Real risks for one encounter

[christian76]

dear doctors,
my name is chris I am a 30 yrs. old man from germany.
I did something very dumb. I went to a sexstreetworker because I was courious for something new. I had with this lady mutual unprotected oralsex for 5 minutes and another 5 minutes of protected vaginal sex. condom seemed to be intact after intercourse I had also a shower after that. I feel very bad and guilty for this big mistake. The problem is that my doctor scared me to death. he said that it was of course a very risky encounter because nearly all sexstreetworkers would have some sSTD and that chances are high as well to get an STD from this 10 minutes session also scabies are likely. he gave me 14 days of 200  mg doxycyclin as for prophylactic for syphilis and other bacterial STDs & zinc for herpes, & bad smelling crotamiton gel for scabies. he wanted also to prescribe HIV PEP which I refused (as I think that oral activity is low risk and I am anxious because of side effects).
Also I have been vaccinated 8 month ago for HEP B and A, cause I travel a lot.
He will test me in a few weeks for: HIV, syphilis, HEP C, HEP B (though I am vaccinated since month?). As you can imagine it would have been better not to visit my doc, because now I am very scared and it feels wrong to even touch my wife and hug my boy. In my few my doc seems to be conservative and unreasonably overcautious regarding HIV and STDs…
So I doubt that all this stuff was necessary .

1. what are the real chances getting HIV from this encounter?
2. would the doxycyclin really prevent much of the bacterial STD and above all syphilis?
3. are chances really that high to get also HEP C / B / A by oralsex?
4. Do I have to use condoms with my wife, I am very scared to pass something deadly to her.

This was the first and last time I did such stuff. My curiosity is over…
Hopefully you will answer.

CHRIS

[Edward W Hook, MD]

I think your doctor overstated the situation.  He is correct that the risk of STD and HIV is higher when one's sex partners are commercial sex workers rather than others.  At the same time, the risk remains rather low.  For instance, if 1 in 1000 people in the general population have HIV and the rate is twice as high in CSWs, while risk is increased, it remains rather low.  For your exposure, you are correct that the rates of STDs, including HIV is higher in CSWs but it is still more likely than not that your partner did not have and STD or HIV.  In addition, it turns out that most exposures to infected partners do not lead to transmission of infection.  Further oral exposure is low risk for getting HIV and STD, even if your partner was infected and your genital contact was condom protected which helps as well.  Finally, taking the doxycycline will have prevented syphilis, chlamydia, non-gonococcal urethritis if you had been exposed, as well as some gonorrhea.  

You did the right thing not to take the PEP.  It was not necessary.  

As for your questions:

1.  Less than 1 in 10,000 exposures if she was infected and she was probably not infected.  Very low.
2.  Yes
3.  Hepatitis C is almost never sexually transmitted and your vaccination will protect you from hepatitis A and B.
4.  No, you are no  likely to be infected.

Hope this helps. You will be fine.  Take care.  EWH

[christian76]

Hi folks,

this is just fyi. Meantime I have received my latest lab results (and guess what, all like Dr. Hook has predicted)
Syphillis, HIV 1/2:  - p24 antigen, HAV, HBV, HCV, Clamydia, Gonhorrea: all negative...
Some interresting facts  that show how unlikely an HIV infection was for me (what a waste of money, nerves and sleep)...

inhabitants germany: 83.000.000
HIV / Aids infected         60.000 (50.000 male - 10.000 female)
75 % of HIV cases are in the group MSM, 12 % heterosexual, the remaining cases are
IV drug users, immigrants from high risk countries

Many questions are about sex with CSW and appropriate  risk. I read an interresting article from the german
department of desease controll (Robert Koch Institut). In an voluntary not official study of more than 1900 CSW who came to german puplic health center in order to seek free of charge medication and tests for STDs all women who agreed were tested for major STDs. The prevalence of STDs in this high risk population was like this:

HIV prevalence                  1 %
HBV prevalence                 4 %
Syphilis                            5 %
Gonorrhea                       19 %
Chlamydia                       39 %

Bare in mind that these CSW came to see anonymous help because most of them had  uro-genital problems or other aches and pains, so the prevalence in other CSW (in officially recognized Sexbars) might be far lower than these figures. If you can compare this with other countries in the EU or with CSW in the USA no one knows but it seems the Forum's Doctors here are right, even in CSW HIV is more rare than one might think. However a small percentage have it. I have learned my lessons well. There are good reasons for fidelity. There are especially good reasons for condom use, in particular with CSW and by the way they also have the right to stay healthy.
There's a good reason to donate sometimes for the unfortunate ones who caught the virus and for the ones don't having access to good medical support like people have in the EU or USA ...

[christian76]

Again, thanks for even answering on saturday. No questions left.

[Edward W Hook, MD]

Brief answers.  If you have HSV-1, it makes it very unlikely that you can get infected with HSV-1 from another person at any location.  The antibodies your body has created in response to your own infection will prevent further infection.  You do however remain vulnerable to HSV-2 and could get if from a sex partner; your HSV-1 infection offers some, partial resistance to infection but would not prevent it completely, just reduce your chances of infection.

Regarting HIV and STD treatment and prevention, sceintists from all over the world share information regarding advances in treatment and prevention of both STDs and HIV. The quality of care available in Germany is very good and any differences between care available in Gemany and North America reflect local decisions and resources, not knowledge.  EWH

[christian76]

Dear Doctor!
Thanks a lot for your very quick answer. Let me ask you something additional. How big are the odds of contracting Herpes by mutual oralsex, given that I have Herpes 1 since I was a child. Most People in Germany have it. Provides my imunesystem defense against Herpes 2? Another question is are there differences in the way of treating STDs in the USA and the EU? My opinion is that especially germany is not really up to date regarding HIV, have doctors in the USA knowledge wich is more up to date or depends this on the individual doctor. As you work in this place 30 yrs. you must have quite a unique ,,knowledge". hard to explain in english ... Do countries work together to share the lastes news about fighting HIV? I know the  questions are offtopic, anyway this will be my last mail, i have calmed down a lot eversince... Chris