Risk assessment and need for testing

Dear docs,

I am a 35 year old male living in UK, heterosexual.

My sexual history so far consists of 4 girl friends and  around 6-8 sex workers.
Till now I have practised condom protected vaginal sex with all of them and a few episodes of unprotected oral sex( both ways). I understand that this is not considered a risk. I have no reason to believe that any of my girl friends were at  high risk for HIV/STD.
I had an annual sexual health screen for last 2 years from a private clinic and all tests were negative.

Recently  met up with a  40 year old lady , white caucasian  and british ,on a dating site. We went out a few times. She explained that she had just come out of a  long term  relationship. She is otherwise healthy , has a decent job,  no drug use, is educated and seems sensible.

To cut a long story short, we ended up having unprotected vaginal intercourse recently, a few weeks back, 3 times in one night. (She said she doesnt normally engage in casual sex. )

1.Based on this, is there any risk of HIV and would you advise any STD/HIV testing, and if so, when?( My last test was 1 year back)

2.If not, how frequently would you advise a sexual health screen and what should be tested for apart from HIV ?

(The UK govt does not advise routine HIV testing, apart from for pregnant women and MSM , although routine testing is recommended in certain regions where prevalence is high)

Thanks

[Edward W Hook, MD]

Welcome to the Forum.  I will provide you with an assessment of your risk from the encounter you describe (low) and then will give you my own recommendations regarding the frequency of STD?HIV screening.  There are no "official" recommendations for routine screening of heterosexual men.  In the U.S. there are specific recommendations for specific groups such as women or persons with HIV and for specific diseases (chlamydia in particular) but heterosexual men are not the subject of such recommendations.  Thus, ultimately the decision about your risk and when and whether or not to test will be up to you.

The encounter you describe is low risk.  STDs and certainly HIV are quite uncommon in women who are not IV drug users or otherwise at risk and rates tend to be lower among middle aged women than adolescents and younger women.  that she states she was previously in a long term relationship and denied having lots of prior partners also makes her lower risk.  That's not to deny that it still might have been a good idea to use a condom as you have with your prior partners.

Testing/screening.  We recommend periodic STD "screening (testing in the absence of symptoms) for persons who have had multiple partners over a period of less than a year.  I would make this recommendation whether or not you were using condoms, just to be on the safe side.  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, just like blood pressure checks.  As to the timing, that is up to you.  No immediate need in your situation.

Hope this helps.  EWH

[ukresident]

Thanks for the reply.
So do I understand correctly that you do not consider this to be  situation with significant risk?

Also, apart from HIV, what other tests would you recommend in the annual screen?

[Edward W Hook, MD]

Correct.

For annual screening the most important tests are for gonorrhea and chlamydial infection.  Herpes testing in the absence of symptoms is not recommended and there is less need for testing for syphilis because it is very rare (some include it nonetheless).  We would suggest HIV testing as well, not because it is particularly likely but because it is important and easy to add.  EWH