STD chances from Two hour encounter

Hello Doctor

    On Saturday Nov 17th I had a two hour encounter with an expensive (important?) masseuse/escort.  Within the two hour episode:
    1.) Unprotected oral (both ends 3 times, not to ejaculation)
    2.) Protected  Vaginal Sex (3 times , roughtly 10-20 each time)
    3.) Full Body Massage (really good by the way)
    4.) Kissing

   I asked her if she was clean, she said not to worry, she is clean, but it's always good to get testing.

    Here are my symptoms after four days
    1.) Sore Throat (mild)
    2.) Clogged Ears
    3.) Nausea
    4.) A Lot of worry

     I checked repeatedly for discharge and I do not have any, nor do I experience discomfort in my genitals, other than a heightened sensitivity, which I think could be anxiety.

    I have an appt today to see my doctor, in which I will ask for a blood test, swab for STDs and HIV. I understand per previous posts, that in terms of HIV , my chances are nil. i would like to know your thoughts.

Thank you for your time.

[Edward W Hook, MD]

From a statistical perspective your risk for HIV is virtually non-existant and your chances of having acquired an STD from this exposure is very, very low.  I would urge you not to worry and once the test results for bacterial STDs from todays visit are back you can feel totally comfortable.  Below I will provide some elaboration on this summary statement.

Exsposures:
First realize the the chances of your partner  being infected are low,  Many visitors to this site seem to assume that if they have been exposed to a commercial sex worker they have been exposed to HIV and/or STDs.  The facts are that most CSWs are not HIV infected, nor do they have STD.  

Second, your exposures were low risk.  There is virtually no risk of acquiring HIV from oral sex (giving or receiving), from having protected vaginal sex, from kissing or from contact through a massage.  With regard to STDs, the only plausible concern is that you may have been exposed to something during oral sex.  In this context the STDs of concern are gonorrhea (but not chlamydia) non-gonococcal urtheritis (NGU) or possible herpes although this too is very unlikely unless your partner had a lesion (sore).  The tests for bacterial STDs (gonorrhea, NGU) are very good and if they are negative, that too makes your having acquired an STD unlikely.

Finally, the combination of symptoms you describe do not add up to STD or HIV.  You may have a community acquired viral respiratory tract infection or this may be a (not uncommon) manifestation of anxiety but the combination of symptoms you describe (and they should be considered as a group, not individually) are inconsistent with STD and HIV, including the acute retroviral syndrome.

Please don't worry and after you visit today no further testing is needed.  EWH

[whatisay]

Rest easy the doctor will most likely say- by activity

1) oral you to her- at risk for herpes gon. and syphilis, but low very low risk.
2) safe sex
3) safe
4) colds and general infection s we all get all the time HSV 1 which you may already ahve as this is so common.  

by symptoms

you have a cold- symptoms rarely indicate an STD and the docotr never relies on them for an HIV infection because early HIV infeciton symptom are so similar to everyday run of the mill infections.  Fever? sore throart?  only caused by HIV?  Lastly anxierty is the main cause of symptoms when someone posts with a similar story.

Relax- get tested to put you at ease, but not because of the event.  Wait for the docotr to confirm this, but I hipe this helps put you at ease.

[Justthefactsplease]

Thank you WhatIsay, it's pretty much as I thought. But it's hard to be objective when it's your own body, so we rely on the words on someone else.

[Justthefactsplease]

Thank you WhatIsay, it's pretty much as I thought. But it's hard to be objective when it's your own body, so we rely on the words of someone else.

[Justthefactsplease]

Thank you Dr Hook,

    I just finished my appt.  Upon retelling my fears to my doctors, she immediately checked my neck area and above.  She said everything looks good in my neck,my ears are good, I'm breathing fine, and that the only thing I have is a little redness in the tonsil.  She said it looks  like I caught a cold.
    She didn't even recommend testing, but to put me at ease, she took a swab from my throat, a urine and blood sample for STD Screening.
     The only thing she could not comprehend were the abcesses on my leg.  Mind you, I've had abcesses before and I am susceptible to infection.  They look like pimples and they hurt a little. They could be alot of things, an abcess (abscess), a pimple, or just a reaction to the massage oils.
     At any rate, she prescriped Bactrim for those red bumps and told me to use them if they don't clear up soon, or get worse.
    I await my blood report on Monday/Tuesday and will update the thread.

