Welcome to the forum. Thanks for your question.
Escorts (which I define as expensive female sex workers by appointment) are generally believed to have low rates of HIV and other STDs. Most use condoms consistently, especially for vaginal or anal sex, and are tested frequently.
But even if your three escort partners were thought to have STDs, you are at little risk. Oral sex can be considered safe sex -- not completely free of risk, but zero risk for some STDs (including HIV and probably viral hepatitis) and low risk for all others. For all STDs, the transmission risk is a lot lower than for unprotected vaginal or anal sex. The chance you caught anything from a total of only 3 oral to penile exposures is very, very low. Your apparent lack of symptoms also is reassuring: if you had acquired herpes, gonorrhea, or syphilis, probably you would know it from the symptoms. Chlamydia rarely infects the oral cavity, and therefore rarely if ever transmitted by oral to penile sex. HPV is not usually transmitted by oral sex either.
From a strict risk assessment or medical standpoint, you don't need testing for any STD. However, most anxious persons probably are more reassured by negative tests than by the opinion or an expert. So I recommend a urine test for gonorrhea and chlamydia (these are valid any time more than 2-3 days after exposure) and blood tests for HIV and syphilis (which should be done at 6 weeks or more after your last exposure). No other tests are necessary or recommended.
Feel free to let me know the results after you are tested. Stay mellow in the meantime; you definitely can expect negative results.
Best wishes-- HHH, MD
Hello Dr Hunter. Many thanks for giving me some reassurance. The sad thing is that I'm a medical student about to graduate next year and despite knowing all this, I'm getting up to these risky activities. It has been almost two days since that encounter I spoke about above. I guess I'll know by this coming sunday if anything's up at all. Herpes is the only real worry of mine. I'm glad you mentioned that it is low risk. Would you mind giving me a number at all? Say 1 in a....? Many thanks again!
From an oral to genital exposure, you are at risk only for HSV-1, not HSV-2. The latter could theoretically be an issue, but oral HSV-2 infections are uncommon and I've never seen or heard of a genital HSV-2 infection that was acquired by orogenital exposure. For HSV-1, the average risk probably is no higher than 1 in 1,000 for oral sex exposure. Also, half of all adults have positive HSV-1 serological tests, generally dating to unrecognized childhood infection. If you're among that half the population, you are immune (or at least highly resistant) to a new HSV-1 infection. Finally, I would point out that although nobody wants genital herpes, if it happens, HSV-1 is the preferred type; in general there are few long term consequences of it and little risk of transmission to future partners. So even if you had the unusual bad luck to be infected after so few exposures, it probably wouldn't have much impact on your life. If you do a quick PubMed search, you can find literature on the differing natural courses of genital HSV-1 versus HSV-2. The thread below also addresses it.
Best wishes for success in your medical career.
Thanks so much Doc for this and for wishing me luck. Say if I don't get symptoms until the next 7-10 days, is it reasonable to be almost certain that I didn't catch it?
hello dr hansfield. hope you are well. i've taken your advice as stated above. i took a hiv rapid test on day 31 post the above event. i did it for some peace of mind as for the next 2weeks i'm busy . its true that this negative result is not conclusive. but is it ok to feel a little relieved at this outcome? i havent tested for chlamydia, gonorrhoea or syphilis as they didnt worry me at all plus no symptoms so.far. would you like to.comment on the result at all? many thanks sir
By 31 days, the antibody tests (both rapid and lab-based) pick up at least 95% of HIV infections -- so this is a very reassuring result.
Thanks for your comment. Does this mean that this test has 95% sensitivity at 31 days? Or does this mean that 95 out of 100 would have seroconverted by now in order to be detected by the above tests? Sorry I'm a little confused.
The former. The blood antibody tests are virtually 100% sensitive once antibody is present.