[Question #8869] Girl from Kenya

38 months ago

Dear Dres.,

I met a girl on a dating platform. She`s 23 from Mombasa, Kenya (10% HIV rate/women). She`s come to Germany 2 years ago. We have met trice and on 2 occasions we did mutual masturbation without any penetration or even frottage. She has a son in Kenya and asked if I can support her with money. So I suggested to give her 100 € every time we meet and she accepted. I asked if she has sex with other men and she denied. I asked about her status and she said that she has ben tested negative back in Kenya but has never tested in Germany as she hasn`t been dating here so far (don't know if I can believe that). I have asked her to go for HIV/STD-tests with me and she agreed to do HIV-rapid tests together, but she doesn't want to go to a laboratory. I will get the Autotest VIH/Ratiopharm which is supposed to be very reliable. I guess even after being tested we will use condoms for penetrative vaginal and perhaps anal sex.

Questions:

1) How would you elaborate on our safety in this setting, esp. the reliability of the rapid-test? I know that testing for Chlamydia, Gonorrhea and Syphilis would make sense too, but I couldn't manage to convince her to go to a laboratory.

2) Is it mostly safe to go for unprotected oral both ways and protected penetrative vaginal (perhaps anal) sex?

3) I was vaccinated against Hepatitis A/B in 2008. My titer was checked for Hepatitis B this March and it was 427 IU/l which should be highly protective!? So no worries about all types of Hepatitis, right?

4) Anything else I should be thinking of? I guess I am mostly concerned because of her being of Kenyan descent (feel bad for saying so, but mean it only bc of HIV-rate). But with the rapid tests we should be safe, right?

My wife had a hysterectomy in March after she's been in menopause for some time. We won't be returning to a sex life together and my sex drive is high. I really appreciate your thoughts on this. I meet the girl tomorrow for testing and perhaps sex.

Kind regards

Karl

H. Hunter Handsfield, MD

38 months ago

Sigh. I've been contemplating how to respond, or whether to respond at all. As we (including Dr. Hook) have discussed on at least two occasions, excessive anxiety driven questions are strongly discouraged. Despite the personality features that drive your uncertainties, you are perfectly capable of answering most if not all your more recent questions (in the past ~2 years) for yourself. (Yes, I recall what you have said about your professional responsibilities and, by implication, your intellectual capacity.) Hence a succinct reply.

1, 2, 4) You may be kidding yourself to believe a woman who accepts cash for sex is unlikely to have other partners. I am skeptical, which is only enhanced by her refusal to be tested for STIs other than HIV. For commercial sex, I would always recommend only condom protected penetrative sex; and you'll need to accept the small risk that will accompany oral sex and/or mutual masturbation, and the risk of condom failure when you progress to vaginal or anal sex. (Don't get me wrong: you're in a better position than I am to evaluate your new partner's truthfulness. But I stand by my skepticism.) Rapid HIV testing is OK, but not quite as 100% conclusive as the lab-based AgAb tests. If this relationship goes forward, you'll need to plan on occasional HIV and STI testing. At least you apparently will not be putting your wife at risk.

3) Correct no worries about hepatitis A and B on account of being vaccinated, or for hepatitis C. (Hepatitis C is not heterosexually transmitted, despite common beliefs to the contrary -- or so low risk it can be ignored.)

HHH, MD

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38 months ago

Dear Dr. Handsfield,

thank you!

I do absolutely agree to your skepticism, just wanted to make clear that I did ask her about her status and history. And I also agree that I reliably could predict your answers. As I wrote to Dr. Hook, I am working with a counselor and am well aware that I suffer from a special anxiety disorder – fear of loss – combined with a generally otherwise (over)controlled lifestyle. So I am transferring my fear of loss in STD anxiety. Well, I am working on it!

But your answer helped me to reflect the situation a bit further and so we did the testing today (negative) but I decided to skip any sexual contact today.

So I am well aware that until now I have zero risk here and that IF we proceed to penetrative sex that I THEN have to live with some low, but real risk and that periodical testing is then indeed warranted.

I will work with my counselor to establish if I am stable enough to do so. I am also aware that this forum cannot help me further and that I generally have to work on my inner integrity.

I thank you for your thoughtful answers over the years. I promise to you and myself that I will fight any temptations to come back here.

Kind regards

Karl

H. Hunter Handsfield, MD

38 months ago

I'm glad to hear all this, and that my reply was helpful. I agree with your statements and happy that you clearly understand my assessment.

Thanks again for your kind words about our services.

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38 months ago

Dear Dr. Handsfield,

I have really only one final follow-up. Admittedly I feel that I can predict your answer 90%.

My main fear is still syphilis and the possibility it might present on my mouth or even fingers.

I don't frenchkiss my wife. Rather seldom I give her a social kiss on the cheek as I do with my daughter. In normal household relations, is there any chance I might transmit a syphilis infection (mouth/fingers) to my wife or daughter?

Thank you for a final answer.

Kind regards Karl

H. Hunter Handsfield, MD

38 months ago

Syphilis is not carried on the fingers or lips, cannot be transmitted by fleeting contact including social kissing, and is never transmitted non sexually in households.---