But I know things can feel better. I have had some amazing off the charts chemistry with some providers and I’ve always declined on the offers of sex. But while I don’t want to have an affair, I do want to experience great sex before I’m too old for that. 

All that to say, I plan to connect with an escort (and by that I mean specifically a well-reviewed, somewhat expensive sex worker with whom you schedule a session) and I want to understand the risks. While I find that condoms make sex less physically  stimulating for me, I would absolutely use  protection for vaginal and anal intercourse. But even that, I know comes with some risks. And for oral sex I’m considering no protection, just so I can enjoy it more. But again I know it comes with risks.

So morals and ethics aside, how risky is all of this. What are things I can do to mitigate some of that risk, and still have a good, anxiety free experience. (I’m an anxious person).  

Thanks for your time. 

First a brief comment about "morals and ethics aside":  No user ever need be concerned about such issues. We support and favor healthy sexuality and never intentionally condemn, demean or disrespect the sexual choices and plans expressed -- provided, of course, that they are consensual and not coercive or likely harmful to the parties involved.

Second, congratulations for a safe and responsible approach to your planned sexual choices and practices. This also was apparent in your two previous threads several months ago.

To your specific question. Perhaps most important, most escorts, i.e. female sex workers of the sort you describe who typically are costly and work by appointment are believe to have low rates of STDs especially HIV. Many are well educated, typically they care about their health and know the score, usually promote condoms and insist on their use for vaginal and anal sex, and get tested frequently. Many or most of their clients are unlikely to be infected, such as men like you. Of course the risk isn't zero and I endorse your plan to use condoms for vaginal or anal sex, and I also agree with your apparent understanding that oral sex on you is low risk for all STDs. For that matter, the same is true of cunnilingus -- which you don't mention but might be likely. Of course condoms are not 100% protective, especially for infections transmitted by skin-to-skin contact (herpes, HPV, syphilis), although they are close to perfect (if properly used) against those transmitted primarily through genital fluids (like gonorrhea, chlamydia, trichomonas and HIV).

All in all, the risk of any infection after any single exposure probably would be in the range of one chance in thousands -- and for the biggie (HIV), one in millions. Assuming no symptoms or overt condom failure, I would not advise testing after every such exposure, but rather on a schedule -- maybe every 5-10 such events. And when you have such testing, don't necessarily seek out various labs' "comprehensive" testing panels; many or most tests included are too low risk to warrant testing at all (e.g. viral hepatitis), or the tests are not sufficiently reliable in asymptomatic persons (e.g. herpes blood tests). I would recommend only urine testing for gonorrhea and chlamydia and blood tests for HIV and syphilis.

Finally, you could consider vaccination against hepatitis B and HPV, if you haven't previously been vaccinated.

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

HHH, MD

So for clarity, you feel that as long as I follow these safety protocols, I’m safe enough that I don’t need to test, and that my regular partner (wife) is safe?

But also that if I make it a regular thing (which I really doubt I would) I should test at regular intervals. Correct? 

It’s interesting- when I look on the boards, outside of people who are  not careful in both practices and protection, I’ve never heard of a US  escort (the kind we’re talking about) transmitting an STI to their clients. 

Does that match up with the medical data? 

Thx again! 

Yes, this advice is data driven; or for some aspects without clear data, my judgment based on years of experience and understanding of the mechanics and biology of STD transmission. But don't rely on this forum as evidence that STD transmission occurs from high-end female escorts. Clearly it does, just not very frequently. Remember that people who post questions on this forum are an exceedingly tiny subset of all sexually active persons at potential risk for STDs.

There probably is little risk from analingus performed on you. For the oral partner, analingus primarily risks non-STD enteric infections like viral diarrhea or, less often, more serious intestinal infections. Honestly, I would avoid it.

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.