CSW exposure in Sydney

[larry152]

Dear Doctors,

First of all, thanks for the amazing job you are both doing on this forum.

During a business trip in Australia, I visited a legal brothel in Sydney and had oral and vaginal sex with a (Chinese?) CSW. I didn't ask her for her HIV / STD status but the owner later told me that the girls were clean and had a regular check-up done. I think I remember she put me a condom (including for oral) but I was somewhat drunk and now am second-guessing myself (although I know that CSWs in legal brothels there wouldn't generally do anything unprotected). I'm HSV-2 positive.

As you must well know, HIV is rare in CSWs in Australia and Sydney in particular. I understand from various reports / studies done by B. Donovan and others, that there's never been a documented / reported case of HIV from / to a CSW since the beginning of the epidemic. In addition, based on annual surveillance reports published by the University of NSW, HIV prevalence is similar and even lower for CSWs than the general population at less than 0.1% (among the 3225 CSW tested last year by the SHCs across Australia, none was positive).

My questions, which I must acknowledge are not unique at all, are the following:

-Assuming it was unprotected (I know that oral sex is close to no risk), that the risk she was infected is 1/1000 (does that sound reasonable?) and the risk of transmission is 1/500 for vaginal (based on my on HSV-2 status), my risk was 1 in 500,000 or close to zero for that exposure. Do you agree with that calculation?
-I think you are going to tell me that I do not need testing except for peace of mind / re-assurance. Do you confirm?

Many thanks for your time and support.

[larry152]

Hi Doctor,

Sorry for the follow up question. I really intended to stop with the previous one but 16 days post exposure (last Saturday), I had a sore throat (still have it and not so severe: inflamed tonsil with a little pus I guess). No fever, no rash, just this sore throat. Dr Handsfield has repeatedly stated that acute HIV symptoms usually occur 10-14 days after exposure and almost always include high fever in the picture. I guess I just have the same viral / bacterial infection I had by the way last year at the same time of year.

I'm fairly sure your previous answer regarding HIV stands. Could you please confirm there is still no valid reason to worry and I should move on?Thanks. Best regards.

[larry152]

Great. Thanks Doctor.

[Edward W Hook, MD]

I woul agree with your assessment about other STDs as well.  Again, my guess is that your exposures were condom protected and if that is the case, there is virtually no risk for gonorrhea or chlamydia.  Take care.  EWH

[larry152]

Thanks so much for your answer and re-assurance Doctor.

I know this is not the right forum for this follow-on question which should belong to the STD forum and I apologize about this but it is related to the same exposure. I would assume that, although higher than HIV, the risk for chlamydia and gonorrhea transmission from such exposure would be limited given the low prevalence of both in female CSWs in Australia (almost 0% and 5-6%, respectively, based on the same above-mentioned NSW Uni's report). Would you agree with that statement?

That will be it for my questions. Thanks again for taking the time to read them and keep up the great work on Medhelp.

[Edward W Hook, MD]

Welcome to our Forum.  It is clear from reading your post that you have both carefully researched and thought through the exposure you report.  I have little to add except to point out that all of the estimates you have use are a bit conservative and that in all likelihood, despite your memory deficit, that a condom was used throughout the encounter.  I agree with your estimates but also would be most surprised if the encounter were not condom protected.  Either way, this encounter was probably lower risk for HIV than if you ha met a non-CSW partner at a bar either in Australia or here in  North America.  I agree that for your testing is only to provide peace of min, not because of any appreciable risk of HIV.  Take care.  EWH