Risk assessment/need for testing

[ukcentral74]

Dear doctors

I am a 38 year old heterosexual man living in  London, UK and am healthy.
I had a full STD screen 2 years ago including HIV , syphilis, Chlamydia, , all of which were negative.

Since then:

1. I have visited a chinese massage parlour several times, received protected oral sex . On occasion I fingered the girls  and also licked her genitalia briefly( probably not enough to be called cunnilingus ).

2. I had  deep french kissing and  completely protected oral and vaginal sex with 8-10 sex workers /escorts. These were highly paid sex workers , not street workers. Most where white caucasian , a mix of British  and Eastern European . I made sure that the condom was on and intact all the time apart from one occasion when I received unprotected oral sex . I also performed oral sex ( cunnilingus) 3-4 times.

3. I was in a  relationship with a girlfriend for 6 months . She is 42 , of French origin, highly educated professional. She has two kids and had separated from a long term partner/husband 2-3 years ago. According to her own admission, she does not "sleep around". She does not use drugs or alcohol. When I mentioned that I had been tested previously and was negative, she mentioned that although she had not been tested recently, she did not have any known STDs or any risk factors for the same. As we were going to have a long term relationship, we had unprotected sex several times over a period of 3-4 months.( Just mentioned that as it was not really "casual sex")

Now we have terminated our relationship and am just now possibly entering into another relationship. I do not have any symptoms .
Should I get tested now? What do you think of my risks from above? I have resolved not to use any sex workers again  from now on .

Many thanks

[Edward W Hook, MD]

Welcome to our Forum. There are really two questions here -should you get tested (yes) and what is the risk that you were infected by various partners/sex acts.

First, since you have had multiple partners since your last test I would advise you to seek testing for common STDs at both your genital and oral sites, as well as blood tests for syphilis and HIV.  While the risk for infection is low, because any of these infections can be asymptomatic, you might benefit from the assurance provided by periodic STD "screening (testing in the absence of symptoms) because you have had multiple partners over a period of less than a year.  As a matter of personal protection, we recommend annual testing for anyone who has had two or more sex partners in the past year (we consider this to be health maintenance- we also recommend you get your blood pressure and cholesterol checked regularly).

As for your partners, it is important to remember that few commercial sex workers, particularly those who are "higher class" have STDs - it’s bad for business and they have an interest in protecting themselves, therefore they test regularly.  In general, the risk of having sex with a CSW is lower than a one-night stand with someone you just met at a bar.  Your more serious partner might well have been infected asymptomatically as well, therefore, I suggest you get tested.

As for types of sex, there is a higher risk for infection from genital-genital sex than giving or receiving oral sex.  Infections are more common and transmission is more efficient per exposure from genital-genital contact than oral sex.  Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through receipt of oral sex and gonorrhea is a rare consequence of cunnilingus with an infected partner.  Chlamydia is almost never transmitted through oral sex.

Thus I suggest you get tests of a penile specimen (swab or urine) for gonorrhea, chlamydia and NGU and an oral swab for gonorrhea.  Blood tests for syphilis and HIV are easy to do and reliable (blood tests for herpes are not).

Hope this helps. Testing will help you to enter new relationships without doubts or concern.   EWH

[Edward W Hook, MD]

Glad to hear it. STay safe.  EWH

[ukcentral74]

I had a full  STD screen. Negative for everything including HIV, Syphilis, Gonorrhea and Chalmydia.

Thanks for your help and support

[Edward W Hook, MD]

Your overall risk of infection is very low.  EWH

[ukcentral74]

Thanks for the prompt reply. I will get tested shortly as you suggest, but  I would be obliged for  your pre-test assessment of my risk  level. Many thanks