Dear Doctors,

I am a 36 year old male from UK. Heterosexual, otherwise healthy, no drug use, Last HIV test March 2008-, negative.
Since then :
1.Had 2 girl friends , had steady relationship with each for 6 months each. Had condom protected vaginal sex always and occasional unprotected oral sex. Both are educated professionals . However had unprotected sex with one of them only in one instance- 2-3 times in one night, 1 year ago. She is in her 40s, had just came out of a long term relationship and told me that she didnt have any other partners apart from husband. She said she had been tested a few years back as part of investigation of ? infertiity and found to be negative. She had however been treated for chlamydia. I did an NHS test for chlamydia( urine) which was negative

2.Apart from this, had contact with around 7-8 escorts in the last 2.5 years. These are highly paid sex workers. Always condom protected vaginal sex . Condom was intact all times and I took extra care when I withdrew to make sure there is no accidental slippage etc.. Had sessions of intense kissing . Oral sex was mostly protected but had 3-4 episodes of of unprotected oral sex( both ways-fallation and cunnilingus). Last session( protected vaginal and protected oral was 4 weeks back) . No anal sex.

I have no symptoms.

Based on this, how would you assess my risk of HIV and STDs?

Would you consider this a high risk life style and have you encountered patients with similar histories who had any significant STDs?

Should I test and if so , what tests ?

Many thanks

[Dr Sean]

Hello

Yes, I would consider this to be a sexually high risk behaviour pattern.

I understand your point regarding the amount the sex workers are paid but generally speaking STD's don't respect wallets.

You are potentially from the oral sex - fellatio and cunninglingus - at risk of acquiring one or more of:-

1) chlamydia
2) gonorrhoea
3) herpes 1 or 2

4) an outside chance of syphilis

There is no chance of acquirng HIV from being sucked. There are an extremely small number of cases - perhaps a dozen out of 85 million cases of HIV - where cunninglingus is thought to have been implicated as a causative route.

I have indeed met many people who have contracted STD's from exposures similar to yours.

Best regards, Sean

Dear Dr. Cummings,

Thanks for the reply. Some more doubts please!

1.I understand that Chlamydia can be silent.
But would you expect some symptoms from gonorrhea and syphilis at least in the initial infection phase.

And regarding Herpes, if there are no symptoms, would you still suggest testing? If an asymptomatic person has a positive Herpes test, would you treat it?

2.So what tests would you suggest?

HIV?
Chlamydia, Gonorrhea, Syphilis and Herpes?
3.Finally., I am considering booking an appointment on Saturday in your clinic as I am not in London and am free only on Saturdays.Would most of the blood test results( HIV, syphilis, Herpes) come back on the same day if I have a Saturday morning appointment? ( I am aware that microbiolgic tests for chlamydia, gonorrhea may take some time)

And finally , are you still giving a discount at your clinic to those who have posted in this forum

Thanks for your time and valuable opinion!

[Dr Sean]

Hello

Thanks for the reply. Some more doubts please!

1.I understand that Chlamydia can be silent.correct
But would you expect some symptoms from gonorrhea and syphilis at least in the initial infection phase.penile gonorrhoea certainly; throat gonorrhoea not in over 90% of cases. Syphilis as previously mentioned is fantastically rare in heterosexuals

And regarding Herpes, if there are no symptoms, would you still suggest testing? noIf an asymptomatic person has a positive Herpes test, would you treat it? no

2.So what tests would you suggest?

I think if you're having them then to have chlamydia and gonorrhoea from both mouth and penis; I always like to do HIV tests - I think every sexually active adult should be screened for HIV - irrespective of the perceived risk

HIV?
Chlamydia, Gonorrhea, Syphilis and Herpes?
3.Finally., I am considering booking an appointment on Saturday in your clinic as I am not in London and am free only on Saturdays.Would most of the blood test results( HIV, syphilis, Herpes) come back on the same dayyes if I have a Saturday morning appointment? ( I am aware that microbiolgic tests for chlamydia, gonorrhea may take some time)

And finally , are you still giving a discount at your clinic to those who have posted in this forum sure - bring your paypal / google receipt and we'll discount you by £15

best regards, Sean