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unprotected sex with sex worker
Hello Dr Handsfield: I've found your forum greatly informative. I had a quick question for you: I had unprotected sex with a prostitute in Las Vegas last week, which consisted primarily of oral sex. She did it to me - and I to her. At the last minute, for literally 2 minutes, I got stupid and inserted myself vaginally - without a condom. I pulled out just before ejaculation. At the beginning of the encounter, this person had assured me she was clean. This is my first (and last) encounter with a prostitute - and it was a dumb, alcohol induced mistake. I completely get that part - in spades. My question: is it your opinion that I need to get tested for HIV and other STDs after this encounter? Thank you, sir.
MEDICAL PROFESSIONAL
Welcome to the forum.
The chance any particular Las Vegas CSW has HIV is very low, probably under 1 in 1,000 -- and even lower in this case, since most people don't lie when asked directly. Further, if she had HIV, the chance of transmission from the exposures you describe is no higher than one in many thousand. Together these odds mean the chance you caught HIV is no higher than one in several million -- probably lower than your odds of hitting the mega-bucks at the slots. (I calculate odds in this fashion frequently, but it feels particularly satisfying for a Las Vegas exposure!)
As we have said many times, in general it doesn't make sense for sexually active people to get tested for HIV or other STDs after individual exposure events unless the risk is especially high, e.g. a partner known to be infected or especially high risk situations like anonymous unprotected anal sex between men. It's wiser for sexually active persons outside mutually monogamous relationships to just be tested routinely from time to time, like every 1-2 years. This exposure definitely doesn't qualify as sufficiently risky. You may decide to be tested if this reassurance isn't sufficient and you need the psychological relief of a negative result, but from a medical or risk assessment perspective it definitely isn't necessary.
The risk of other STDs is higher, but still low enough to not require testing, assuming you don't develop any STD symptoms like genital sores or penile discharge. On the other hand, obviously you are sexually active and not monogamous, so perhaps it's time for routine testing, since it's on your mind.
Regards-- HHH, MD
The chance any particular Las Vegas CSW has HIV is very low, probably under 1 in 1,000 -- and even lower in this case, since most people don't lie when asked directly. Further, if she had HIV, the chance of transmission from the exposures you describe is no higher than one in many thousand. Together these odds mean the chance you caught HIV is no higher than one in several million -- probably lower than your odds of hitting the mega-bucks at the slots. (I calculate odds in this fashion frequently, but it feels particularly satisfying for a Las Vegas exposure!)
As we have said many times, in general it doesn't make sense for sexually active people to get tested for HIV or other STDs after individual exposure events unless the risk is especially high, e.g. a partner known to be infected or especially high risk situations like anonymous unprotected anal sex between men. It's wiser for sexually active persons outside mutually monogamous relationships to just be tested routinely from time to time, like every 1-2 years. This exposure definitely doesn't qualify as sufficiently risky. You may decide to be tested if this reassurance isn't sufficient and you need the psychological relief of a negative result, but from a medical or risk assessment perspective it definitely isn't necessary.
The risk of other STDs is higher, but still low enough to not require testing, assuming you don't develop any STD symptoms like genital sores or penile discharge. On the other hand, obviously you are sexually active and not monogamous, so perhaps it's time for routine testing, since it's on your mind.
Regards-- HHH, MD
Thank you very much for your time, Dr. Handsfield. I should add that I'm in fact happily married and have been perfectly monogomous for 9 years. Now you can imagine how utterly dumb I feel having put myself in this position. Thank you again for your reassurance and wisdom. Best regards.
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