So around 43 day ago I did the big bad choose of going to a Asian massage here in the us the Asian lady offer me a service so we had a vagina sex i did ask for condom and it seem like she has in a hurry I did see put condom and lube too we the exposer last around 10 to 15 sec and I dnt remember it has fast so I do remember her taken the condom off and cleaning with a towel but I dnt remember if the condom had broken or moved or any other defects I am little nerve that what if it did what is the change that I get a std or hiv for this I now that 1 in 1000 per exposure so I am nerves because I been feeling sick sore throat tiredness I am uncircumcised and I noticed a rash in my penis head I’m going to the doctor on Monday. I’m gonna test for STDs and HIV. I was wondering in your medical point of view. What is the chance of me testing positive? I also read that condoms are only 7o% effective against STDs and HIV. Is this true and should I be worried? I have a wife and I don’t wanna get her infected. That’s my main concern if tested could I keep having sex with my wife on protector what’s your recommendation please help? And again, thank you for everything you guys do. I really trust your guys’s opinion your expertise helps a lot. I do remember using condom, but I’m just a little worried that about the risk factor. It was a one time exposure too. I’m never gonna do it again. It’s not worth the anxiety.

From both those discussions and now, I would say you tend to greatly overestimate STD/HIV risks and over-think the details of exposure. None of this description suggests significant risk for HIV or other STDs. As for "feeling sick" and possible penile rash, you can be confident they have nothing to do with the sexual exposure a month earlier. None of the symptoms mentioned is typical for either HIV or other STDs.

Condom effectiveness, and numerical estimates about it, can be complex. First, there is "biological effectiveness", i.e. how well a properly used condom that doesn't break works to prevent infection (or pregnancy) for any single exposure. For HIV, it's around 99% for either vaginal or anal sex. Second is what is termed "use effectiveness", which undoubtedly is what is intended by the 70% figure you cite. As the name implies, it takes into account human error, improper use, breakage, etc. For some STDs, 70% is about right (although I usually cite 90-90% for HIV). The difference between 99% and 70-80% is due mostly to human error -- most often delayed placement of the condom after transient penile insertion.

Do not over emphasize your lack of circumcision. That in fact increases the risk of HIV if exposed -- but of course you have to be exposed. It roughly doubles the risk. "Double" sounds like a big deal, but it isn't. If someone's overall risk of HIV is say one chance in a million (which is where I would place your risk from the events described), double raises the risk to one chance in 500,000 -- still zero for all practical purposes.

An HIV test at this time will prove 100% your symptoms are not due to HIV. It is not possible to have HIV symptoms (even a few days after exposure) and test negative for the virus. And as discussed in your previous threads, a second AgAb (4th generation) blood test in a couple of weeks -- 6 weeks after exposure -- will prove 100% you didn't catch HIV. As for other STDs, consider a urine gonorrhea/chlamydia test; you definitely can expect a negative result. You also could have a conclusive syphilis blood test at 6 weeks. Finally, with an unexplained rash of the head of your penis, it makes sense to see a provider -- a urologist is fine. Assuming it's redness under your foreskin, you can expect a diagnosis of nonspecific balanitis -- not an STD -- and treatment with a steroid and/or anti-yeast cream. This isn't from the sexual exposure you have described.

In my medical experience the answer is no:  you should not be worried at all. "What would you do if you were in my shoes?" I would not have felt a need to test for HIV or any STD and would be continuing unprotected sex with my wife without worry. But I'm not you, and that's not my advice. Clearly you need a conclusive test result to put your fears to rest. (If you don't want to wait until 6 weeks, you could have an HIV PCR RNA test now. That negative result will prove both that your s symptoms are not caused by HIV and that you are not infected.)

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

That concludes this thread. I hope the discussion has been helpful.