Ask A Pro is a our new column focusing on work and health, intended to share straightforward information about what you can do to keep yourself as safe as possible while on the job. Questions will be answered by sexual health expert Sarah Patterson, M.Ed. (See full bio below.) Questions you’d like to have answered can be sent to sarah.elspeth.patterson (at) gmail (dot) com, or to our info (at) titsandsass address. Full anonymity is guaranteed.
Dear Ask A Pro,
I’ve been escorting for about six months and I usually don’t require that my clients wear condoms during blowjobs. I’m not having symptoms of anything, but I asked my gynecologist if I could do a test for oral STIs to be safe and she said I didn’t need it. She knows I’ve had some unprotected oral sex, but she doesn’t know about my job. I think she was trying to save me money but should I go back and tell her it’s important to me to get it? How at risk am I from giving bareback blowjobs anyway? I’ve heard that spitting isn’t much safer than swallowing but does that make a difference?
Dear Swab Seeker,
Firstly, kudos to you for asking about a throat swab. It’s really important to ask health care providers what’s possible in terms of STI testing, so you can assess for yourself what you consider important, based on your own experience. It also sounds like your gynecologist is just basing her response on what she does know about your sexual activity and may not have enough information to give you the best answer. Using throat swabs is also pretty rare outside of providers who see men who have sex with men, so it’s also possible her clinic doesn’t do this as a standard procedure.
So, you have a few options in terms of your disclosure. You could tell her what you do for a living, you could tell her you are sexually active with multiple people, or you could simply tell her you want the throat swab in order to be thorough with your testing procedure. Whatever you decide, make sure you feel ok with the tone and content of her response, before continuing to see her as your sexual health provider. If you don’t like what she says or how she says it, you’re less likely to come to visit her regularly and get the tests you need for your own health.
Depending on how many clients you are seeing, you may want to have a throat swab every three to six months. Every six months is a limit set for HIV because of how long it takes to show up in your system, but chlamydia and gonorrhea show up much more quickly. So if you’re seeing a couple of people a week, there’s no reason you can’t get tested every three months for good measure. If you’re using protection for vaginal or anal sex, you probably don’t need to get an anal swab, but that is an option as well. Both of these swabs are designed to test for chlamydia and gonorrhea (HIV inhabits the whole body, so the general HIV test is what you will need every 6 months). In terms of exposure, chlamydia and gonorrhea are the two that folks are most likely to contract orally and can be treated easily with antibiotics.
In terms of the heavier hitters like HIV, there have been a few documented cases of HIV having been transmitted to receptive partners through fellatio, even in cases when insertive partners didn’t ejaculate, but it’s very, very rare and the risk is still significantly less than with anal or vaginal sex. And when HIV is documented, it often involves the person having more than one type of sex—some combination of anal, vaginal and oral sex. The truth is that there is no 100% safe sex, no matter what, and this is a risk that we all take on when we have sex with anybody. That’s why it’s always more desirable to have clients you can have brief, straightforward conversations about safety with, so you’re both clear on the risks.
In terms of the spit/swallow debate, there’s no evidence that it makes much of a difference, so the jury remains out. Best to do what you will not feel anxious doing in the moment (and also, not fret about afterwards). If you’re not comfortable, your session will not be as good, because you won’t be as relaxed and able to get into your groove. And while we’re on the subject of things you do to get in your groove, do not brush your teeth or use dental floss right before a session. Both of these things irritate the gums and open very tiny legions that STIs can get into. For the same reason, mouthwash (particularly the bite-y, Listerine variety) is too abrasive right before a session. Stick to mints and gum to be safe while keeping things fresh.
Sarah Elspeth Patterson is a health educator and founding organizer of Persist Health Project, a community-based health care organization in New York City. As the first health care provider in New York City run by and for folks involved with and impacted by the sex trade, Persist offers comprehensive health services while providing trainings to other health care professionals who serve us.