[Question #6447] Protected risky sex with stripper/prostitute

13 months ago

Hello Dr.,

I went to a big party and my friends hired a stripper/prostitute. I was drunked and I proceeded to have intercourse with her.

This is the first time I have this type of experience and I am feeling a deep deep anxiety. 


She first started dancing(naked) over my flaccid penis and we made light contact between her vagina and my penis (I didn’t check her for any warts or any sort of things). Then, we proceeded to have intercourse with a condom for about 10-15 minutes. She rubbed herself before and after with baby wipes for “hygiene”. She was young female and location is in the northern Mexico zone (not Tijuana though). After that, a went home and clean myself with soap, powder soap for clothes and antibacterial wipes (which burned a little). I also tried to pee after the encounter. I have a partner and I wouldn’t like to infect her in any way posible. I haven’t spotted any signs of warts or sores over me. This happen 2 das ago.


 My primary concerns are:


1) can I acquired HIV, Syphilis, herpes or any other type of STD with this type of encounter?

2)How long should I wait for testing and what tests? If any needed

3) are there any cases were warts, sores (or any type of weird skin condition) don’t appear even if someone is infected?

4)how long should I wait to have sexual encounters with my partner?

5) do I need protection for this encounters?


Since I am very anxious any stat will be very welcome

Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

Welcome to our Forum.  Many visitors to our Forum do so following activities that they have come to regret a few days after an exposure.  I'll do my best to help.  Before I answer your specific questions, let me provide a few generalizations which may help to set the stage.  First, most commercial sex workers do not have HIV or other STIs -its bad for business and they tend to be well aware that their profession may put them at risk.  Therefore they tend to get checked regularly and if anything, are probably less risky than a causal one night partner met in a bar.  Second, even if your partner had HIV or another STI, most single exposures do not result in infection - Gonorrhea and chlamydia are transmitted around once every five exposures and HIV if NOT transmitted following more than 99.9% of exposures to infected, untreated partners.  Finally, you mention HPV.  Please remember that over 80% of sexually active persons have HIV, no matter how few sex partners they have, thus not only are single exposures unlikely to result in infection but most people already have it and have no adverse outcomes because of it.  With that, I'll address your specific questions:

1) can I acquired HIV, Syphilis, herpes or any other type of STD with this type of encounter?

Please see above.  A single exposure can certainly result in infection but it is uncommon.  Nonetheless, getting tested for the most common STIs is reasonable, even in the absence of signs or symptoms- see below.


2)How long should I wait for testing and what tests? If any needed

The most common STIs are gonorrhea, chlamydia and trichomonas.  All can be easily tested for at any time more then 3-4 days after an exposure using a urine test in which the initial portion of urine is collected in a cup and sent to the lab for testing.  The risk for both syphilis and HIV is much lower and it takes longer for these tests to provide reliable results.  Tests for syphilis are reliable 30 days after exposure and while tests for HIV are more than 99% reliable at 30 days, they are not completely reliable until 6 weeks after an exposure.  Please note, we recommend AGAINST any testing for herpes or HPV in the absence of obvious signs or symptoms. 


3) are there any cases were warts, sores (or any type of weird skin condition) don’t appear even if someone is infected?

In fact most HPV infections are not visible but as described above, we urge our clients not to worry too much about HPV/warts.  Most people are already infected and there are no good tests.  As a result, even when a person gets HPV it is virtually impossible to tell where it came from.


4)how long should I wait to have sexual encounters with my partner?

See above.  You will have to make the decision.  At least until you have been tested for gonorrhea, trichomonas and chlamydia. 


5) do I need protection for this encounters?

Again, you have to decide on this.


Finally, let me point out that if you can find this person and arrange for her to be tested at this time, if her tests are negative, you are in the clear.  Again, if this is possible, the most important tests are gonorrhea, chlamydia, trichomonas as well as perhaps syphilis and HIV.

