[Question #10482] Please tell me my risk

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22 months ago

Dear doctor, First of all, I would like to thank you very much for your help and your efforts for human health over the years.

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22 months ago
 My situation is this, in my relationship with an expensive sex worker, after ejaculation, I realized that the condom was not in place after taking it off. I asked her later and she stated that it slipped while taking off the condom and she held the tip with her hand and took it off himself. Then, to reassure myself, I had a duo test 26 days later and the results came back negative. I completely trusted the results and closed the issue. 
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22 months ago
But again, I couldn't control myself and 4 days ago, I called someone from a place that is not an expensive agency. As far as I know from the past, most of the girls sometimes do not use condoms. The girl who came to me was from Kyrgyzstan and I asked her if she used a condom before having sex with her and she told me that she used it in all her relationships, even the blowjob without a condom. And had oral and once vaginal sexual intercourse with her, protected by a condom. I am married and I regret it very much, I want to know if I need to be tested or not.
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H. Hunter Handsfield, MD
22 months ago
Welcome. Thank you for your confidence in our forum and for your question.

The first event carried little or no risk. Escorts are generally believed to be low risk partners with little chance of having HIV.  By "escort" I mean exactly the sort of partner you describe:  expensive female sex workers by appointment (as opposed to brothel workers, bar pick-ups and so on). Such women often are well educated, typically know the risks and how to protect themselves, use condoms consistently, and get tested frequently. So it probably is very unlikely your partner has HIV. Second, it sounds like you can trust her that your penis was covered, i.e. you were fully protected, when actually having sex. Had you asked ahead of time, I would have advised that testing for HIV and other STDs was optional. (More about testing below.)

Your second exposure is a somewhat different story. This sounds like a partner who definitely is at risk for HIV and other STDs. However, you wisely used a condom at least for vaginal sex -- and maybe for oral as well? Not clear from your question, but oral sex is low risk for STDs in general and essentially zero risk for HIV.

Whether you "need" to be tested is not something I can advise. For the first exposure, there was little if any risk and your negative AgAb (4th generation, "duo") test at 26 days is nearly conclusive. Combining the low risk to start plus the test results, you can be certain you didn't catch HIV. For the second, the risk might have been a bit higher, but still low given the condom. But nobody can say it was zero riskboth exposures, the chance you have HIV is extremely low, although nobody can say it's zero. Same for other STDs, like gonorrhea, chlamydia and syphilis.

The risk is low enough that you probably should feel comfortable continuing unprotected sex with your wife. But you still might consider a urine test for gonorrhea and chlamydia (which can be done now) and, about 6 weeks after the second event, another HIV AgAb test and a syphilis blood test. Just to be 100% certain and not spend the next year worrying and wondering!

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

HHH, MD
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22 months ago
Dear Doctor,
Thank you very much for your answer.
Sorry for my English, before having sex, I asked to her about habit of condom, and she said she use condom always for oral and vaginal sex. Because she afraid.
I also use confom for oral and vaginal entrercose, I will have all my tests, thanks again/
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H. Hunter Handsfield, MD
22 months ago
OK, thanks. I'm glad to have helped.---