Over the weekend, out of the blue, my wife suddenly wanted to have sex. We had unprotected oral and unprotected vaginal intercourse.

I got myself tested a couple of times (say 10 and 6 months ago) all clear. Because I thought my wife and I wouldn't be engaging in sex I haven't tested since as I have never had any symptoms.

Should I get tested- I am also worried that my wife and I have had unprotected sex a couple of days ago.

What is your advice- how worried should I be?

You're going about your extramarital sexual experiences with care and great safety; I wouldn't do anything different myself. It is generally believed (admittedly with only soft data, but a lot of common sense) that female escorts are low risk partners in terms of HIV and other STIs. (It sounds like we agree on what "escort" means:  expensive female sex workers by appointment, as opposed to bar pick-ups, brothel workers, etc.) Such women typically understand the risks, care about and protect their health, use condoms regularly, have partners who generally are low risk themselves (e.g. men like you), and get tested frequently.

Are you completely free of STI risk? No, of course not. Unprotected oral sex is quite safe, with low risk for all STIs and near zero risk for some, including HIV; and of course properly used condoms are highly protective. However, condoms can fail, sometimes are improperly used (e.g. partial penetration before applying the condom), and protect less well against infections transmitted skin-to-skin (herpes, HPV, syphilis) than those transmitted through genital fluids (gonorrhea, chlamydia, HIV). I generally advise men in your circumstance to be tested for common STIs (gonorrhea, chlamydia, syphilis, HIV) from time to time, like once every 6-12 months, even if there have been no apparent lapses in sexual safety. (Assuming no symptoms of STI -- in which case you of course should be tested right away.)

In absence of symptoms, it is very unlikely you have anything you could have transmitted to your wife. (HPV is an exception, but generally doesn't matter much -- which we can discuss later if you have concerns about it.) However, it would be reasonable for you to proceed now with testing for gonorrhea, chlamydia, HIV and syphilis -- expecting negative results. Of course you'll have to discuss the situation with your wife if anything turns up, but that's unlikely. 

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

HHH, MD

Thank you for your response and kind words.

A quick update. I did as you suggested and got tested. All clear.

I am now in the horns of a dilemma. After the 'one off' wife has not shown any interest in starting a regular sex life up again. I am now thinking that it could be another 6 months, a year or longer....

I don't want to take unnecessary risks or indeed put her at risk, but I still have a healthy interest in sex. I am wondering whether my approach of a once monthly visit to the type of high-class escort we discussed is a reasonable thing to do in the circumstances. It is the unprotected oral I suppose that is the issue.

 I have no interest in an affair/random pick-ups because other than the lack of sex we have a strong marriage.

I would value your opinion.

Thanks again for your help.

I would think it would be OK to continue with unprotected oral exposures in the circumstances described. But here too, it's your decision not mine.