[Question #12019] HIV Risk
10 months ago
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Dear Doctors,
I hope you are having a good day. last night I engaged both vaginal and oral sex (both protected) with an escort from Russia or Ukraina. She only does protected vaginal with the clients (NOT strict about oral). since I have engaged again protected vaginal sex with a sex worker My question is that:
1-does it impose any risk for HIV? or it is almost zero?
2- i have this conflicts, many people or site on internet claim the condom is effective in preventing HIV maybe around 80-90%. is it true? what is it based on? if it is like that so we need to have a greater pandemic of HIV
3- i am almost sure the condom remained and covered the tip, but the vaginal fluid on the shaft that maybe was not covered is not the route of transmission, right?
4- is it possible to get hiv after trying to remove the condom improperly and while removing the condom the secretion touches the tip? is it even possible? since i heard exposure of the virus outside of the cell inactivates it
5- do i need pep?
6- your final assessment about the risk? and do i need to test?
I appreciate it in advance
2- i have this conflicts, many people or site on internet claim the condom is effective in preventing HIV maybe around 80-90%. is it true? what is it based on? if it is like that so we need to have a greater pandemic of HIV
3- i am almost sure the condom remained and covered the tip, but the vaginal fluid on the shaft that maybe was not covered is not the route of transmission, right?
4- is it possible to get hiv after trying to remove the condom improperly and while removing the condom the secretion touches the tip? is it even possible? since i heard exposure of the virus outside of the cell inactivates it
5- do i need pep?
6- your final assessment about the risk? and do i need to test?
I appreciate it in advance
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H. Hunter Handsfield, MD
10 months ago
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Welcome back to the forum. However, looking at your two previous threads, it seems to me that all your questions were answered there -- or the answers are obvious from those discussions. You really should not rely on this or any other forum to ask about every new sexual exposure, especially when they all are so similar! I'll try to help -- but if you apply the principles implied in my comments now, it should not be necessary in the future.
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Assuming "escort" means an expensive female sex worker by appointment, it is unlikely she has HIV or any STD. Such women tend to know the score, care about their health, take precautions like consistent condom use, get tested frequently, and have low risk clients -- men like you. And with a condom used for vaginal sex, and oral sex being zero risk for HIV even without a condom, it is exceedingly unlikely you were exposed or infected, even if your partner has untreated HIV. To your questions:
1. Litte or no risk; see above.
2. You're mixing up condom effectiveness over time ("use effectiveness") with effectiveness for any one exposure ("biological effectiveness"). A properly used intact condom that doesn't break is nearly 100% protection against infections transmitted through genital fluids (HIV, gonorrhea, chlamydia) (biological). Use effectiveness, usually estimated at 90% for HIV, takes into account human error in condom use, breakage, etc. That doesn't imply in your recent exposure.
3. This detail doesn't matter. There is almost always exposure to vaginal fluid on the skin above the condom. That's why they are less protective against STDs transmitted skin to skin (syphilis, herpes, HPV).
4. No, this does not raise the risk of HIV.
5,6. I would not advise PEP in this situation. From a medical/risk perspective, you don't even need testing. Of course you are free to be tested anyway if you remain nervous about it, but it would be strictly for reassurance. Based on this and your two previous forum questions, I would say you should ignore any one exposure unless especially high risk -- the condom breaks, you learn your partner actually is infected, etc. A smarter approach would be to be tested for HIV, syphilis, gonorrhea and chlamydia (and nothing else) after several such events or maybe once a year or so.
In the 20 years of this and our previous forum, with thousands of questions from users concerned about HIV, nobody has yet tested positive. You will not be the first. If and when it happens, it will be from a very much higher risk exposure than the ones you have described.
I hope these comments are helpful. Let me know if anything isn't clear.
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10 months ago
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I appreciate your help doctor. The fact is that, i start searching the internet and find a bunch of information that triggers this stress. I have some questions as well:
1- during the vaginal sex, i use to lose my erection (not completely), i tried to keep the base of the condom with my hand to prevent slipping. Now i wonder, if there was a slight slipping like 1 or 2 cm under the base of shaft and im pretty sure that foreskin and the opening were covered since after the sex it was still on the penis, so it is considered a complete protection?
2- i used the same condom she gave me an oral for vaginal, it does not increase the chance of hiv?
3- even if she was infected, the chance of me getting infected is really small like almost zero?
4- can i just stop worrying and let everything behind ?
Thanks in advance
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H. Hunter Handsfield, MD
10 months ago
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The internet is not a friend to most anxious persons. Like others, you are being drawn selectively to information that inflames your fears. If you feel compelled to keep searching, I would advise limiting yourself to professional sources and avoiding those by and for people at risk or with the problem you fear (like Reddit, for example).
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1-3. None of these details makes any difference in your risk of infection or in my assessment or advice.
4. Yes, that is exactly what you should do.
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