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Worried sick about sex with escort
Hello Doctor,
I am worried sick about what just happened about an two hours ago. I went to see a female escort but believe I ended up having unprotected sex against my will.
The escort gave me a hand job for a few minutes, then proceeded to do protected oral. Then, when I wasn't hard, she took off condom and continued rubbing penis as she straddled by pelvic area. Before I knew it it began to feel as though my penis was in her vagina with no condom. I am 99% sure I was having sex with her, because it no longer felt like her hand and felt like a warm vaginal cavity. Because I was only ever semi-erect, it's tough to tell for sure when penetration might have taken place.
I ejaculated (in what felt like her vagina). But then I noticed there was semen all over my upper legs. But she wiped her vagina as if it'd been penetrated.
She didn't give straight answer as to whether I was inside her; only a smug insincere response first that it was no big deal but then that it didn't happen, and that is "her little trick." She had evil grin as though she'd just "got" a lonely dude by infecting him with HIV against his will.
Questions:
1. Some part of me wants to believe it was indeed just her hand, but based on info I've given, do you think I had unprotected sex?
2. If it was unprotected vaginal, what was the point of escort starting with protected oral?
3. How many HIV-positive escorts deliberately straddle unprotected clients in efforts to infect them?
4. What is my risk of HIV from this exposure?
5. I'm considering PEP... how quickly do I need to go get it... will tomorrow afternoon be too late??
6. How long does PEP therapy take to be effective, and after that length of therapy how effective is it when initiated after 24 hours post-exposure?
7. Straight up, do you recommend PEP?
8. In USA, can I obtain this from an urgent care center, or do I need to go somewhere else?
9. Is presence of semen around penis/legs germane to insertion likelyhood?
I am worried sick about what just happened about an two hours ago. I went to see a female escort but believe I ended up having unprotected sex against my will.
The escort gave me a hand job for a few minutes, then proceeded to do protected oral. Then, when I wasn't hard, she took off condom and continued rubbing penis as she straddled by pelvic area. Before I knew it it began to feel as though my penis was in her vagina with no condom. I am 99% sure I was having sex with her, because it no longer felt like her hand and felt like a warm vaginal cavity. Because I was only ever semi-erect, it's tough to tell for sure when penetration might have taken place.
I ejaculated (in what felt like her vagina). But then I noticed there was semen all over my upper legs. But she wiped her vagina as if it'd been penetrated.
She didn't give straight answer as to whether I was inside her; only a smug insincere response first that it was no big deal but then that it didn't happen, and that is "her little trick." She had evil grin as though she'd just "got" a lonely dude by infecting him with HIV against his will.
Questions:
1. Some part of me wants to believe it was indeed just her hand, but based on info I've given, do you think I had unprotected sex?
2. If it was unprotected vaginal, what was the point of escort starting with protected oral?
3. How many HIV-positive escorts deliberately straddle unprotected clients in efforts to infect them?
4. What is my risk of HIV from this exposure?
5. I'm considering PEP... how quickly do I need to go get it... will tomorrow afternoon be too late??
6. How long does PEP therapy take to be effective, and after that length of therapy how effective is it when initiated after 24 hours post-exposure?
7. Straight up, do you recommend PEP?
8. In USA, can I obtain this from an urgent care center, or do I need to go somewhere else?
9. Is presence of semen around penis/legs germane to insertion likelyhood?
MEDICAL PROFESSIONAL
The addtional information does not change my opinion or advice. Question 4: Yes. Question 5: I have never seen a patient with an apparent one-time exposure who acquired HIV from it -- certainly not a heterosexual exposure.
Thanks for the thanks, but that should end this thread. It is unlikely there is any information you could provide that would change my assessment and advice. Take care.
Thanks for the thanks, but that should end this thread. It is unlikely there is any information you could provide that would change my assessment and advice. Take care.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help, but not sure I can. You're mostly asking me to judge the details of your sexual exposure, but you were there, I wasn't. To the extent I can try, I'm answering personally; there is nothing in my professional experience or training that helps. To your questions:
1,2,9) When an escort insist on condoms, it usually indicates she doesn't have HIV and intends to remain that way. And since oral sex is generally a lot safer than vaginal sex, if she used a condom for oral sex, it's a good bet she wouldn't allow an unprotected penis into her vagina. That the majority of your ejaculate apparently was external seems to support the probability that you weren't in her vagina.
3) How many escorts deliberately try to infect their clients? Zero, I would guess. I can't imagine it happening.
4) Even if there was unprotected vaginal sex, and if your escort partner had HIV, the average chance of transmission is once for every 2,000 exposures. (That's why many spouses of HIV infected people remain infection free themselves for years on end.) (Going back to question 3: if someone wanted to give someone HIV, why would s/he use a method that has only 1 chance in 2,000 of being successful?)
