Protected Sex with Ghanaian Prostitute

[steve529]

4 days ago I had sex for the first time with a prostitute in Ghana with unknown status. The anxiety is causing me great stress and I can assure you I will never do something so foolish again, even in my own country.

I had protected vaginal intercourse with the prostitute using a condom. One condom slipped when I pulled out so I got a new one and put it on. I confirmed no breakage in either condom post examination. After reading many posts I am assured I am at low risk for fluid transmitted STDs. My worry is skin to skin transferable STDs. My worry stems from not actually taking the time to look or ask the status of possible STD infection due to my intoxication.

My questions are;

1) Can you confirm the low risk fluid transmission STD exposure (HIV ect)?
2) Am I also low risk for skin contact STD infection? Can this number be Quantified?
3) Do you recommend any testing (aside from my personal piece of mind)? I ask because of future sexual encounters.
4) If testing is recommended, what STDs should the tests include, what tests for each STD and finally the time period for each test so the results can be trusted.
5) Should I abstain from hand, oral and vaginal sex while I wait for testing? I would hate to have something and infect another person because of my foolishness.

Thank you for your time and knowledge.

[steve529]

Thank you Dr. I will do exactly as specified.

[Edward W Hook, MD]

Welcome to the Forum.  Had your encounter been unprotected, your concerns would be particularly appropriate since HIV rates are relatively high amongst Ghanan commercial sex workers (but still most Ghanan CSWs do not have HIV).  Condom use was the right thing to do and use of the condom, as long as the tip of the penis was covered, makes the possibility of HIV not a concern (same for most other STDs).  While there is a theoretical risk of STDs spread by skin-to-skin contact causing your infection, the risk is also relatively low.  The STDs of concern following the sort of exposure you mention are herpes (HSV), syphilis and HPV (genital warts).   As far as each of these suggestions is concerned, I would suggest the following:

HSV.  If you do not develop an outbreak, presenting as small blisters and or ulcers at sites of exposure in 10-14 days following exposure, you almost certainly did not get HSV.  No other testing is needed.

Syphilis. This infection also presents as lesions, this time in the form of genital ulcers at sites of exposure.  Lesions appear, on average, within 21 days of exposure. In addition a blood test for syphilis, performed at about 3 months following exposure will provide complete assurance that you did not get syphilis.

HPV. If you got genital warts from this exposure, they would be expected to appear a few weeks after exposure.  If not, do not worry about this one either. There are no recommended tests for HPV infection in men.

I  hope these comments are helpful.  Overall, your risk of infection is quite low.  EWH