What are my risks

Hello Doctor, my name is Ronnie and I recently went on a date with a girl from a date site. We met and she seemed like a really nice and cool girl and somebody I was going to spend a lot of time with. So we went to dinner and then had drinks. I think we stayed out a little too late and ended up going back to her place. I then had unprotected sex with her. She works as a nurse and was on a very expensive dating site so I didnt think anything of it, but I was alarmed by 2 things.

1) she had a prescription for xanex and took about 4 of them while we were drinking. She also at the end of the night when I was leaving asked me something about cocaine. I did ask her later and she did say she doesnt take that.

2) we had sex on a first date which seems to me like a little too easy.

Now she did say that she was clean and there was nothing to worry about. She also said she is real anal about STD's and gets tested. I am just looking for advice on if i should get tested. She also told me she was ashamed by having sex with me so early and asked me if we could just be friends instead of dating. I was just looking for advice to see if I would require testing or if this is a high risk situation.

Thank you

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  Bottom line: no appreciable HIV risk here.

The likelihood of HIV in the average sexually active young woman in the US or other industrialized country is very low, well under one chance in 1,000.  And neither of the things that "alarmed" you suggests she is at particularly high risk.

1) Dropping a few Xanax doesn't imply high HIV risk, whether or not she uses cocaine.  Injection drug use (with sharing of injection equipment) is the only drug habit associated with increased HIV risk.

2) I agree that people who have sex on the first date are, in general, at higher risk for STDs (but not necessarily for HIV) than people who don't do that.  It's especially true for people who don't use condoms for sex with casual partners.  But guess what?  There were two people here who had sex on the first date and who decided to have unprotected sex.  Statistically speaking, your partner was at higher risk for HIV or other STDs from you than you were from her.

In general, I recommend against STD/HIV testing after individual exposures, unless the risk is particularly high -- for example, if you knew for sure your partner had an STD, was an injection drug user, etc.  Rather, people who are sexually active outside mutually monogamous relationships should just have routine testing for HIV and other STDs from time to time, like once a year.  So if you haven't been tested recently for HIV and the common STDs (chlamydia, gonorrhea, syphilis), this would be a good time, since it's on your mind -- and because, as a person who has unprotected sex with new partners on the same date, you are marked as someone at increased risk.  But not because of this particular event.

My final thought is that you might give your partner a call and discuss this with her.  You might find she is just as worried as you are.  She might be relieved to hear you are concerned as well, and maybe you'll go get tested together.  Who knows what might come of it?  Romance?

I don't mean to be facetious -- at least not too much.  Get tested for peace of mind, and consider discussing it with her.  You can expect negative results.

Best wishes--  HHH, MD