Thank you.

[ibizan]

why would it b that CSW's who have loads of sexual contacts don't statistically have  std's/and they use condoms or not...and those of us with low/minimal contact get them?man whoever said life is fair?

[mayflowers]

I have to agree with ibizan.  CSW worker must all have HPV, just b/c statistically they have a huge amount of contact with people.    Even with condoms, we know that HPV can still be transmitted.  Most of them probably already have herpes.  I would assume that before they got into the business, they slept with a lot of people - how else do you get experienced?  With that "training" they probably have already had a few different diseases.

I really have to disagree with ppl that say that sex workers don't have STD's.  It's just common sense that they do have something and in particular I would say HPV and herpes.

[ibizan]

any stats on female csw's and rate of high risk hpv or low risk?probably hard to track yes?since condom use doesn't completely stop hpv from going thru skin.....curious and not fair!sigh!

[ibizan]

i know so many women who don't use condoms of half butted use them...multiple partners and no hpv or std's.....yet.....these guys/gals would hafta have something with all the contacts they have...how could they not?i'm head scratching here......thanks mayflowers..like reading ur feedback!

[mayflowers]

I think that everyone who has been with more than one person, has HPV but they just don't know it yet.  Most ppl get it in their teens or 20's and their immune system respresses it.  And the fact is that most people don't experience  anything bad from HPV.  Only 5% actually have negative effects of HPV.  So, if they don't have a bad pap, they will never know they have HPV.  It's very common and even Dr Hansfield says that it all sexually active ppl have been exposed to at least 1 type of HPV, and the most common are 16 & 18 which also cause abnormal paps and cancer.

[Justthefactsplease]

After reading Dr. Hook's statement:

My assumption that CSWs don't have STDs is because their health is the most important thing to them, and that's what keeps them going. Basically, because sex is their field, they practice safe sex and act accordingly.

For example, porn stars.  They have regular check ups.  I assume sex workers are the same.

Those are just my thoughts.

[mayflowers]

All porn stars have HPV and most have herpes.  That is actually a fact.  Search porn and you will Dr. H's answer.  HPV is unavoidable with the number of people they sleep with and herpes is usually avoidable yet people don't always know when they are going to have an outbreak.

There was also a rash of hysteria a few years ago when a porn star got HIV while working in Brazil (they don't follow US guidelines) and transmitted it to 4 other actresses.  Remember this a window of time that it isn't detectable.

While you are probably safer with a good, high class sex worker b/c they use safe sex practices and are tested on a regular basis for bacterial and HIV, you must be aware that there is a window of time that certain diseases don't show up.   While I agree that HIV is probably not an issue with CSW b/c of their safe sex practices, other diseases are still a risk.

Here's a question - how does the CSW know that the person they are with doesn't have something?  Unless you use a body glove, they are still exposing themselves to some rather unsavory characters, people that lie about their status.

Of course, this is just MY opinion and not that of Medhelp.

[ibizan]

In my opinion women r ones who suffer the brunt of HPV..i think if a male had a LEEP surgery he wouldn't like it.Unless u have wart bearing strain and ur body clears it no problemo!i don't believe CSW's ask customers if they have diseases they want the $$$$!and unavoidable to contract something even with condoms!Don't buy that most CSW's are that health conscious and have good self esteem..having sex for $$$ with tons of people for a living is pretty lowlife in my opinion.Several i've encountered in my work are drug addicts.they have a right to earn a living but i wouldn't want to be with someone whose had sex with a zillion people...but men are wired diff than many women.....and people lie about their histories.If i woulda remained celibate like i was and not believed my x about his history and was adamant about condoms i wouldnt've gotten HPV.Upset with myself still......better than I was this past summer but have no desire for sex or 2 meet anyone......finding one who is truthful and considerate of a partner in this day and age is a rarity.Lucky people who do!my health is more important than sex!