I hope this information is helpful.  EWH


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13 months ago
Thanks for the reply Dr. I have some follow up questions feedback I want to clarify from your answers.

“most single exposures do not result in infection - Gonorrhea and chlamydia are transmitted around once every five exposures and HIV if NOT transmitted following more than 99.9%“ 

1) Do you mean protected or unprotected sex?

Please remember that over 80% of sexually active persons have HIV”
2) I guess you meant HPV, just to confirm.

“Nonetheless, getting tested for the most common STIs is reasonable“
3) reasonable due to my encounter (rubbing then protected sex)? Or just in general, regardless of the protection or type of encounter?

The most common STIs are gonorrhea, chlamydia and trichomonas. All can be easily tested for at any time” 
4) can you tell me the names of the urine tests names? Since there is no doctor near my area due to holidays and bad medical conditions around. And what to look for in those test. I understand if you can’t give any information on this.

5) How can syphillis be transmitted with the use of condoms? Due warts need to have strong friction? If there is no warts but the person is infected?

6) is hard for me to think that you can have Gonorrhea, Chlamydia, Syphilis or trichomonas and not present any symptoms. Why is that some STDs are asymptomatic (I got the HPV and HIV part)? if a don’t present any genital discharge, sores or warts, can I still have any of the above?

7) can I contract any type of std if I had a light rubbing (probably 2 minutes) genital to genital (or almost genital to genital)?


“let me point out that if you can find this person and arrange for her to be tested at this time“
8) due to the “laws” (informal laws, mobs) of their businesses, outsiders can’t ask anything from the sex workers, just sex and condoms. I got some stats from my region: approximately 3,000 got infected from some type of STD in a year. There’s approximately 1 million people in the region and 700,000 people are young people 15-29 years old. Can I pull any meaningful statistic from this? Do I need more or other type of data? What’s the statistic for contracting stds with condom? (Since most doctors and internet places just say “low”, I don’t know how they based the “low” part), regardless of region.

9) is there any medication I can take that can prevent any type of std?

Thanks again for the wonderful information, can’t get it anywhere else!

Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

Straight to the follow-ups:

1. I was referring to unprotected sex.  99.9% of unprotected exposures to untreated, HIV infected persons do not lead to infection.

2.  Again, I apologize.  typing too fast.  I was referring to HPV.  Over 80% of sexually active persons have HPV.  HIV on the other hand is rare in most of the Americas and Europe. 

3.  Reasonable because you were anxious. The encounter you describe was virtually no risk- STIs are not transmitted through genital rubbing and condoms are very effective for preventing STI acquisition during intercourse.

4.  There are a large number of urine tests for STIs, too many to name.  If you get tested, use your last follow-up to let me know which test you have and I can comment if I need to.

5.  Condoms may not cover the entire penis or even slip down.  While as long as a condom covers the tip of the penis is will prevent gonorrhea, chlamydia or trichomonas, there may be contact with a syphilis or HPV lesion on an uncovered surface..

6.   All STIs can occur without symptoms.  Some STIs such as gonorrhea usually cause symptoms but about half of chlamydia and trichomonas in men can occur without symptoms or a discharge.  Syphilis sores are painless and may go unnoticed in some people.

7.  Theoretically genital rubbing can result in transmission of herpes, syphilis and HPV but even for those STIs it is less common than with penetrative sexual contact.

8.  Thanks for the clarification.  It is difficult to be more precise than to say "low".  Low varies from infection to infection and figures are imprecise but it is safe to assume that the chance she had any STI is less than 5% ( 1 in 20).

9.  We recommend against preventative treatment.  Different STIs need different medicines and different amounts of those medicines.  Often taking medicines just confuses things for persons who take them.

Thanks for your thanks.  I hope my additional comments are helpful.  EWH

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13 months ago
Hello dr,
Bear with me in the long post.
 My main concerns are:

•urine test 

I made a test for urine 5 day after exposure. General urine exam and PCR for gonorrea and chlamydia: here’s the image for the results.

