[Question #3724] Unprotected oral and other risks

34 months ago
Thank you for your help. Can you assess the risk of my recent experiences with escorts and the risk of being a regular user of escort services.  I've been seeing escorts for 4 years ago, and I've had protected oral sex and protected vaginal sex with about 30 ladies in that time.   I've always made sure that the condom has covered my penis during sex and I haven't experienced a broken condom.  Also, I'm careful not to grind (or rub) my genital area on an escort's genital area: Will this minimize the risk of STIs that are transferred from skin-on-skin contact?  Further, does risk accumulate over time?  If I pursue this lifestyle, would you expect that one day I would contract an STI?  Recently I've had two experiences that left me questioning risk: (1) I visited a pre-op transsexual for the first and only time. I performed oral on his condom-covered penis. My mouth/lips didn't touch any part of his uncovered genital area and he didn't cum. No other sexual activity occurred. The encountered ended after no more than 10 minutes when I realized that some fantasies are best left unexplored. (2) I visited a high-priced private escort: an Australian lady of European descent. She gave me a sensual massage and rubbed her genital area on me fairly vigorously: Should I be worried about that? Then with a condom in hand, she performed oral sex on me but didn't use the condom.  I didn't object immediately because I wasn't sure what to do or say.  But when she tried to perform oral sex on me again, I did stop her.  So, I had about 2 minutes of unprotected oral sex. When I questioned her about it, she said that she didn't have any STIs and I shouldn't worry.  We proceeded to have protected vaginal sex; it only lasted about 5 minutes. Should I worry about unprotected oral sex and protected vaginal sex? I have a wife, so I'm nervous about contracting and then passing on an STI.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Welcome to the forum. Thanks for your question.

The expert consensus is that escorts (expensive female sex workers by appointment, as opposed to brothel workers, bar pick-ups, etc) are at low risk for HIV and STDs. I'm unaware of formal research, but the consensus is that most escorts care about their health; know how to protect themselves; generally use condoms for vaginal or anal sex; have mostly low risk clients (men like you); and get tested frequently. In addition, it sounds like you consistently have safe sex. Condoms usually aren't recommended for oral sex -- much more important for vaginal or anal, so you've been even safer than most men might be in these situations.

As for the two exposure events described, neither involved unprotected vaginal or anal penetration, hence they were low risk for all STDs.

Having said all that, with this sexual lifestyle, your STD/HIV risk is low but not zero, and I would recommend regular (but infrequent) testing to be maximally safe -- largely as protection against the possibility of unrecognized condom failure and/or risk from oral sex. Specifically, consider yearly testing, with a urine test for gonorrhea and chlamydia and blood tests for HIV and syphilis. You can definitely expect negative results, but of course better safe than sorry.

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

HHH, MD

---
34 months ago
Thanks for the reply. Having read many questions and answers on this forum, your reply is as I expected. I do get tested once a year and so far, no problems.  And yes, I always use condoms during all forms of sex (except with my wife).  But I am wondering whether the vigorous rubbing of genital areas - either during a sensual massage or sex - makes any tangible difference to the likelihood of contracting herpes or warts (or some other transferrable STI)? How easily are these STIs transferrable in the absence of obvious symptoms (e.g. sores) and when using condoms?   Further, I am still wondering about accumulated risk. If I saw one escort per fortnight for the next ten-fifteen years, do you think I would still have a low risk of contracting any STI?  Note that I live in New Zealand, and the Government health authorities are very active in monitoring STI rates.  The statistics I've seen indicate that escorts have very low rates of STIs (somewhere between 1/100 and 1/1000). However, I have seen a number of escorts from Brazil, China, Korea and Thailand that have been touring New Zealand. Your advice and comments are much appreciated.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
For the STDs transmitted primarily by skin to skin contact (syphilis, herpes, HPV), it is logical that more prolonged or vigorous exposure could increase the risk in absence of penetration. However, "vigorous" genital apposition obviously is a very common sexual practice, and yet I and most experts -- indeed, entire STD or GUM clinics -- rarely if ever see patients with those infections who have not had penetrating sex. So I would still consider that a low risk event.

You're absolutely right about cumulative risk. If the risk is say 1 chance in 1000 per exposure, then the cumulative chance of infection would be 10% after 100 exposures. If you think about it, this is why periodic testing is recommended (e.g. once a year) rather than running off to a clinic or lab after each exposure. With yearly exposure, you're probably being tested after far fewer than 100 exposures.

If you're speaking about repeated sex with a particular escort over 10-15 years, remember a) that the chance any particular escort is infected at any one time still is low, and b) all STIs are transient; even for the lifelong ones (HSV2, sometimes HPV), they are transmissible only intermittently and (usually) briefly. So the cumulative risk just discussed probably would be less than estimated above.

You're obviously intelligent and thoughtful. Accordingly, I'm sure I don't need to say the following, but perhaps it doesn't hurt:  you have chosen a sexual lifestyle that cannot be pursued without at least modest STI risk, with rising risk the longer it continues. This doesn't mean that after, say, 10 years it is 10 times more likely one of your tests will return with a positive result. Each year probably is no more risky than the previous one. In any case, you are going about this lifestyle with excellent attitude and apparent adherence to principles of safe sex. As long as that continues, your risk will remain low. But not zero. There is no free lunch!

---