[Question #8465] STDs - CSW and General Safe Conduct

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44 months ago
Hi Doctor, First of all, I am almost confident that the situation that motivated me to post this question carried neglible risks of transmission for virtually all blood borne STDs and a bit more risk for skin contact STDs, however, I still would like to hear from an expert like yourself about the specific situation I will detail below but I also have a couple of generic questions. The event was simple, I met a CSW in Switzerland which works for an established legal entity and charges higher than average escorts in Europe. Anyhow, I had protected oral (recieving), protect vaginal, and a protected anal for which a different condom was used as instructed by the girl and did not last more than 8 min after which I decided to return back to vaginal intercourse, the condom was changed, it was intact, maybe some secretions seeped into it from the bottom but it was good. No other activities were performed. The questions are: 1. As far as I understand, these kind of activities did not carry significant risk to require irregular testing? The only activity that I don't usually partake in was the Anal. 2. This is a general one, I frequently see escorts and have been for a decade now, I have never done it without protection and have never had any condom breakage except with a girlfriend once. Having said that, What is the period that you would recommend for me to test ? I usually test every year for HIV and HepC as a part of general health checkup but the last time I tested was late 2019 and all was good. 3. Another general question, I realize the importance of regular testing and I see this as a standard recommendations from you guys on this forum especially for those who frequently meet SWs and I have seen many times a specific justification for this which is no matter how much protection and precautions we take, infections could still happen. Now, that kind of statement worries me a bit because it means if condoms were used rightly and did not break, residual risk exists, how?

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44 months ago
I'm sorry for the shitty formatting, something went worng at the end and it all became jumbled up. 
And thank you in advance for your time, dedication, and efforts.
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H. Hunter Handsfield, MD
44 months ago
Welcome to the forum. Thanks for your confidence in our services. I don't see anything wrong about the formatting of your question, by the way.

Your opening statement is correct. The exposure described indeed "carried neglible risks of transmission for virtually all blood borne STDs...". I would also describe your risk as minimal for the STDs transmitted skin to skin.  To your specific comments and questions:

1) "As far as I understand, these kind of activities did not carry significant risk to require irregular testing?" I'm not sure what "irregular" means in this situation, but I would not have recommended any HIV or STD testing at all after the events described. 

2) Given the sexual lifestyle you describe, a smarter approach is to just have routine testing from time to time, as you apparently have been doing for HIV and the hepatitis C virus. In fact, I would delete HCV testing entirely. It has been oversold as an STD, and in fact hetersexual transmission is exceedingly rare if it occurs at all. The only proved sexual transmission scenario for HCV is among men having potentially traumatic anal sexual activities (i.e. with potential blood exposure) with other men. The 20-year spouses of HCV infected persons are at no higher risk of HCV than anyone else in the general population, unless they also share drug injection equipment with their spouses.

3) As the foregoing implies, you correctly state our recommendations on this forum -- which are consistent with the advice of most STD/HIV prevention experts. But don't overread the reasoning. There are two broadly used measures of condom performance:  biologic and use effectiveness. Biologic is what you cite:  no infectious agent can pass through intact latex or polyurethane (and rarely if ever through natural membranes either). Use effectiveness takes human error, condom breakage, and so on into account. And even with 100% biological effectiveness and no known misuse, why take the chance? Routine testing from time to time just is common sense. 

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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44 months ago
Thank you so much Dr. Handsfield for your detailed response. 

By irregular I meant testing out of my normal routine. Good to know about the HCV. I will certainly restart my annual checkups and will add STD panel for sure.