Please summarize risks of sex with escorts/swingers

[JohnDoe50]

There is a fairly large number of somewhat anonymous men and women who have sex with multiple partners-- mainly through online swingers clubs and escort agencies.  While the average woman may have sex with only 3-5 men in their lifetime, a female swinger or escort may have sex with 5 men in one night.  Setting aside all the moral and legal issues, I would really appreciate some info on staying safe.  Assume for all of these questions that there are no obvious tell-tale signs of infection.

Question #1:  What is the actual transmission risk for most of the predominant STDs for the male to transmit an STD to a female during uncovered penis-vagina sex?  What is the actual transmission risk for most of the predominant STDs for the female to transmit an STD to a male during covered penis-vagina sex?

Question #2:  Condoms are helpful but HPV and Herpes can still be transmitted even with covered penis-vagina sex.  What is the actual transmission risk for most of the predominant STDs for the male to transmit an STD to a female during covered penis-vagina sex?  What is the actual transmission risk for most of the predominant STDs for the female to transmit an STD to a male during covered penis-vagina sex?

Question #3: What is the actual transmission risk for most of the predominant STDs for the male to transmit an STD to a female during uncovered mouth-vagina sex?  What is the actual transmission risk for most of the predominant STDs for the female to transmit an STD to a male during uncovered penis-mouth sex?

Question #4: What is the actual risk for either a male or female to transmit an STD to their partner while French kissing?  I'm mainly assuming herpes and I realize that a large portion of the population is already infected.

Question #5: Does washing with mouthwash or anti-bacterial soap before and/or after sexual contact have any benefit or detriment to transmission rates for penis-vagina, mouth-penis, mouth-vagina, or mouth-mouth sexual contact?

Thank you.

[Edward W Hook, MD]

Welcome to our Forum.  I will try to answer some of your questions to the extent that there are data to rely upon.  As you might imagine, for most STDs there are not good estimates of the per exposure risk of transmission of infection due to the ethical issues related to such studies.  

In some closed swingers groups in which all members get tested on entry and only have sex with other tested members and not outside of the group, the risk for STD is very low. On the other hand, in open groups were people are having partners outside of the groups infections can be introduced and spread quickly.  Meeting truly anonymous partners over the internet, or, for that matter, through any other mechanism is rather risky as you do not know when they were last tested and whom they might have had sex with in the interim.  

Let's try to work through your questions.

1.  There are only good data for gonorrhea. For gonorrhea transmission from infected females to uninfected males appears to occur at a rate of about 20% per exposure. For infected males with uninfected partners the numbers are higher, about 40%.  Chlamydia rates are thought to be similar but there are no good studies. Correct and consistent condom use makes exposure virtually no risk.

2.  See above. When carefully studied condoms reduce the risk of transmission of virtually every STD.  For diseases like gonorrhea and chlamydia the risk gets to essentially zero. For lesion diseases such as herpes, syphilis and HPV while there is some risk of infection it is decreased by more than 50% through condom use.

3.  Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you had gotten gonorrhea or NGU you would have most likely developed symptoms of urethritis (penile infection).  

4.  The only possible risk for transmission through kissing of any sort is oral HSV and the risk is unquantified but, in the absence of obvious lesions is very, low, estimated to be less than 1 in 1000 exposures.

5.  No, washing with any sort of cleansing agent has no beneficial effect and in some studies use of harsh cleansing materials actually increases risk;

Hope these answers help. Please be careful. EWH

[JohnDoe50]

Thanks doc.