Need help on course of action

After 9 years of marriage, had a weak moment and called a call - girl while away on a trip. Besides guilt eating away at me, I do have some other concerns.
This happened yesterday. We had mutual unprotected oral sex to completion. Afterwards I had protected vaginal sex for another 5 minutes. To my horror, when she was leaving, I noticed what looked like a cold-sore on her lower lip.
I know that I already have HSV-1 since I had shingles before.

My question is which STDs I should be concerned about ( what are the %chance of me getting them) and what symptoms and what timeframe should I be on the look-out for?

Should I avoid having sex with my wife and for what period of time?

Should I get tested for anything, and if yes,for what and when?

Sincerely,
Very embarrassed and concerned.

[H. Hunter Handsfield, M.D.]

Because you had protected vaginal sex, you can pretty much dismiss any risk for HIV  or chlamydial infection.  The risks of HSV-2 and HPV undoubtedly are a little higher, but still low for any single episode of vaginal sex.

If the sex worker indeed had oral herpes (cold sore), you may or may not be at risk for genital herpes due to HSV-1.  Your history of shingles is irrelevant.  Shingles is not due to HSV-1, but to an entirely different virus called varicella zoster virus (VZV), sometimes called herpes zoster virus.  On the other hand, roughly half the population has HSV-1 infection, mostly oral and mostly asymptomatic; if you have had it, you are immune to catching it again.  Fellatio also puts you at slight risk for gonorrhea (much lower than for unprotected vaginal sex) and nonchlamydial nongonococcal urethritis (NGU).

Aside from the possible sign that your partner might have oral herpes, I don't have any way of estimating the likelihood she has other STDs.  But in general, call girls (i.e., relatively expensive CSWs in hotels or through telephone services) are pretty low risk, HIV negative, and know how to protect themselves against STD (and do).  Syphilis and HIV in particular are unlikely - but of course all these estimates vary all over the map.  

At this point, there's not a whole lot you can do to assess whether you were infected.  Be on the lookout for symptoms (see below).  If you like, you could have a type-specific blood test for HSV-1; if positive (as it likely will be), it will mean you were immune to catching her oral herpes.  It is much too soon for the test to be positive from this exposure; so if it is, it means chronic, older infection and indicates immunity to new infection.  In theory, you could get tested for gonorrhea, chlamydial infection, HIV, and syphilis, but the risks were so low that it probably isn't worth the time, energy and money.  There is no way to evaluate for new HPV infection.

As to symptoms to watch for, anything from genital bumps (warts), sores/blisters), or--theoretically--abnormal discharge from the penis or discomfort on urination (chlamydia, gonorrhea, NGU).  Most symptoms of these STDs would show up within 1-3 weeks, although syphilis can be delayed for up to 3 months.  For more detail, search the web and elsewhere for information on the specific STDs.  You can start with the link "STD Quick Facts and Articles" on the STD Forum home page; the CDC's excellent information (www.cdc.gov/std), or the American Social Health Association, also an excellent sources (www.ashastd.org).

Bottom line:  Your overall risk of catching an STD in the episode you describe is very low.  If you haven't had symptoms within a couple of weeks, you can be reasonably confident all is well and that you won't infect your wife.

Good luck--  HHH, MD

[HHH,MD]

In my original response, I should also have said that genital warts can take 2-3 months to show up, sometimes longer.

HHH, MD