[Question #816] Unprotected Sex Exposure

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94 months ago
Dear Sir/Madam

I am a 27 year old circumcised male living in the UK. I will keep my situation as brief as possible. On 30/05/16 I had unprotected vaginal sex with a csw of Romanian origin for about 30 minutes. It was the first time I have ever had unprotected vaginal sex in my life. Here is the background. I met her on 28/05/16 and we spent a few hours together and engaged in protected sex and unprotected oral. However there was an unusual sexual connection between us and I went back to see her again that same night and once more we had protected sex but it was passionate. I got to know her a little and vice versa, she said she had just started this job and previously worked in a hotel and I told her I never had unprotected sex before and other things about myself.

On 30/05/16 despite having condoms on the table we let emotion take control and I had unprotected sex (i still can't believe I did this). Since then she has phoned me and given me her real number and we have spoken like friends. But humans can be sinister and it is difficult to judge atm whether her feelings are genuine? It is all very confusing at the moment for me and perhaps her too. I haven't yet asked her about hiv or other stds but I will. Until then doc what do you recommend? PEP? Normal test after 4 weeks? Should i be overly concerned? I am healthy and in good shape but without a gf for 7 years I have been paying for sex regularly but previously vaginal sex has always been protected. 

Thanks for your time.
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Edward W. Hook M.D.
94 months ago

Welcome to the Forum.  I'm pleased that you thought enough of our perspectives to ask for our advice.  I will be happy to do so.  From your note, it seems that you and your partner have established a level of communication that is not typical of persons who have sex with commercial sex workers.  This may be an advantage to you as it provides an opportunity for you to ask her questions that might be more difficult to ask otherwise.  If, as it sounds, you plan to remain in contact with this woman, perhaps you feel comfortable enough to suggest that perhaps the two of you could go and be checked for STIs together.  This would help you in terms of the concerns you express, might lead you to more comfort in further unprotected sex if you plan to continue to see her, and would be good for her sexual health in terms of providing opportunities to make sure she does not have an asymptomatic STI.  If you choose to do this, you should pay for her evaluation as well as your own.

Whether you ask and she is willing to be checked for STIs or not, I would suggest that you get checked for the most common STIs (gonorrhea, chlamydia, etc.) at this time.  The fact is that most commercial sex workers do not have STIs, including HIV and even when they do, transmission of infection does NOT occur with most exposures.  Even so, getting checked is prudent.  Testing for gonorrhea and chlamydia can be carried out at this time using a urine specimen collected just as you begin to urinate and will provide accurate information.  Testing for HIV and syphilis will not be accurate until 4 weeks after your exposure (HIV testing should be done with a 4th generation, HIV antibody/p24 antigen test, not an antibody only test).

I would not recommend PEP in the situation you describe- the risk is quite low (likely close to 1 in 100,000) and PEP is expensive and may cause side effects. 

Personally, I would not be too worried about this exposure but, as I mentioned above, testing is prudent, particularly if you are able to get your partner tested at the same time.  If her tests are negative, then you can be confident that you are not at risk for anything that was tested for and move forward without concern.

I hope these comments are helpful.  EWH