[Question #11993] Risk of Exposure-HIV

11 months ago

I regretfully had an exposure involving an asian massage parlor worker (unknown status) a few weeks back. Interaction included handjob, uncovered oral sex, and condom covered vaginal sex. During the acts I had two small sores on my penis from the excessive hand rubbing. These were deep enough that they developed small scabbing over the next few days. As I believed these open wounds increased risk, I received and started PEP at 20 hours. All of this happened domestically in the US.

My questions: What was my level of risk to HIV? Would you have recommended PEP?

Thank you in advance for your answer.

Edward W. Hook M.D.

11 months ago

Welcome to the Forum. Thanks for your questions- I 'll be glad to comment.

The encounter you describe was was close to no risk (I'll explain why below). If you had approach me for PEP, I would have declined to prescribe it.

Why do I say this was low risk-

1. Most commercial sex workers do not have HIV.

2. Receipt of masturbation, oral sex and condom protected vaginal sex are virtually nl risk events. Masturbation is classified as no risk by CDC and WHO; there are no proven cases of HIV acquired from receipt of oral sex; and condom protected sex is safe sex

3. Even if your partner had untreated HIV, the risk of infection is less than 1 infection for over 2000 exposures, i.e. chances are more than 99.9% that you WOULD not become infected

4. When genital sores are caused by STIs, they are associated with increased risk for HIV because in the base of the sores there are inflammatory cells which are the targets for HIV- this is not the case for traumatic sores/abrasions.

I hope that this perspective is helpful. You have nothing to worry about. EWH

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11 months ago

Thank you, Dr Hook. I appreciate the knowledgeable and timely response.

Edward W. Hook M.D.

11 months ago

I'm glad you found my comments helpful. EWH---