[Question #8578] Unprotected sex with streetwalker in Mexico

42 months ago

Hi Doctors,

Yesterday I had brief intercourse with a street prostitute in Puerto Vallarta. It wasn’t planned but we got carried away and she ended up inserting my unprotected penis into her vagina. It lasted under a minute before I came to my senses and pulled out. I am worried about HIV or another STD. I’m also worried about giving my wife something. Should I seek treatment like PEP? Thanks for the great work you do.

H. Hunter Handsfield, MD

42 months ago

Welcome. Thanks for the advance thanks and your confidence in our services. I happened to log in soon after you posted your question: most users should not expect nearly real-time replies!

In potentially high risk situations, PEP decisions to protect against HIV really need to be made by experts who understand the local epidemiology. I have no way of knowing the prevalence of HIV in partners like yours in or around Puerto Vallarta. In general, street commercial sex workers are considered pretty high risk. If that is confirmed by local experts, PEP probably would make sense. To be clear, even if she is infected (and not on treatment), with such a brief exposure the chance of HIV is probably under one in several thousand. But you'll need to visit a local emergency room, urgent care center, or HIV expert provider to know for sure.

As for other STDs, post-exposure prophylaxis isn't a standard recommendation and I don't recommend it. The odds of any infection are low, but of course not zero. But I would not object if you were to seek out effective treatment against gonorrhea and chlamydia, e.g. a shot of ceftriaxone 500 mg (or oral cefixime 800 mg) plus a single 1-gram dose of azithromycin by mouth. These also would prevent syphilis if you had been exposed, and might allow resumption of sex with your wife after a day or two. However, there is no way to prevent herpes or other viral STDs in this situation.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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42 months ago

Thanks for the speedy reply! As I type this I’m on a flight back to Canada. Though I now judge the risk of contracting HIV as somewhat remote, I think I’ll head to an ER as soon as I land, just to be prudent. Thanks again for sharing your knowledge, especially in such a non-judgemental way.

42 months ago

Update: I went to an urgent care centre and asked for PEP and they denied it. Apparently it's only available to people who know that their partner is 100% certain to have HIV, so I'm out of luck. I couldn't get prophylactic treatment for gonorrhea and chlamydia either, but I did purchase doxycycline (ten 100 mg capsules) before I left Mexico. Will that effectively prevent those two infections in addition to syphilis?

H. Hunter Handsfield, MD

42 months ago

Be clear: I recommend you not take any antibiotics. Thinking you were still in Mexico and might be tempted, and perhaps without access to the quality of care to which you are accustomed, I suggested possible options if proper evaluation were not available. Doxycycline is not reliably effective against gonorrhea, and the dose you purchased is insufficient to reliably prevent or treat chlamydia or syphilis, but could interfere with later diagnosis. At this point, a smarter approach is to wait another day or two, then have a urine test for gonorrhea and chlamydia. The likelihood of syphilis is extremely low -- be on the lookout for a penile sore (chancre) in the next three weeks, but it's unlikely.---

42 months ago

Ok understood. I'll get tested in a few days and monitor for symptoms, and I will not use the drugs I purchased.

H. Hunter Handsfield, MD

42 months ago

OK. Threads normally are closed at this point, i.e. after two follow-up exchanges. But I'll leave this open until you post your gonorrhea/chlanydia results, should you wish to do so within a week. But I won't have any more comments until then. Stay mellow in the meantime -- you can expect negative results.---

42 months ago

Hi Dr. Handsfield,

My doc declined to test but prescribed 800mg oral cefixime and 1 gram of oral azithromycin. Thanks again for the great advice. Take care.

H. Hunter Handsfield, MD

42 months ago

Thanks for the thanks. Best wishes.---