•herpes

Symptoms after exposures (9 days after):

Bumps, sort of “pimples” with no puss but looks like fluid but they don’t break. They are also kind of little so I can’t really tell if they is fluid or other type of stuff (or even if they break). I little bit of sore throat. On the other side, I don’t have fever, lymph nodes, flu like symptoms, headaches, I don’t see clearly fluids in the bumps/blisters like things, doesn’t itch unless I scratch it. They don’t hurt if I touch them.

Side note: I suffer from Eczema, so I don’t if this is a mix of light herpes and eczema, just eczema or just herpes. I didn’t really paid attention to the groin area for eczema so I don’t really know if this “things” are normal. And I shaved the day of exposure.

Bump day 9-10 after exposure

https://imageshack.us/i/plpzhxJtj

After it burst (now its kind of gone or skin colored, 2-3 days after the burst) didn’t see any scabbing.

https://imageshack.us/i/pnAWWjSbj

Is this herpes? Is this eczema?

What test should I make for herpes? Or do you think it’s not necessary?

•Syphilis
Do the bumps on the groin (shown in the images) reflect any kind of secondary stage syphillis?
Is it necessary to make a syphillis test?

•hepatitis & HIV
How does hepatitis transfer? Does condom protects hepatitis? What test should I do? If any.

•prostitute
The prostitute told me she didn’t lubricate really well naturally, that’s why she used a lot of lubricant OTC. My concerns are: is not naturally lubricating a sign of STI? Does lubricating products enhance STI more?

•symptoms & anxiety & eczema & pregnancy

Does having anxiety makes you create STI symptoms? I mean if you “think” you have “herpes” you could produce blister like symptoms due to anxiety. Or if you think you have HIV, you start having fever, pain, etc. Symptoms. Is this posible? Common at all?

I suffer from eczema (atopic dermatitis) since I was a child. Does having eczema helps acquiring STI? Since it’s kind of related to the immune system. Or viceversa or doesn’t affect at all? How easily can it be mistaken for another STI condition?

If you compare the chances between acquiring any type of STI or getting pregnant. Which one is bigger? Protected and unprotected? (Just for my curiosity)

•further testing and beyond

I am planning of making more tests for syphillis, HIV and herpes. Which test do you recommend for each? Do you think they are necessary due to my case? Do you think is wise to have protected sex with my partner?


I hope the thread stays open just to display the results for future tests, so you can just comment if necessary on anything.


Thanks again dr!


Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

this will be the final reply as part of this thread. As per Forum Guidelines there will be no further replies.  Straight to your many questions

1. Your 5 day results are all negative. The results for gonorrhea and chlamydia are conclusive.

2.  We do not look at pictures of lesions on this Forum.  The results are typically hard to interpret and misleading.  What you describe really does not sound like HSV but the only way to be sure is with a swab test from a lesion tested with PCR.  Even in this case, positive tests are helpful, negative tests are not.  Blood tests are not useful. 

3.  See answer above.  If the lesion you noted were syphilis, which I doubt, a syphilis test at this time would be positive.

4.  Condoms protect from hepatitis.  I would not worry and would not test.  if you must test, the blood test is the thing to pursue.

5.  A lack of lubrication is not a sign of an STI.

6.  Yes, anxiety often makes persons notice normal sensations and skin changes that they would otherwise overlook.  This would hold for eczema as well- you could mistake you eczema for an STI rash.  Having a trained clinician, preferably a dermatologist may be helpful in sorting this out if the lesion is still present.

7.  IF a partner is infected with an STI like gonorrhea, you are more likely to acquire gonorrhea from unprotected vaginal intercourse than you are to make your partner pregnant. 

8.  I would NOT test for herpes. The tests are frequently confusing and misleading.  Regularly available tests for syphilis and HIV will be reliable,.

This concludes this thread.  Take care. EWH

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