Cumulative Risk from Exposure to CSWs

[fritterbay]

Hello Doctor,
Thank you for the wonderful work you are doing on this site.
I am a married man thinking about approaching sex workers to add some spice into my sex life. This is what I am planning to do and I need your advice in risk assesment:

I am planning on having sex with commercial sex workers (I would attempt to do it with individuals who 'appear' to be 'non-pro's ie, possibly college students in need of extra money). I am thinking of contacting them 1-2 times/month. I will always use a condom (have even thought of using 2 condoms to reduce risk furthur). My questions are
1. What would be my risk in contracting STDs esp the bad ones like HIV, Hepatitis B or C, herpes etc if I were to do this for an indefinite period of time lasting years?
2. Are there quick tests like Orasure Gum Swab test that I can ask them to do before engaging in sex to make sure they are HIV free?
3. Do you have any info on the disease profiles of CSWs from Brazil/Asia who are in this country?

Thank you for your time.

[H. Hunter Handsfield, M.D.]

To the person who attempted a question to another forum user, not me:  That's still a thread jump and not permitted.  That's what the HIV Support forum is for.

[monkeyflower]

I second the poster who said two condoms was a bad idea. One is plenty--and safer. Use plenty of waterbased lube to further reduce friction. You can even put a drop inside the tip to increase your sensation, but don't use too much or it could slip off.

[H. Hunter Handsfield, M.D.]

You quote an apparently conservative source.  Sex per se has never been demonstrated as a mechanism of HCV transmission and I am unaware of proved transmission by oral sex or intercourse.  Long-term partners living in the same household with infected men or women have somewhat higher rates of HCV than the general population, which naturally makes people think of sexual transmission.  But such persons have lots of opporunity for non-sexual exposure to blood and body secretions, and the short term partners of people with HCV have never been found to have higher-than-expected infection rates, despite frequent unprotected sex.  HCV might best be thought of as sexually TRANSMISSIBLE (infrequently) but not usually sexually TRANSMITTED.  Most apparent sexual transmissions occur in gay men, in whom sexual practices involve greater potential of blood exposure than in heterosexual men and women.

HHH, MD

[jamesy78]

Doctor you say Hep C isn't sexually transmitted anyway.
I live in the UK and government websites for NHS here says that Hep C is mainly through blood to blood contact, but it can also be acquired through unprotected sex. It says it is rare but can happen either throough unprotected Oral sex or Intercourse.
Are they being over conservative? Like when they say a 3 month test its required for HIV results.

[fritterbay]

Thanks for all the useful comments and tips.

[guiltnworry]

Just a suggestion...don't use two condoms (like you said you thought about).  They weren't made for that and the increased friction increases the chance of breakage, putting you at higher risk for STDs...

[fritterbay]

Thanks, doctor.

[H. Hunter Handsfield, M.D.]

FB:  Personal preference; polyurethane and latex are equally effective.

JH:  Personal criticism is strictly forbidden.  Another comment like the one I deleted will get you permanently banned from the MedHelp forums.

[fritterbay]

Thank you, doctor, for your succinct and authoritative response. Do you reccomend latex or polyurethane condoms?

[Imdumb]

There is a thread just below this one that has some good info that might help you.  The Dr. said you could go to a escort daily for the rest of you life and as long as you were doing safe sex, you could expect never to get an HIV or most STD's.  The execption is there is some risk of herpes or HPV, but the condom will protect even this pretty well, but not 100%.

[H. Hunter Handsfield, M.D.]

If you use condoms consistently, you are doing just about all that is necessary or practical to protect yourself.

1) Your risk of HIV and hepatitis B will be zero, for practical purposes.  Hep C isn't sexually acquired anyway, so that's not an issue.  A small risk of herpes continues, because condoms don't prevent skin-to-skin contact above the condom.

2) Neither OraSure nor any other HIV tests are approved by the FDA for self-testing at home; only for use by licensed health care providers.  Even if you could get ahold of some test kits, I don't recommend such testing by nonprofessionals.  Anyway, given the nature of partners you hope to recruit, the chance of finding one with HIV is very low.

3) I have no clue about STD/HIV statistics in immigrant CSWs from Brazil, Asia or anywhere else.