[Question #11753] Concerned About HIV Risk After Brief Unprotected Encounter

12 months ago

I'm seeking some advice regarding a recent experience I had that's been causing me a lot of anxiety. I'm based in Dubai and was feeling really sexually frustrated, so I ended up booking the services of a sex worker. She's Egyptian, in her forties. From the start, I was feeling guilty about it, so I asked her if we could just be intimate and kiss and perform massage instead of going all the way. However, in the heat of the moment, I became aroused, and for about 20 seconds, we had vaginal intercourse without a condom.

I quickly realized what I was doing, pulled out, and put on a condom before continuing until I finished. She mentioned that she's had residency here since last year, which I know involves mandatory HIV testing, but I'm not sure about the truthfulness of the statement or her current health status, and I didn't feel comfortable asking. She also mentioned she’s been married three times, has two daughters from her first marriage, and recently had an abortion after a relationship has ended.

It's been 4 days since this happened, so I know it's too late for PEP. I’m not experiencing any symptoms, but I’m very worried. What’s my risk of contracting HIV from this brief encounter? Should I avoid having sex with my wife until I get tested at 6 weeks, or is it safe to proceed?

Any advice would be greatly appreciated.

Edward W. Hook M.D.

12 months ago

Welcome to the Forum and thanks for your questions. I’ll do my best to address your anxiety. This was a very low risk encounter. HIV rates among CSWs in Dubai are very low and your partner, like most people, probably told the truth. Even if she had untreated HIV, your risk of infection is less than 1 in 2000. Thus even if she had HIV ( unlikely) there is a more than 99.9% chance you WOULD NOT be infected.

You are correct- it is too late to take PEP and if you’d asked if you need it, I would have said no.

Personally, I would not be worried and would not hesitate to have unprotected sex with your wife.

If you feel the need to prove you did not acquire HIV, an HIV RNA PCR test any time more than 11 days after your encounter will be conclusive. Alternatively, if you are comfortable waiting, a 4th generation, combination HIV antigen/antibody test Will provide conclusive results any time more than 6 weeks after your encounter.

I urge you not to worry. EWH

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12 months ago

Thank you, doctor. Given your clinical expertise, how common is it for similar encounters to result in transmission of serious infections? The numbers you mentioned are reassuring, but understanding the clinical rarity, or maybe nonexistence, of transmission in brief, low-risk encounters can be reassuring. Like, anecdotal evidence of clinical encounters you or your colleagues had.

Edward W. Hook M.D.

12 months ago

I don’t have much to add to the figures that I have already provided. We do our best to provide our assessments based on scientific studies. I will add, however, that in answering nearly 10,000 questions on this site, Dr. Handsfield and I have never had a person acquire HIV. Your risk for infection is very low. EWH---