[Question #10131] HIV Exposure and Risk

25 months ago

Hello Doctor and thank you for taking my question.

I am a heterosexual male and recently had a severe a lapse in judgement and had vaginal and oral sex with a female sex worker in the United States.

I performed oral sex on the sex worker and also had vaginal sex with a condom. I did not orgasm, we stopped, removed the console and then decided to try again. Unfortunately we did not have another condom so I re-used the same one. Not something I have done before. I made sure that the condom was on and covering my penis and did so again when we changed positions. I reached orgasm while in the second position and after doing so in the moment removed my penis and didn’t think to hold the base. I quickly realized that the condom was no longer on my penis and the sex worker reached down and was very quickly able to remove the condom and she was not in the least bit concerned.

I wasn’t necessarily concerned but roughly 5 days passed since this encounter and I noticed that I felt drowsy and unusually sleepy for approximately 48 hours and was also feeling hot and cold during the day like you might when you have the usual cold virus. Last nigh, which would be 6 days since the event, I also noticed that I was unusually hot and woke up a couple of times with my legs and back, which were under relatively heavy covers, very sweaty. My energy levels are pretty much back to normal today, and I feel fine.

I know that re-using a condom is not proper use. But, based on what I’ve described how likely am I to have contracted the virus? Is this a situation that I need to worry about given the symptoms that I’ve described? Can performing oral sex have exposed me to HIV?

Thank you in advance.

H. Hunter Handsfield, MD

25 months ago

Welcome. Thank you for your question and your confidence in our services.

While it isn't best to re-use condoms, the fact of condom use itself is far more important. When the penis is withdrawn from a condom that remains in partner's vagina, protection is generally believed to age complete. That your partner wasn't concerned about this a good sign: she was aware she wasn't at serious STD risk from you, and that you shouldn't be worried either

For those reasons, your initial reaction ("I wasn't necessarily concerned") was the right response. As for your symptoms, there is no STD that causes anything like you describe. You might have acquired a minor viral infection; or any of those other minor, unexplained periods of not feeling well that all humans experience from time to time. You never mention HIV, but I suppose that's your main concern when you as whether you might have "contracted the virus". You can forget it: acute HIV symptoms cannot begin sooner than 8-10 days, and do not last only a few days. Further it is unlikely your partner has HIV; if she does, the chance of infection from the events described is under one chance in hundreds of thousands. (HIV is harder to transmit than you might think!)

As for oral sex, no risk at all: there has never been a proved case of HIV transmission oral to penis. Based on how some people believe they were infected -- which is often mistaken -- CDC has calculated a risk of one in 20,000 if the oral partner is infected. That's equivalent to receiving BJs by infected partners once daily for 55 years before transmission might be likely. (Divide 20,000 by 365.)

So now the question is whether you should be tested. Because of the irregular condom use plus unprotected oral sex, you are at much higher risk for gonorrhea and chlamydia than for HIV. For reassurance, you could consider a urine gonorrhea/chlamydia test; and then blood tests for syphilis and HIV after 6 weeks. (Syphilis is nearly as low a risk as HIV, but it's both serious and treatable, so testing is pretty much routine after questionable sexual exposures.) But stay mellow in the meantime: if you go ahead with testing, you definitely can expect negative results on all of them.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

---

25 months ago

Thank you sir. I do appreciate it very much. A final follow up. With chlamydia, Syphilis and gonorrhea, are these usually asymptomatic? Y

H. Hunter Handsfield, MD

25 months ago

Urethral gonorrhea almost always causes obvious symptoms; it's hard to miss painful urination and pus dripping from the penis. Chlamydia usually causes similar symptoms but much milder, and often no symptoms at all. Syphilis usually is obvious when the exposed site is external, like your penis. Internal infection (e.g. in the vagina in women, the rectum in men who have had receptive anal sex) often causes no symptoms. But even with obviously exposed sites, asymptomatic infection sometimes occurs---
---

25 months ago

18 days after the event I experienced some mild symptoms, like an on and off dull pain in both testicles. It would come and go throughout the day. And on one occasion I felt like I still had urine to clear, forced it, and a small amount of clear discharge that resembled pre-ejaculatory fluid came out. It was odorless.

That day I started the 7 day course of doxycycline. I took a day and half dose and then submitted a urine test. After the urine test I still experienced some on and off dull testicular pain and after urine one on another occasion I squeezed the head of the penis as a test and was able to squeeze another small amount of the clear liquid. This was the second and final occasion during which the clear discharge was observed.

The test came back negative for chlamydia and gonorrhea.

My question: would the antibiotic have resulted in a negative test after only two dosis? Could the test have been a false negative? If it was in fact chlamydia and if the csw also had HIV would this have increased the chances of being infected from a single exposure?

I had vago al unprotected sex one time with my long term sex partner prior to the symptoms presenting themselves, how likely is it that I passed chlamydia or whatever was ailing me to them

24 months ago

Hello. Do I need to submit payment in order for my recent follow up to be answered? It is ok if I do of course. I am just checking since the question was posted three days ago and hasn’t been answered. I am of course sensitive to the fact that the forum isn’t staffed 24/7, so I apologize in advance if this appears impatient.

Thank you

H. Hunter Handsfield, MD

24 months ago

Apologies for the delay in replying. No new question needed.

On one hand, when in doubt, unexplained symptoms -- whether related to STI risk or anything else -- are best addressed with an in-person health care visit. OTOH, I have to say the symptoms you describe are highly typical for anxiety magnifying trivial symptoms you would otherwise ignore, or even normal body sensations, also with awareness increased due to your STD worry. I very much doubt you have (or had) any infection, or even a physical cause for your symptoms.

Accordingly, I see no need for you to have started taking doxycycline. And two doses is too soon to convert the test results to negative, so you can be sure you were not infected and therefore no chance you infected your regular partner. (If you had tested positive, I would have judged that it came from your regular partner, not the exposure you describe above.)

That completes the two follow-up exchanges included with each question which normally means the thread is closed. However, on account of the delay in reply, I'll leave this open for another day or two in case anything else comes to mind.

---

24 months ago

Thank you for responding. This service and the level of expertise within, is top notch. I’m hesitant to ask another question given that it would almost certainly be anxiety driven at this point, you’ve addressed my concerns and have done so definitively.

My final question before the thread is closed is purely out of curiosity. Is there a statistic that estimates how much more likely it is for HIV to be transmitted from a single vaginal sex exposure when Chlamydia is at play compared to when it is not? (i.e 1 in 1000 vs ??).

Thank you again and take care Dr.H.

H. Hunter Handsfield, MD

24 months ago

All STDs that cause genital tract inflammation elevate the risk of sexual acquisition of HIV. There are no specific data on the degree to which risk is elevated by preexisting chlamydia. HSV2 is the most potent STD in this regard and roughly doubles the risk of HIV if sexually exposed. So the increased risk from chlamydia is less than that. If we guess a 50% increase in risk, then the average chance of HIV from a single episode of unprotected vaginal sex would rise from one chance in 2,500 to somewhere around one chance in 1700 in the presence of chlamydial infection. In other words, still a very low risk. Given that under one in a thousand sexually active women in the US has HIV, that means the per-exposure risk would be one chance in 1.7 million (versus one in 2.5 million without chlamydia). In other words, pretty much meaningless for any particular exposure. And that's without condoms, which would add another 99% protection factor.

That concludes this discussion. I'm glad you found it helpful; thanks for your thanks. Best wishes and stay safe.

---