[Question #6755] Repeated a mistake - unprotected vaginal sex

12 months ago
Hi Drs,

I'm late 20s Indian origin male. I'm uncircumcised. I repeated a mistake without my knowledge. I just met a CSW in sanjose, says she's 39. She's white ( most likely ), agency chargers 300$.

I shaved my genitals an hour before meeting her and do have some minor cuts.  We had unprotected oral sex and used a condom for protected intercourse. The problem here is the condom slipped off soon. Long story short since she's out of condoms we proceeded to have sex, twice! I ejaculated outside both the times. She doesn't seem to be worried about anything, I'm a stranger she had sex unprotected. Assuming she's a high risk encounter, please let me know the following keeping in mind I'm uncircumcised and had cuts from shaving genital areas

1) My chances of acquiring STDs in this high risk encounter 

2) risk of HIV!

3) PEP suggestions

I'm also yet to get my self tested from previous activity. I was afraid and also eased my self into believing I'm fine after your risk assessment and me having no symptoms.
Edward W. Hook M.D.
Edward W. Hook M.D.
12 months ago
Welcome to the forum and thanks for your questions.  I’ll be glad to comment.  Although STIs and even HIV are somewhat more common among CSWs, most do not have infection and this is particularly the case for higher priced CSWs (bad for repeat business).  Nonetheless, I agree that she was OK with unprotected sex is a bit concerning.  Further, most single exposure do not lead to infection (the rate varies according to the STI - for unprotected vaginal intercourse with a female partner with Gonorrhea or Chlamydia infections occur about 20% of the time per exposure while for HIV  the rate is less than 1 infection per exposure).  That you shaved shortly before your exposure does not change your risk meaningfully, even if there were nicks or abrasions.  In response to your specific questions:

1.  The STIs which are most common in this situation are Gonorrhea, Chlamydia, nongonococcal urethritis, and trichomonas.  Your risk of having acquired any of them is low but not zero and the best way to be sure is to be tested.  Symptoms are usually present within 5-7 days but not everyone gets symptoms so the best way to be completely sure you are not infected is to have a urine test for Gonorrhea, Chlamydia, and trich  at least 3-5 days following the exposure.  NGU is typically symptomatic and if your tests are negative for the other STIs, I would not worry.  Similarly I would not be worried about Syphilis unless a lesion appears.

2.  The risk for HIV is many times lower than for other STIs.  Testing for HIV using currently available 4th generation blood tests is more than 99% accurate at 4 weeks and absolutely conclusive at 6 weeks.

3.  PEP is a personal decision.  If you choose PEP be aware it is often expensive but is well tolerated and is a one month commitment which will make your tests for HIV unreliable until 4-6 weeks after completion of the medication.  I would estimate your likelihood of having acquired HIV as being less than 1 in 1000 and probably far lower than that.

I hope this information is helpful.  EWH
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12 months ago
Thanks Doc. Do you suggest I wait till symptoms appear to get myself tested? 2) Out of general curiosity, if HIV is not so commonly transmitted even thru unsafe practices, how do we have some many HIV cases? Is it not sexual mostly?
Edward W. Hook M.D.
Edward W. Hook M.D.
12 months ago
Thanks for your follow-up questions. My recommendation would be to go on and get testing irrespective of whether you develop symptoms or not. Many of the STI’s I mentioned can be present without symptoms.

You are correct that there are lots of cases of HIV, however HIV is far less common than other STI’s.  Further, there are millions and millions of persons worldwide and lots of people having sex. This translates to all too many cases of HIV.

EWH
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