[Question #9100] Unprotected sex with prostitute

36 months ago

Hello drs, I know it’s stupid and I believe i’ve been well educated by you guys since my last post 2 years ago. After my 2 year ago encounter I tested for all the STD’s available in a top tier clinic in Dubai which caused me nearly 700$~. With all of this the only thing that turned out positive after my protected encounter was Gardnerella Vaginalis. I was treated for that then got into a serious relationship for a year then had a tough breakup which led to many stupid actions.I traveled around in the last 9 months a lot specially to egypt as I had some work there. Met a beautiful young lady in one of the 5 stars top hotels in egypt. Had sex with her and paid her. Through the last 9 months I met her for nearly 12-15 times protected, I have no other partners nor did I have any other sexual contact with anyone else. 5-6 hours ago she came into my room, we’ve built a great bond and I only paid her for the first 3 times out of all the other times. She said that she “ likes me “ and listed one of the reasons that people who usually order her are 40+ due to the high price she asks for. I don’t really know her intentions towards but we both smoked and drank a bit. Had sex with a condom like usual. She kissed me and things went downhill when I removed the condom while we changed positions, I told her about it and she just went with the flow. When I ejaculated she started laughing and telling me about how stupid we are for having sex without a condom. We went to take a shower and had sex again without a condom in the shower. I asked her jokingly about the last time she was tested and it was 3 months ago but she tested for only hiv and hepatitis nothing more or less. I’ve been tested as a routine checkup 2 weeks ago and everything came back clear Do I need prep? I called a doctor here asking him about prep and he laughed saying he only give it to needle accidents. What should I do? Im planning on taking doxy for 3-4 days to prevent gono and chlamydia or syphilis for startes

Edward W. Hook M.D.

36 months ago

Welcome to our Forum and thanks for continuing confidence in our service. I'll be glad to comment.

While I understand that there may be some cost involved, I recommend that you and/or your partner get tested. There are several reasons for this. While it appears that your partner typically uses condoms with her other clients (you did not say this but it sounds like that's the case), she has not been well tested well and it has been three months since any testing at all. The best guidance for you would be for her to be tested- if her tests are negative, there is no risk to you. The testing I would recommend include testing for gonorrhea and chlamydia at any time for her or if you are being tested, 3-4 days after the exposure. Testing for syphilis and HIV should be done in you at 4-6 weeks or, in her at this time.

Taking doxycycline would reduce your risk for syphilis and chlamydia for sure but it is debatable as to whether or not it would be effective for preventing gonorrhea.

Hope this helps. Again, the best way to expeditiously find out whether or not you were exposed, as well as being beneficial to her. EWH

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36 months ago

I tried getting a rapid test and invite her over to test her for HIV but I found out it’s not possible in egypt since HIV tests should be managed by the government and it’s hospitals

I even believe she’ll refuse testing since these girls out here view the condom as a protection from pregnancy not STD’s.

When I asked her about her testing she was annoyed telling me that she rarely if ever have sex without a condom.

What are the next steps that I should do? Would it be worth it to book a flight to my country in hope of getting PEP in the correct time?

Antibiotics/medication here are given with no prescription here so I got myself a 1 week dose of vibramycin do you think it’ll be enough to prevent syphilis?

What medication do u suggest getting?

Nothing regarding HBV?

What are my chances of getting std’s from this encounter?

Edward W. Hook M.D.

36 months ago

Thanks for the additional information. I understand and appreciate the logistical barriers to testing that you raise. The decision about PEP is a personal one. The chances of getting HIV are very low since- A. You do not know that she has HIV and most people, even most CSWs do not have HIV, and, even if she does have untreated HIV, your risk of infection on a statistical basis is less than 21 infection for every 1000 sex acts, making your chance of infection IF she is infected less than 1%. PEP is, of course, a personal decision but the odds are very much in your favor that you were not infected.

Yes a week of doxycycline taken twice daily for a week would reliably prevent syphilis (as well as chlamydia).

Risk fo HBV is difficult to quantify but also relatively low. Are you vaccinated against HBV? Is so, there would be no risk. EWH

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36 months ago

Thanks for the work you’ve done with conjunction to Dr.HHH here and medhelp deserves awards and the respect I have for you guys. You’ve been the best in this field and If you guys ever have a clinic in the middle east I’d be doing all my checkups there as I don’t think anyone has better knowledge.

I’ve been skeptical in using vibramycin twice daily for a week or azithromycin 2g once. I really want to prevent chalmydia-gonorrhoea and syphilis as they have the highest risk of transmission. I’m unfortunately unvaccinated to HBV but I’m planning on getting it asap.

- If you were in my case would you take doxy or azithromycin as a prevention of the past STD’s?

-I’m planning on getting a pcr rna hiv test in 2 weeks then a Ab/Ag test 4weeks post exposure. Do you think it’ll be enough?

-after completing one of the antibiotic courses, should I start counting the days after the last dose? Or should I test for gono/chalmidya 1 week post exposureand 6weeks for syphilis regardless of my antibiotic use?

- Do you think an HBV test would be reasonable and advisable after such exposure? If so how long after it?

Thanks again since this is my last reply. You deserve the best!

Edward W. Hook M.D.

36 months ago

Recent studies have showed a powerful effect of doxycycline in preventing chlamydia and syphilis following a risky exposure and while I am not a fan of general use, in your situation, a week of doxy is reasonable. I would not do it routinely or with condom protected sex but in your situation, recent exposures to an untested CSW, the benefits may out way any risks.

I agree with your plan for HIV testing. It will provide you with reliable information.

Please get vaccinated for hepatitis B. it is highly effective and eliminates a potential problem. The vaccine is safe and well tolerate. I'm ambivalent about the need for hepatitis B testing unless you develop symptoms. If you choose to test however, best to wait to test until about 6 weeks following exposure

Thanks again for your thanks. As you know, this will be the final response as part of this thread which will be closed shortly. Take care. EWH

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