[Question #7210] Stds from protected encounters.

59 months ago

Im a 46 yo straight male. From the ages of about 25 to 38 i used the services of probably over 75 CSWs in multiple countries. I always used condoms. I did std testing during this period , like every 6 months. My only ever diagnosis was gonnorhea which i caught from unprotected oral sex. Also during that period I had 3 mutually monogamous relationships where unprotected sex was the norm. Those 3 partners were checked for stds and were clean. I subsequently married 8 years ago and was in a mutually monogamous marriage until 2 weeks back. I succumbed to temptation whilst in Austria. Over a 3 week period i visited about 5 high class fkk clubs ( brothels) and had protected oral and protected vaginal sex with about 12 -15 CSWs, mostly eastern european ladies. There was some French kissing involved too. Prostitution is highly regulated in Austria and all CSWs are required to obtain a health card form the authorities which they must show to access the clubs. In order to get the card the girls need to register and submit for std tests which include a pap smear every 6 weeks and a blood test every 3 months (checks for HIV, hep B, hepC - but not sure what else). If a CSWs std test stamps are out of date they cannot work. I had researched all this before visiting the clubs and reconfirmed at the clubs themselves. So i thought i was being super safe.:

1. I dont know the full list of infections the CSWs are being tested for in Austria but it appears that HSV2 testing is not routine generally? So based on my recent exposures what are the chances that i could have caught HSV2?

Based on my sexual history what are the chances I already have asymptomatic HSV 2 anyway. (I have oral hsv1 and also got shingles twice)
Why have my doctors never tested me for HSV2 / HPV over the years?
What are my chances for Syphilis & HPV?
Any other stds i need to be concerned about?
Do you recommend testing / disclosure before i have sex with my wife again?

Thanks

59 months ago

I should add that none of my long term partners / wife ever got tested for HSV2 or HPV either to my knowledge, we only ever did the standard ones doctors prescribe like HIV, hep B, VDRL, chlamidya and gonnorhea.

Edward W. Hook M.D.

59 months ago

Welcome to our Forum and thanks for your questions. Thanks as well for your commitment to safe, condom-protected sex. Condoms remain the most broadly effective and reliable means of preventing acquisition of STIs. They are not perfect, they break about 1% of the time they are used, sometimes persons do not use them for the entirely of penetrative sex and quite rarely lesion infections like HSV occur in parts of the genital not covered by the condoms. From the sounds of things, your condom use has served you well. Let me address your specific questions:

Herpes infections, both genital HSV-2 and oral and genital HSV-1 are not uncommonly asymptomatic and persons are unaware that they are infected. Persons with oral HSV-1 (cold sores) are at somewhat reduced risk for HSV-2. There are many pitfalls to blood tests for HSV (false positives, false negatives) and I would not recommend testing for HSV at this time.

2. Based on my sexual history what are the chances I already have asymptomatic HSV 2 anyway. (I have oral hsv1 and also got shingles twice)

See my comments above. Your HSV-1 reduces your risk for HSV-2 as does your condom use but persons with more partners are more likely to have acquired the infection, whether or not they know it. As I said above, I see little benefit at this time to testing for HSV-2.

3. Why have my doctors never tested me for HSV2 / HPV over the years?

Our Forum has many questions regarding HPV. I recommend that you read some of our other comments in HPV. In brief however, There are no recommended tests for HPV in men. Given your history it is more likely than not that you have acquired HPV in the past. In fact, most adults, even those with only a single partner acquire HPV at some time. At present for you, you and your regular partner may or may not have HPV. The important thing is that she be tested at recommended intervals with PAP smears for HPV-related problems. For you there is little benefit to testing. Rather, should you develop unexplained penile lesions, you may want to have a dermatologist take a look.

As for HSV, routine blood testing for HSV is not currently recommended either, in large part for the reasons mentioned above.

4. What are my chances for Syphilis & HPV?

See my comments about HPV above. Syphilis is a relatively uncommon infection. If you have not had a blood test for syphilis, a single test would be reasonable but your risk for syphilis is low, and particularly low from the recent encounters you describe.

5. Any other stds i need to be concerned about?

6. Do you recommend testing / disclosure before i have sex with my wife again?

You are clearly concerned. To be honest, I probably would not be worried but testing is easy and reliable. My sense is that negative tests might be reassuring to you .

I hope that these comments are helpful. EWH

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59 months ago

Thanks Doctor, that was reassuring.

1. If you don't recommend HSV2 testing id rather not do it. I mean, If i took a HSV2 test now and it comes back positive, i will never know when/where i caught it or if its a false positive right? At which point would you recommend a HSV2 test,..only if lesions appear?

2. I was tested for Syphilis just before i got married, so if i have it, it could only be from the recent exposures. With this additional info do you recommend against testing for syphilis too? (Also - This might be one of the tests done by the authorities for CSWs in Austria but im not sure. Ill have to brush up on my German to check online!)

Thanks

Edward W. Hook M.D.

59 months ago

Thank you. I’m glad that my responses were helpful. In response to your follow-up questions:

1. You are correct, I do not recommend HSV blood testing in your situation. As you point out if the test were positive you would not know when you had acquired the infection. Furthermore if you have been a ongoing relationship this long and have not transmitted herpes, it becomes steadily more unlikely that you will in the future. Sometimes in situations such as this it is simply best not to test. Should you develop unexplained genital lesions, testing would be appropriate. At that time the preferred test would be a PCR swab test taken from the sore, even if the lesion was not an open sore.

2. Given the additional information, I also find it most unlikely that you acquired Syphilis. In most settings where commercial sex work is legal, part of the required routine testing his blood tests for Syphilis. Further, Syphilis remains a relatively uncommon STI and when it occurs occurs at the present time, most infections occur amongst men who have sex with men, not CSWs. I think you have a little to game with Syphilis blood testing. EWH

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59 months ago

Noted and noted.

Final questions then

1. Is there any available data on the per episode transmission risk of syphilis when a condom is used?

2. Regarding the french kissing, is there a possibility of acquiring oral gonorrhea or oral clamydia from french kissing? ( The CSWs normally perform unprotected oral sex on other clients, hence they may have oral gonorrhea/clymadia)

Thanks

59 months ago

Btw..i assume where you said “ I think you have a little to game with Syphilis blood testing” you meant ‘You have little to gain from syphilis blood testing’, right?

Edward W. Hook M.D.

59 months ago

As you know, we provide up to three responses to each client’s questions. These will be my third responses and therefore this thread will be closed later today without further replies.

The only scientific data available on condom effectiveness are for gonorrhea, chlamydia, and trichomoniasis. There is a small amount of inferential data on herpes but it is imprecise. The general assumption however is that condoms are highly effective for syphilis prevention as long as they prevent contact between any lesion which is present and the uninfected partner.

There is an ongoing debate in the field as to the risk of our acquisition of gonorrhea from French kissing. Most experts feel that it is very unlikely and very rarely occurs although investigators in Australia suggest that it is a possible contributor to the spread of oral gonorrhea. Chlamydia of the throat is very very uncommon and is not a concern. Those of us on this forum feel that French kissing rarely if ever results and gonorrhea transmission.

Correct, “... little to gain...”

This thread is now complete. Take care. EWH

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59 months ago

Thanks again Doctor. I have just realized that one of my exposures was at a club just over the border in Switzerland, where i believe there may not be the same mandatory testing requirement as for CSWs in Austria, I assume this one exposure to a CSW who may not have been tested makes no difference to your advice?

Edward W. Hook M.D.

59 months ago

No change in my assessment or advice. EWH---