Guidance

[Shanghai2013]

I am having a lot of anxiety over a recent encounter and I wanted to get you assessment on my risk.  

I am a man...I had protected vaginal and unprotected oral (received) with multiple (2) csw's in Hong Kong about 5 weeks ago.  Post exposure I started doxycline for anti-malarial protection (am traveling/working in South Asia and was belated told to use for malaria prevention ).

I have not had any discharge or other symptoms that I am aware of...

My anxiety is based on the fact that I will be meeting my significant other in a few days and I am worried about exposing her.  I will not be able to get a screening before meeting her.  Should I be concerned and look for a way to avoid sexual contact?

It would seem my main risk would be asymptomatic ghonnerria?  Clearly I would like to get tested but until then I need to manage risk.  Avoiding contact will put a strain on the relationship (as would the truth, unfortunately)

Appreciate your thoughts and guidance.

[Edward W Hook, MD]

Certainly CSWs are somewhat more likely to be infected than many peole although having an STD is bad for business and hence most CSWs take precautions and are checked regularly.  In general, your risk for STD may be higher picking up someone who is has many other partners from a bar for a one-night stand than from having sex with a CSW.  

And no, my overall assessment does not change given the change in timing of the doxycycline.

Take care.,  EWH

[Shanghai2013]

Thanks for the feedback.

I appreciate the assessment.  Only point of clarification is that I was not taking the doxy at the time of infection.  I guess it doesn't changed the overall assesment very much.  

Only surprise was your comment about csw's not being likely infected.....outside of places where it is regulated (Amsterdam, etc)....I would have expected re opposite?  

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help. the exposures you list are rather low risk.  Most commercial sex workers do not have STDs, even those who do rarely have oral infections, and most exposures to infected persons do not lead to infection.  In your case, since your vaginal sex was condom protected your only risk was from receipt of oral sex.  

The major STDs of concern for persons receiving oral sex are gonorrhea and nongonococcal urethritis.  The doxycycline you are taking is recommended therapy for NGU and is active against many (but not all) strains of gonorrhea.  NGU should not be a concern.  Further, with regard to gonorrhea, the antibiotics would not only cure it if present but, if you were taking it when you were exposed, it would also reduce your risk of becoming infected.

Since you are asymptomatic and most gonorrhea does cause symptoms, as well as considering both the sorts of exposure you mention and that you were taking antibiotics at the time, your risk of any STD from the exposures is quite low.  Is it zero, no, but the likelihood of infection in your case is certainly less than 1 in 1000 and probably lower than that.  Testing is the best way to be sure but if you cannot arrange for testing, the risk that you are infected and will infect your significant other is quite low.  

I hope this guidance helps.  I see you have posted the same question on the International Forum and anticipate that you will get a similar assessment from them.  EWH