5-7) PEP is not indicated in this situation and you'll probably have trouble finding a doctor or clinic willing to prescribe it. We would refuse if you were to come to my clinic. The effectiveness of PEP is believed to be quite high, probably in the 90% range. However, this is not a very scientific estimate; there are no good data on how well it works.
8) If you insist on pursuing PEP, first call your local health department to learn local guidelines; or, if there is an HIV/AIDS clinic in your vicinity (e.g. at a major medical center) call for their advice.
All things considered, I think there isn't any significant HIV risk here. Of course given the many uncertainties about the exposure, of course I cannot guarantee that. But if I were in your situation, knowing what I know, I don't think I would even have an HIV test, let alone seek PEP.
I hope this helps. Best wishes-- HHH, MD
1,2,9) When an escort insist on condoms, it usually indicates she doesn't have HIV and intends to remain that way. And since oral sex is generally a lot safer than vaginal sex, if she used a condom for oral sex, it's a good bet she wouldn't allow an unprotected penis into her vagina. That the majority of your ejaculate apparently was external seems to support the probability that you weren't in her vagina.
3) How many escorts deliberately try to infect their clients? Zero, I would guess. I can't imagine it happening.
4) Even if there was unprotected vaginal sex, and if your escort partner had HIV, the average chance of transmission is once for every 2,000 exposures. (That's why many spouses of HIV infected people remain infection free themselves for years on end.) (Going back to question 3: if someone wanted to give someone HIV, why would s/he use a method that has only 1 chance in 2,000 of being successful?)
5-7) PEP is not indicated in this situation and you'll probably have trouble finding a doctor or clinic willing to prescribe it. We would refuse if you were to come to my clinic. The effectiveness of PEP is believed to be quite high, probably in the 90% range. However, this is not a very scientific estimate; there are no good data on how well it works.
8) If you insist on pursuing PEP, first call your local health department to learn local guidelines; or, if there is an HIV/AIDS clinic in your vicinity (e.g. at a major medical center) call for their advice.
All things considered, I think there isn't any significant HIV risk here. Of course given the many uncertainties about the exposure, of course I cannot guarantee that. But if I were in your situation, knowing what I know, I don't think I would even have an HIV test, let alone seek PEP.
I hope this helps. Best wishes-- HHH, MD
MEDICAL PROFESSIONAL
Perhaps your STD clinician has more specific information than I do about the likelihood escorts in your community have HIV. If that's not her reasoning, and if you are accurately describing her opinion and advice, obviously I disagree. I already said that if I were in your situation, I wouldn't even feel a need to be tested, and I would continue unprotected sex with my wife (or other partners if I were single). Accurate HIV testing can be done well before 3 months.
Otherwise, I have nothing to add to my previous comments. That will be all for this thread; I won't have any further advice.
Otherwise, I have nothing to add to my previous comments. That will be all for this thread; I won't have any further advice.
I did place some telephone calls to a local hospital system and an std clinic; both told me I would "have to come in" to discuss anything. So I went to an STD clinic today (not necessarily just about PEP) and described my exposure in detail, and asked what to do. The nurse practitioner gave me a urine test for two STDs. They advised to return a few weeks for blood tests for other STDs.
Anyway, she told me that based on the time since exposure (just about 72 hours) that PEP for HIV would not be very helpful, advised against it but said it was up to me. I declined.
However, she voluntarily was lecturing me on the risk of HIV and was telling me based on info my partner was "very high risk," and that based on the high presence of other STDs in sex workers, and the condition of their sex organs that if my partner did have HIV, that it was "very likely" I got infected. She further said that caucasian males who see sex workers are at an extremely high risk of becoming infected with HIV.
Anyway, this information alarmed me and also more severely alarmed someone close to me.
Just wondering why this info (which seems to somewhat mirror what some health agencies suggest) is different from your advice (which also seems to be implied by different "official" information here and elsewhere)?
With this info in mind, is my risk high enough that I will want to be extra cautious with exposing others to my own bodily fluids until I can tested in three months?
Anyway, she told me that based on the time since exposure (just about 72 hours) that PEP for HIV would not be very helpful, advised against it but said it was up to me. I declined.
However, she voluntarily was lecturing me on the risk of HIV and was telling me based on info my partner was "very high risk," and that based on the high presence of other STDs in sex workers, and the condition of their sex organs that if my partner did have HIV, that it was "very likely" I got infected. She further said that caucasian males who see sex workers are at an extremely high risk of becoming infected with HIV.
