[Question #7025] Protected w/Csw

8 months ago
Hi doctors,
Please excuse my english and I’ll try to make the long story shorter.

I’m a medical student, and a really anxious person.

I have had only 6 encounters throughout my hole life all with escorts.

I mostly have sex in Amsterdam as I go there for vacation. I also take with me a rapid test or oraquick to test escorts before having sex(most of them would reject the test and if they did I will try to find one who'll accept eventually) 
I do this just to decrease my anxiety although it may not be accurate.
After each exposure I take an STD panel test after aprox 3-4 months.

But today.. I had sex for the first time in my country.
Prostitution is illegal here and most prostitutes are illegal immigrants that doesn't have any access to medical care.
Thats my main cause of not having sex here.

Anyway, please do not judge me as having a girlfriend is also illegal here and I’m way too young to get married

The exposure was only 5-6 minutes and it was protected. Used alot of lube and she removed the condom with tissue once we were done.

The escort had a scar near the labios menores that looks like syphilis but its fully healed.
I only inserted half of my penis into her to minimise contact with the scar (ik im stupid).
Just went to a friend who I asked for a favour and gave me doxycycline supply for 1 month without asking for the cause.

I’m planning in taking doxy for a month just to stop syphilis if the infection did occur

1) am I at risk of HIV? Or any other std as I did not test her nor she tests her self

2) should I continue using doxy? 

3) any advise? 
Appreciate your work 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
8 months ago
Welcome. Thanks for your confidence in our services. No user of this forum ever need be worried about being judged for their sexual lifestyle or decisions, as long as there's no evidence of coercion or harm to another person.

Based on your general situation and the sort of country you describe, it seems likely you have had distorted education about HIV, STDs, and their risks, and probably about the "dangers" of sex outside marriage. Eventually, your medical training should help you understand the truth about these issues.

Presumably Amsterdam events also were condom protected, right? If so, it is exceedingly unlikely you have HIV, and probably you haven't even been exposed. My understanding is that registered female sex workers in Amsterdam are regularly tested for HIV. (I don't blame most of them from refusing your offer to test them for HIV before having sex; that seems highly unrespectful -- if I put myself in their situation, I also would refuse.) Contrary to local assumptions, ex-pat sex workers in middle East countries have low HIV rates -- I'm of coutrse not familiar with all countries and situations, however. But you used a condom there too. And when a woman has HIV, even without a condom, the average risk of transmission to a male partner is once for every 2,500 exposures.  As for other STDs, the risks also were very low. 

To your specific questions:

1) You are not at risk for HIV. But if you want complete assurance about it, find a way to have an HIV blood test (not a rapid oral fluids test) 6 weeks after the last exposure. If you do so, it will be negative.

2) I strongly recommend against taking doxycycline in this situation. And certainly not for a month! That makes no medical or scientific sense.

3) Other advice? As implied above, do some research on STD/HIV, if your formal medical edutaiton doesn't cover these issues in an objective manner. As you read the literature, do your best to disregard and move beyond the moralistic or religious education about sex, STDs and HIV that you may have had. This approach also will be necessary in providing high quality care to your future patients. (Think how you will advise patients who have concerns similar to your own.)

I hope these comments are helpful. Let me know if anything isn't clear. Best wishes for your medical education and for a rewarding career as a physician.

HHH, MD
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8 months ago
Thank you Dr. 

I’m a second year medical student and sexual issues are considered as a taboo over here and in our lectures we only take the basics(Till this time).. our info is also outdated unfortunately.

I was thinking about taking doxy for 14 days not a month. I took the 1 month prescription as I may have to use it for 28 days as some journals suggest for advanced syphilis( just in case). I’m pretty sure she had a healed syphilis chancre scar and this worries me.

Regarding  HIV, I think most of them get some sort of STD since she didn’t provide the condom. I brought it by myself.

Access to STD testing is available here but pep is only given to special cases.

Do you suggest me taking pep? 

My next test will be in 3 months and includes all STD’s 

Should I worry about the tests? Or should I get a pcr in 2 weeks just for the peace of mind?


( yes all amsterdam exposures were protected and the condom was brought by the escort, I tested after each exposure)

Thanks

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
8 months ago
Do not take doxycycline at all. There is no point and no need. Your risk is too low. You do not yet have the training or experience to rely on the possibility the sex worker had syphilis based on what you saw. And it isn't necessarily true that most sex workers get STDs. At any point in time, most sex workers do not have active STDs or HIV. I definitely also do not recommend PEP. I don't even think you need STD/HIV testing, unless you'll otherwise continue to worry and want to be tested for reassurance by the negative results. You really have a distorted view of STD risks!---
8 months ago
Thanks again doc..
Doctors like you influence me to be a better future physician and work harder 

Should I expect negative results after 3 months? 

I’m also considering the PCR test as I can have it in a private lab and the samples would be sent to Manchester.( it’s a trusted lab )
Last point, i forgot to mention that my sperm was not at the base of the condom when I pulled out, it was at the lower shaft. I don’t think it was broken but why did this happen? Is it due to the size or was there a leak so some came out and the other went to the lower shaft? 

Much respect to you Dr and I wish a happy day  


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
8 months ago
You don't need to wait 3 months. If you want to assure no urethral infection, you can have a urine test for gonorrhea and chlamyida any time 4-5 days or more after the last exposure. For syphilis and HIV blood tests, 6 weeks is conclusive.

Condoms never cover the base of the penis; they are not designed or intended to prevent all skin to skin contact.

That completes the two follow-up exchanges included with each question and so concludes this thread. Thank you for the kind comments. Best wishes for a successful future, both personally and professionally.
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