[Edward W Hook, MD]

A bit of clarification here.  That CSWs are at increased risk for STDs and HIV is a fact.  At the same time, other than HPV and perhaps HSV, most CSWs do not have HIV or other STDs, particularly the ones that can be treated.  A few points to help put this in context.

HPV.  Current estimates are that 75-80% of all sexually active women will contract HPV at some time in their life.  Research shows that women with a single partner acquire HPV at a rate of at least 15% per year (two studies).  Less data for men but likely as data accrue there will be similar figures.

HSV.  Increased partners, increased HSV-2.  At the same time, 8% ( one in 12) Americans with a single lifetime partner have HSV-2 and rates increase with increased numbers of partners.   Also at the same time, in the general population, on average those who have had more than 50 partners have about a 50-50 chance of having HSV-2.  Not everyone with many partners has HSV-2.

Finally, please remember that most STDs are passed to others by persons who do not know they are infected.

So, now back to CSWs.  Like people in general, there is a spectrum of disease rates in CSWs.  This variation occurs based on how long they have been in the business, what kind of protective practices they practice (remember, they do not want STDs or HIV either), where they live, what other problems (drugs, slavery, etc) they have, who their past clients have been and many, many other variables.  That said, I again stand my my statement above.  If you were to go out and test a large number of CSWs, while certainly most would have HPV and many would have HSV (just like in the non-CSW population although with somewhat higher rates), you would find that they had higher rates of other STDs (including HIV ) than the general population but most (over 50%) would not have other STDs, other than the two I mentioned above (HPV and HSV-2).

I hope this is helpful and of interest.  I probably will not add further to this thread.   EWH

[H. Hunter Handsfield, M.D.]

Usually I don't comment on Dr. Hook's threads, or vice versa.  But he and I discussed this thread and I though I would add some educational (I hope) perspective to Dr. Hook's excellent explanations.

Although numbers of sex partners of course contributes to STD/HIV risk, it is not the main determinant.  Patterns of sexual behavior--who has sex with whom, when and how partners are selected, and the frequency of overlap between partners, and other factors collectively are more important.  These factors determine sex partner networks, and the nature of the networks has more effect on overall risks of STDs (especially the treatable bacterial STDs) than partner number does.  This is why STD rates in the US are much higher in some minority populations than in whites and persons of Asian ancestry.  For example, the average no. of lifetime sex partners is no higher in African Americans than in whites, yet AAs have several times higher rates of gonorrrhea or chlamydia and double the rate of herpes compared with whites.  Similarly, the average no. of lifetime partners is pretty much the same in sub-Saharan Africa as in the US or Europe, but STD and HIV rates in heterosexuals are many times higher.  (Neither of these facts is because of African ancestry.  It's social, not biological.)

Now going back to CSWs:  From a network perspective, a CSW typically has lots of partners, but most of those partners are people who are otherwise not sexually active or monogamous.  So the chance she has sex with an infected person may be very low.  (Many CSWs are at greater STD risk from their regular boyfriends than from their customers.)  Some CSWs are very knowledgeable about STD risks and know how to protect themselves.  Some choose their partners well--for example, most of their customers are just like most of the people who post questions on this forum, i.e. very low risk.  Many insist on consistent condom use.

Bottom line:  in the US, a small portion of the total STD burden--probably less than 5%--is attributable to commercial sex.  Most STDs are acquired through mutually consenting, non-commercial sex.  The average young woman someone might meet in a bar or at a college social probably has a higher chance of carrying an STD than the average CSW.

That's not to imply that unprotected sex with a CSW is safe.  Some CSWs indeed are very high risk all the time.  Others are mostly safe, but intermittenly less careful.  (Maybe she's out of cash and really needs a fix, or the rent is due, or the kid at home is sick and needs meds--all the things that affect many of us from time to time.)  So be selective in partner selection, even if it's in a commercial context.  And keep those condoms handy and use them!

This also is my only and last comment.  I suggest that those who want to pursue the discussion take it over to the STD support forum.

HHH, MD

[ibizan]

Thank u for taking the time to clarify and give stats.Very educational as usual!Thread closed by this civilian!

[Justthefactsplease]

Tests were negative.
It's amazing how the symptoms go away once you hear the results.
No need for responses.

A.S.