Anyway, this information alarmed me and also more severely alarmed someone close to me.
Just wondering why this info (which seems to somewhat mirror what some health agencies suggest) is different from your advice (which also seems to be implied by different "official" information here and elsewhere)?
With this info in mind, is my risk high enough that I will want to be extra cautious with exposing others to my own bodily fluids until I can tested in three months?
Dr. HHH,
I just have few follow-up comments/questions before 36-hour mark (some stuff was left out of opening post, others are in response to your answers).
I think I left out of the opening post that I did ask her directly if she had HIV, and she reported she did not and that her last testing date was last month (I am aware you and Dr. Hook suggest that most people do not lie; not sure if same applies with commercial sex workers (with reputation/business on line), when answer would be embarassing/personal, and when such comments come after sex). I realize things can only be assumed, but (1) As a physician at STD clinic, do you have any more thoughts on this?
Also, upon further reflection I was unquestionably inside the CSW's vagina... but I believe it was for between 1-2 minutes only. I'm concerned due to the fact the CSW allowed this to happen (and I'd be just as concerned if it was a non-CSW stranger due to lack of attention to protection... but the fact she was CSW doesn't help). Also, while inside I was not fully erect, and I am circumsized... so I'm not sure whether my penis "reached" her cervix, or if that even matters. I did have some freshly-healed skin and remains of a small cut (crusted over), but there didn't appear to be any blood. However, I experienced itching on skin of penis, especially around area of healing cut. Also, urethra was somewhat sore/mildly burning in following hours. (2) Does that indicate CD4+/macrophage activity in the area, and/or foreign WBCs in urethra/cut?
Given the uncertainty, I will get testing to be sure of my status. I bought a Home-Access HIV-1 test kit (which is supposedly 1st generation). Given that, should I wait till 12 weeks?
Anyway, given my follow-up comments, (3) does that at all change your recommendation for seeking PEP?
(4) About your comment that many serodiscordant couples remain that way for years, does that include repeated episodes of unprotected vaginal sex?
(5) Considering the thousands of cases you've seen in your career, and the plethora of questions on these forums, looking to the ones that involve "real" risk (unprotected insertive vaginal, either with sex workers or know-HIV+ women)... do you have a since of how many of these encounters actually result in HIV infection (I realize you have already stated 1 in 1000 to 1 in 2000; just wasn't sure what anecdotal evidence you've seen on this to corroborate/exemplify the figures).
I thank you in advance for the follow-up answers and for offering this online service.
I just have few follow-up comments/questions before 36-hour mark (some stuff was left out of opening post, others are in response to your answers).
I think I left out of the opening post that I did ask her directly if she had HIV, and she reported she did not and that her last testing date was last month (I am aware you and Dr. Hook suggest that most people do not lie; not sure if same applies with commercial sex workers (with reputation/business on line), when answer would be embarassing/personal, and when such comments come after sex). I realize things can only be assumed, but (1) As a physician at STD clinic, do you have any more thoughts on this?
Also, upon further reflection I was unquestionably inside the CSW's vagina... but I believe it was for between 1-2 minutes only. I'm concerned due to the fact the CSW allowed this to happen (and I'd be just as concerned if it was a non-CSW stranger due to lack of attention to protection... but the fact she was CSW doesn't help). Also, while inside I was not fully erect, and I am circumsized... so I'm not sure whether my penis "reached" her cervix, or if that even matters. I did have some freshly-healed skin and remains of a small cut (crusted over), but there didn't appear to be any blood. However, I experienced itching on skin of penis, especially around area of healing cut. Also, urethra was somewhat sore/mildly burning in following hours. (2) Does that indicate CD4+/macrophage activity in the area, and/or foreign WBCs in urethra/cut?
Given the uncertainty, I will get testing to be sure of my status. I bought a Home-Access HIV-1 test kit (which is supposedly 1st generation). Given that, should I wait till 12 weeks?
Anyway, given my follow-up comments, (3) does that at all change your recommendation for seeking PEP?
(4) About your comment that many serodiscordant couples remain that way for years, does that include repeated episodes of unprotected vaginal sex?
(5) Considering the thousands of cases you've seen in your career, and the plethora of questions on these forums, looking to the ones that involve "real" risk (unprotected insertive vaginal, either with sex workers or know-HIV+ women)... do you have a since of how many of these encounters actually result in HIV infection (I realize you have already stated 1 in 1000 to 1 in 2000; just wasn't sure what anecdotal evidence you've seen on this to corroborate/exemplify the figures).
I thank you in advance for the follow-up answers and for offering this online service.
Ok Dr. HHH. Thank you for your advice... based on it I feel a good deal better.
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