[Question #3876] Question about STD risk from escort.

34 months ago
Hello,

I know you get this kind of questions a lot, but your style of non-biased responses is much appreciated.

3 weeks ago I had unprotected oral (I was the receiver) and protected vaginal intercourse with an agency escort in Montreal. The intercourse was quite vigorous, if that makes any difference. This escort usually works 2-3 days a week and sees about 2-3 clients per day. She's in the $300 per hour range. She looked clean.
She takes her job seriously and apparently gets tested frequently, though I don't know the specifics. So far as I know she does not do drugs.
Now the problem:
I'm in a long term relationship with a lovely lady who I love very much. The incident 3 weeks ago was against my better judgement and under the influence of alcohol, though I of course know that is no excuse.
I have had NO symptoms whatsoever in the 3 weeks since then, and today had fairly brief (maybe a minute or 2) unprotected sex with my partner, thinking enough time had elapsed. Obviously, I seem to be having trouble doing the right thing these days in this department. I need to be a better person. (the old expression of there only being enough blood for the brain or the penis but not both comes to mind, but it's no laughing matter in my current context) 

Having read a lot of your responses both here and back on medhelp, it seems I may have dodged a bullet. Many other sites on the internet are more extreme in terms of STD risks.

One of the difficulties is that my current sitatuation makes it very very difficult to get STD testing done right now. I'd have to wait a few more weeks, most likely.

In the absence of any symptoms, can I fairly safely assume I'm in the clear in terms of having caught and passed on an STD? Again, I know this is a generalized question and the kind you see a lot. 

Many thanks!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

Your objective judgement, i.e. understanding that the chance you have any STD is low, is accurate. As you may have seen from our other comments on this forum, in general it is believed that escorts (expensive female sex workers by appointment, as opposed to brothel workers, bar pick-ups etc) are at low risk for STDs:  as you suggest for your partner, they know the risks, take steps to protect themselves (especially in their choice of clients, such as mostly monogamous men -- guys like you, in fact), and get tested frequently.

In addition, oral sex is safe sex. Even unprotected, the overall risk of any STD is low, much lower than unprotected vaginal or anal sex. In other words, condom protected vaginal plus unprotected oral amounts to an a low risk of infection, even if your partner had a transmissible STD. Which, as just discussed, she probably did not. Finally, 3 weeks without symptoms is additional supportive evidence you didn't catch anything.

I'm not sure why you would need to wait several weeks for STD testing, but even if that isn't possible at the moment, I really don't see any serious risk here. If somehow I were in your circumstances, I would continue unprotected sex with my wife without worry that I might infect her with any STD. In fact, I probably wouldn't be tested at all, even if expert clinical care were readily available.

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

HHH, MD
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34 months ago
Thank you very much for your in-depth response.

Just a bit of clarification about my context - I'm currently on work assignment in a place that doesn't have std testing readily available. I will be returning to a bigger city with such services in a few weeks.

I suppose my main concern is gonorrhea that's asymptomatic... and chlamydia. From the research I've done it seems gonorrhea is fairly frequently present without symptoms (I've seen some places suggest it could be up to 50% of the time). In your estimation, how likely is this?

thanks!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Well, you've come to the right place. I was the lead investigator on the single most important description and scientific analysis of asymptomatic gonorrhea in men. Like me, it's getting old, published in 1974, but it remains the most cited research paper on the subject (https://www.ncbi.nlm.nih.gov/pubmed/4202519).

Asymptomatic urethral gonorrhea actually is rare -- in fact much rarer today than when we studied it 45 years ago. Well under 1% of urethral infections are asymptomatic these days. (Particular strains of gonorrhea bacteria are especially prone to cause asymptomatic infection, and those strains are far less common than they were then. In fact much of my national reputation, which is partly based on this research, comes from the random happenstance of the frequency of those strains just as my research career was getting started.) Chlamydia is far more likely to be asymptomatic in men -- that's where estimates are up to 50%. However, chlamydia is rarely if ever acquired by oral sex; and your vaginal exposure was condom protected. So based on your exposure plus lack of symptoms, it is very unlikely you have either of these STDs.
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34 months ago
Thanks again for your response. It certainly helps set the mind at ease, in that regard at least.

One last question if I may. What's your opinion regarding the recent emergence of the "incurable" gonorrhea? Do you see it as becoming a major problem and do you think it's a fairly significant problem right at the moment?

Many thanks! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
I was interviewed by an online magazine about antibiotic resistant gonorrhea. Here is the URL:  https://melmagazine.com/how-super-gonorrhea-became-super-756f3d819939 

Relatively antibiotic resistant strains of gonorrhea remain rare and still are mostly limited to parts of Asia, with rare cases imported to North America and Europe. Even these are treatable --  more expensive and inconvenient than normal treatment, but so far here has never been a case of incurable gonorrhea anywhere in the world. It could happen, but so far such strains have not emerged.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe!
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