I have been seeing one CSW who is a canadian in Canada and independent. I have seen her a couple of times and usually I recieve an unprotected oral and a protected intercourse. Last time I saw her was two months back and I have had never got any kind of symptoms of anything. She is always very clean and has no apparent lesions or sores anywhere. I have asked her in the first time about her sexual health and she told me she does test regularly and never have contacted anything. I just met her again which is the reason of this thread, this time I performed cunnilingus on her for quite a long time, around 10-15 minutes easily, I mostly stuck to stimulating the clit, I dont know if there were fluids or anything that I might have swallowed from her but there was lots of swallowing of all the saliva and whatever might have been present. The rest of the encounter is like the others, unprotected oral on me and protected intercourse. 

Should I be worried of any STDs due to the new activity, I know before all I did is as safe as it gets, I just need to know whether cunnilingus with all the knowledge I shared would make a difference in the risk and whether on technical ground I should test or not because I dont really feel comfy to do so. I usually test annually, part of normal routine so I feel anxious to do anymore. 

Thank you doctor for your time and support.

Cheers, 

Dani

The bottom line is that this sounds like a very safe situation, with low risk for any STD. Two main reasons. First, escorts (expensive female sex workers by appointment, as opposed to brothel workers etc) are generally believed to be at pretty low risk for STDs:  they often know the score, care about their health, use protection (or stop doing so only after several appointments with men they consider low risk), and get tested frequently. In addition, their partners often are primarily monogamous men or others at inherently at low risk (men like you).

Second, you describe very safe sexual practices. Cunnilingus is a very safe activity, with infrequent STD transmission in either direction, i.e. safe for both the giver and receiver. Rarely the oral partner can acquire gonorrhea, and there's a potential of oral herpes if the female partner has genital HSV. Syphilis is theoretically possible, but it's so rare in partners like yours that it's not a serious consideration. HIV has never been shown to be transmitted by cunnilingus, in either direction. HPV is possible, but most oral HPV infections never cause symptoms and are cleared by the immune system. Chlamydia could theoretically be a risk, but is rarely acquired by oral sex of any kind, and has never been documented to be transmitted by cunnilingus. The details of the practice -- how long, primarily clitoral contact vs other areas of the genitals, probably makes little difference.

So considering all the above, you are at very low risk for any STD. All that said, the risks are not zero. Should you be tested? On one hand, the risk is sufficiently low that it's optional. OTOH, standard advice is that all people who are sexually active outside committed, mutually monogamous relationships should be tested from time to time, like once a year. If you decide to get tested, if your exposure practices don't change (e.g. no vaginal or anal sex), the only necessary testing would be a throat swab for gonorrhea and blood tests for HIV and syphilis. But not now -- only after a substantial number of such exposures. If you do it, you can expect negative test results.

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

HHH, MD

That concludes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful.