[Question #5896] Unprotected sex with escort

18 months ago
Hi,

I am a male and have been with quite a few female escorts over the years (in the US only) and I have had two times where a condom broke and was having unprotected sex for a short period of time, and very recently where I had unprotected sex until I had an orgasm with an escort. I've also had maybe a few experiences of not using a condom while receiving oral sex, and maybe a couple of times giving oral sex to an escort. I feel nervous now that I had unprotected sex without a condom. I know that I can have exposure to STI's that way, but I am wondering if it warrants testing for HIV and all STI's and how long should I wait to be tested.

Thanks. KEB
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome to the forum. Thanks for your question.

It can be answered in two ways. Assuming your history is accurate, and assuming no undetected condom failures, almost certainly you haven't acquired any STD, except maybe HPV (more about which below). Condoms are effective and oral sex is pretty safe, and with absence of symptoms also making an undiagnosed STD unlikely. Also, escorts -- i.e. expensive female sex workers by appointment, as opposed to brothel workers, bar pickups and the like -- are generally believed to have low STD risk and frequency. They tend to know the score, know how to protect themselves, have relatively low risk clients (men like you), and get tested frequently. On all these grounds, HIV/STD testing is likely to be negative.

The second perspective is basic common sense:  All experts recommend that all persons sexually active outside mutually committed relationships be tested for the major STDs from time to time. As sort of implied above, condoms sometimes fail without being noticed; STDs sometimes occur despite successful condom use (perhaps from partners' genital fluids getting into the condom above the rim, but not from microscopic leaks); oral sex is low risk but not zero risk; and not all STD infections cause symptoms, so being asymptomatic is not a guarantee against infection. Therefore, it would be reasonable for you to have blood tests for HIV and syphilis and a urine test for gonorrhea and chlamydia; and plan on repeating these every year or two as long as your current sexual lifestyle continues. When to be tested? Given your cumulative risk, you could do it at any time. But if you want 100% secruity about your most recent exposure, gon/chl urine testins can be done after 4-5 days and syphilis and HIV blood tests afer 6 weeks.

Human papillomavirus (HPV) is somewhat different. It is extremely common:  90% of all humans get it at least once, often several times, and at any point in time, roughly 50% of all sexually active persons have detectable genital infetions at any point in time, and this frequency is not much different in people with few or many past sex partners. Further, condoms are not very effective in preventing HPV. You can assume most of your escort partners have HPV and that you have been infected and now carry one or more HPV strains. Fortunately, the large majority of infections cause no symptoms or complications, and most are cleared over time by the immune system. So nothing to worry about, and no need for testing (and there are no approved tests for HPV in men anyway). I just thought you should know. 

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

HHH, MD
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