including HIV will be negative.  I hope that when they are, you will be able to move forward without further concerns.

As you probably know, we typically close our threads after three replies. This is my 3rd reply.  Thus this thread will be closed later today.  Take care.  EWH
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