[Question #5963] lifestyle risk

19 months ago
Good morning, 

For the last year I've been seeing  escorts twice a month. Sex is always protected, oral sex is with a condom about 50% of the time. From the resources I've read,  my risk of Hiv and other Stds is quite low, but not 0. However, I also see this kind of activey listed as high risk. So I was wonder if taking PrEP is something that you would recomend for someone with my lifestyle?

Also how accurate are rapid RNA HIV test? One week after an exspourse I had a high fever with no other symptoms. That raised a red flag for me. I had a Rapid RNA HIV test from stdcheck.com at 13 days. The result was negative and I was wonder should a get retest with a 4th Gen. test now that it has been 2 months past exspoure?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome to the forum. Thanks for your confidence in our services.

Almost all public health departments, CDC, and other expert organizations have a conservative perspective on risk for HIV and other STDs. In general, their legal departments advise erring on the side of caution. Also, they do not have the luxury of distinguishing between various kinds of sex work, which could get into political correctness issues (race and other issues interpretable as prejudicial).l On this forum, howeer, we are entirely free to rely exclusively on scientific evidence and our own professional expertise and judgement. And the facts are that most escorts (expensive female sex workers by appointment) are pretty safe:  for the most part, they know the score, take dcare to protect themseives, and get tested frequently. And for the most part, their clients are at low risk -- men like you! Of course there are exceptions, but in general such sex workers are believed to be a lot less likely than others (e.g., brothel workers, bar pick-ups, etc) to have active transmissible STDs.

And even if your escort partners were at high risk, with consistent condom use for vaginal sex (or anal), the chance of HIV is exceedingly low. Oral sex is vritually zero risk, even unprotected:  there has never been a scientifically proved case of HIV transmission oral to penis. The risks of some other STDs are somewhat higher, such as gonorrhea, herpes due to HSV1, and nongonococcal urethritis, but still very low,

Anotherr generalization is that PrEP is rarely recommended or used in situations like yours. Even with higher risk partners, in the US and most other industrialized countries, heterosexual HIV rates are too low to warrant PrEP for the large majority of sexually active persons. That said, there are some situations in which PrEP would still make sense -- e.g. if you or your escort partners are ethnic minorities and in certain inner city environments.

 A brief fever, with no other symptoms, is not likely due to HIV. I certainly understand why it raised your eyebrows, however! The negative RNA test at 13 days is around 90% conclusive; to be maximally safe, I recommend an antigen-antibody (AgAb, 4th generation) blood test at 4 weeks. You definitely can expect a negative result, which at 2 months will be conclusive.

Am I ruling out PrEP? No. One thing we're learning is that taking anti-HIV drugs is very safe, with few side effects -- and if it makes you more comfortable in pursuing your current sexual lifestyle, it could be considered. But not on my say-so:  find a doctor (e.g. an infectious diseases specialist), preferably one who understands the details of HIV epidemiology in your immediate environment, including risk in sex workers, then follow her or his advice. Most likely s/he will also advise you against PLrEP, but such decisions are best worked out with a local expert.

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

HHH, MD
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19 months ago
One quick follow up question. I'm not in commited relationship at the moment(just coming out of a messy divorce). But if I am the future would having unprotected sex with one person and maintaining this lifestyle be resonably safe?

Thank you for help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Yes, of course. Except for celibacy, that's the central principle of sexual safety, with the greatest assurance of low risk for HIV and other STDs. Of course actual risk depends on each partner's past sexual lifestyle and partnerships; if any doubt, it is reasonable for both persons in the relationship to have basic STD/HIV testing before having unprotected sex. ---