[Question #3046] Risk analysis

41 months ago
For the longest time, I've wanted to have sex with a woman at a legal brothel in Nevada.  Before I do something that may throw my mind into a frenzy of STI fears, will you please provide a realistic and perhaps conservative estimate of how likely it is for the following to happen.  If I were to have sex with maybe 2 legal prostitutes on 2 consecutive days in Nevada:

1) I will contract genital herpes despite condom use.
2) I will contract HPV despite condom use.
3)I will contract some other STI despite condom use.

My understanding is that condom use is mandatory at these facilities, and the ladies are tested for STIs regularly.  However, I have read that they are NOT tested for genital herpes, except for a visual inspection.  I have also read that they are tested for it.  I am not sure which is true.  Please for the purpose of the question, assume that the women are not tested for herpes except for a visual check, even though the opposite may be true.
Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
Welcome to the Forum.  I'll do my best to help.  You are correct that the CSWs ho working Nevada's brothels are expected to use condoms for all exposures and get checked regularly for STIs.  As such, sex with these women is probably lower risk than having sex with a  casual partner who you might encounter in a bar since such persons probably are not checked nearly as often as the professional CSWs.  With this as background let's try to address your questions:

1) I will contract genital herpes despite condom use.
The likelihood that your partners had herpes is likely similar to that of the general population.  Most exposures to lesion-free expected persons do not lead to infection.  While there are not scientific data to support this, estimates are that the risk for infection with UNPROTECTED sex with an asymptomatic HSV-infected partner is less than 1 infection per 10,000 exposures.  Condoms reduce this risk still further, by more than 50%.

2) I will contract HPV despite condom use.
Similarly, nearly all (over 80%) of sexually active persons who have not had the HPV vaccine will have HPV.  As for herpes, it appears that even most unprotected exposures do not lead to infection.  Condoms reduce the risk for infection by over 50%.

3)I will contract some other STI despite condom use
The risk is insignificant and should not be a concern.

In summary, if your only recent exposure have been with licensed CSWs in Nevada brothels, I would not worry and see no need for STI testing of any sort.  I hope this perspective is helpful to you. EWH
---