Is my lifestyle risky?

[Giancarlo2]

Hello doctor.

I visit prostitutes 2 times per month. That's 24 encounters with csws per year.

That's my whole sex life, I rarely have sex with other women.

My encounters usually go like this:

I start by french kissing her, then proceed to kiss all her body and perform unprotected cunnilingus. After that, she puts a Durex extra sensitive (ultra thin) condom and perform fellatio on me. With that same condom on I proceed to vaginal sex in different positions until I ejaculate. I never engage in anal sex.

My questions:

1) Am I at a significantly greater risk of catching an STD than a person who doesn't visit prostitutes? Do you consider my lifestyle risky?

2) Is the ultra thin condom less safe than other condoms?

3) What are the most likely STDs that I can get? On any given year, after 24 encounters, what are the probabilities of catching these STDs?

4) Any additional advice is welcomed.

Thank you.

[Edward W Hook, MD]

Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through receipt of oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you get gonorrhea or NGU you would most likely develop symptoms of urethritis (penile infection).  Even if your partner had an STD (any STD and it is likely she will not), most exposures do not lead to infection.  

As far as HIV is concerned, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.

EWH

[Giancarlo2]

Hello doctor.

I made this question as a new thread but doctor H.H.H deleted the question and told me to ask it to you as a follow up question in this thread.

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I've been fantasizing with transexuals a lot lately and yesterday I decided to visit one.

We had unprotected mutual fellatio for a long time and also protected anal sex (I was the insertive one).

She has a very good reputation online and everyone recommended her to me.

We chatted before meeting and I told her that I wanted protection for oral sex and she didn't seem to like it. So then I told her I was willing to had unprotected oral sex only if she assured me that she was clean and never had any kind of desease.

She told me:

"Listen baby, I would never ever do anything to harm anyone. Thank god I've been fortunate enough and never had any kind of infection or disease."

So I trusted her. Was it naive from my part? Considering she probably engages in risky sexual acts every week with different men?

I am aware that STD risks from unprotected fellatio are relatively low, but it's always good to read some reassurance for peace of mind.

Sorry for asking something that has been asked many times before but I would like some input to my situation in specific.

[Giancarlo2]

Thank you very much for your answer.

[Edward W Hook, MD]

Welcome to our Forum.  If I were to restate your question I would say HOW risky is your lifestyle rather than IS your lifestyle risk.  The overall answer to your question is that your risk from these sorts of exposures is low and actually probably lower than it would be if you were to meet 24 new partners for sex or over the internet for sex each year.  There are so many things which can influence risk that it is impossible to give you a numerical assessment of your risk.  

There are, of course, many, many variables which might modify your risk for STDs such as whether or not your CSW partners get checked regularly for STDs (the more they get checked, the lower the risk), whether or not condoms tend to break (statistics tell us that they break about 1% of the time). etc.

Overall, as long as your condoms stay intact, there is virtually no risk of HIV from any of the exposures your describe.  HIV is not transmitted by kissing or with condom protected sex.  As for your performance of unprotected cunnilingus on partners, not only is it unlikely that they have HIV but the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  I would not worry about this.  

As for your other questions, again, things are relatively low risk:

1.  Not particularly
2.  Whether ultra-thin condoms break more often than others is not known.  If your condoms do not break, you have nothing to worry about.
3.  Your only risky exposure in the activities you describe is unprotected cunnilingus on your partner.  If she has a lesion you have a risk of gettng the infection which is causing the lesion-herpes or syphilis.  As for other STDs, the only STD which you might be at risk for is for oral gonorrhea and that risk is low (certainly less than 1%, probably lower)

Bottom line, your risk from the activities you describe is rather low.  EWH.