[Question #6532] PEP after paid sex?
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67 months ago
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She was no street walker, but this was not a "high class" situation either. It was a "hostess bar".
I am wondering why she offered it so casually, actually seemed to want it. That never happened before in my limited experience with sex workers.
My real question is whether going on PEP is warranted.
I looked at some of your previous responses online and they seemed to lean against it for a one time vaginal sex encounter. But I wonder if her volunteering unprotected sex (I didn't, and wouldn't have asked for it normally) would change the calculus on that.
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Edward W. Hook M.D.
67 months ago
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Welcome to the Forum and thanks for your question. FYI, while we typically respond to questions in less than 12-18 hours, I happened to be on the site when your question arrived and, as a result, you are getting a question somewhat more quickly than is typical. Follow-up replies may take longer.
Thanks as well for looking at our replies to similar situations. I think the way you are thinking about things is accurate. Ultimately, you will need to make the decision regarding PEP in this situation but you are correct, we tend to lean against it following a single exposure to a commercial sex worker in North America or Western Europe. The reasons for this are as follows- here in North America HIV is rare in CSWs, occurring in less of 1% unless they are on the street looking for drug money. Typically CSWs are careful about all STIs, including HIV and get checked regularly. In addition even if she had HIV and was untreated (effective treatment makes the infection untransmittable) your risk for infection from a single exposure is less than 1 infection in 1000 exposures (i.e. there is a 99.9% chance you would not be infected). With these sorts of odds, your risk for infection is very, very low. PEP is expensive and some people have side effects (mostly gastrointestinal in nature) and test results will not be reliable until about 10 weeks (i.e. the 4 weeks PEP is taken plus the 6 weeks it takes for tests to be conclusive), prolonging your period of uncertainty. These are the data, I'm afraid you need to make the choice. Personally, were I in your situation, I probably would not take PEP although I might seek the woman out and ask when her last test was and what the results are. If you choose to pursue PEP, the sooner you start it the better and most experts feel that there is no meaningful benefit after 72 house following exposure.
I should add that following an exposure of this sort, your risk for chlamydia or gonorrhea in particular is far higher than your risk for HIV. I would suggest you have a urine test for these all too common STIs 3-5 days after the event.
I hope this information is helpful. EWH
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67 months ago
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