protected but stupid

I recently returned from a trip to Cost Rica where I participated in sex with a prostitute.  I was wearing a condom.  I performed oral and vaginal sex with her.  The vaginal sex was deep.  I also touched her clitoris with my fingers.  This is the worst decision I have ever made and I am very concerned and anxious about potentially contracted an STD and passing it to my girlfriend of three years whom I have had a monogomous relationship with up to this point.  I guess since the sex was in a dark place I did not see if there were any sores or lesions on her and this is my biggest fear that My genital area potentially came into contact with one.   My main question is how long should I wait to get tested so that the results will be correct.  P.S. I have not had any symptons and it has been 3 days since intercourse.

[H. Hunter Handsfield, M.D.]

You apparently have a typically inflated view of HIV heterosexual transmisssion.  And if this is really the "worst decision [you] have ever made", you have lived a pretty mellow life.  You had safe sex, which in fact was a good decision, not a bad one.  HIV cannot be transmitted through an intact condom; oral sex is zero risk or close to it; and HIV cannot be transmitted by hand-genital contact.  Even if your genitals came in contact with some sort of "sores or lesions", that would not be a high risk.  In any case, the chance your partner had HIV probably is low.

Bottom line:  There is no HIV risk reflected in your question.  From a risk assessment or medical perspective, you do not need HIV testing at all.  But if this reassurance doesn't calm your fears and you insist, have a standard HIV antibody test 6 weeks after the event.  You can be sure of a negative result, if you haven't had any other high risk exposures that you didn't mention.

Regards--  HHH, MD

[t123645]

I apologize doctor.  I did not realize that this was a post for just HIV.  I am more concerned about other STD's that I may have contracted from this incident.  Since I have anxiety and Love my girlfriend I am going to get tested.  I want to know what time frame makes since to get tested for the potential STD's I may have contracted from potentially not seeing sores or lesions in her vaginal area.  Therefore, Syphillis (syphilis), Clymidia, Herpes, etc...  Please reply to this one and I will not bother you anymore.  Yes, I have lived a very mellow life and this is probably why something like this has me thinking I definetely caught something.

[H. Hunter Handsfield, M.D.]

My reply was intended to cover all STDs, not just HIV.  Sorry I didn't mention the otheres.  Your risk of catching an STD was higher than for HIV, simply because STDs are more common and are more easily transmitted.  But still you had safe sex and were not at high risk for STD; in the absence of symptoms, you don't need testing.  On the other hand, anybody who is sexually active outside a permanent committed relationship -- and even many of those, especially below age 25 -- should be routinely tested for common STDs from time to time, like chlamydia, gonorrhea, and syphilis.  Since it's on your mind, this probably is a good time.

I recommend against including testing for herpes.  Such tests are recommended only when someone is at particular risk, such as having symptoms of herpes or being the regular sexual partner of someone with HSV.

Don't go to a provider naming the tests you want, and don't use an anonymous testing service.  See an STD knowledgeable provider, such as your local health department STD clinic, tell them the story, and let them decide which tests are a good idea.  They'll probably agree HSV testing isn't necessary or wise.

If you analyze your last sentence, you will understand it is illogical.  The risk of getting infected for any particular exposure has nothing to do with one's prior behavior.  It will be very surprising if any of your tests is positive; and if so, it won't necessarily be from your adventures in Costa Rica.