[Question #14053] HIV/STD risks

Avatar photo
1 months ago
Hi Doctors,
Some weeks ago, I was vacationing on an island in Thailand. I brought a bar girl back. We tried condom protected vagina sex a few times, but I was intoxicated. I can't maintain an erection well. We changed a new condom before trying to penetrate again each time. I ejaculated once in the condom. She also did a blow job for me with condom, took off the condom and gave me a handjob till I ejaculated again.

Next day, I met her again and had vagina sex thrice, all protected with condoms. For this 2nd episode, I was fairly sober and believed the condoms had worked well.

I am concerned with the 1st episode, questioning the effectiveness of the condoms (slippages) while my penis is going flaccid in her vagina. My memory was not good in the drunken state. I asked her and she said there were no slippages, but i can't be sure.
Pls assess my risks for HIV/STDs,
considering the 1st episode could have been an unprotected encounter? What to do from here?

Days since encounter
Day 16 - stomach discomfort/bloating
Day 18 - Recovered
Day 20 - No other symptoms
Avatar photo
H. Hunter Handsfield, MD
1 months ago
Welcome to the forum. Thanks for your confidence in our services.

All things considered, these were zero risk events or very close to zero. First, even in Thailand, the chance your partner had HIV is low, probably under a 1% chance. With entirely unprotected vaginal sex with an infected female, your chance of being infected is under one in 2,000. So combining that with a 1% chance she had HIV, your risk of infection probably was in the ballpark of 1 in 200,000. Even with the semi-protected first episode, if we estimate the attempted condom use has 50% protective, your odds of infection become one chance in 400,000. Your risk of other STIs was generally higher, but still on the low side.

As for your symptoms, they really don't fit will with a new HIV infection, which is not a likely cause of "stomach discomfort/bloating" as the main or only symptom. Absence of genital area sores, penile discharge, and painful urination after almost 3 weeks also makes gonorrhea, chlamydia, herpes and syphilis unlikely -- although not quite zero risk. 

"What to do from here?" Maybe nothing; all in all, the odds you have anything at all is low enough that testing can be considered optional, at least from a medical/risk standpoint. However, you wouldn't be here if you weren't worried -- and reassurance is a valid reason for testing even when the risk is nil. Assuming you would like the reassurance of negative test results, you could have a conclusive HIV test now with an HIV PCR RNA test (also called "viral load" test). Or wait til 4 weeks after the event and have a 98% conclusive HIV AgAb test (a lot less expensive -- plus another one at 6 weeks to make the result 100% conclusive. For other STDs, I would advise a urine gonorrhea/chlamydia test now and a syphilis blood test at 6 weeks. You can expect negative results on all of these.

FYI, you also may like to know that in the 21 years of this and our preceding forum, with thousands of questions from persons worried about HIV after a possible exposure, nobody has yet tested positive. You won't be the first. If or when it finally happens, it will not be from a near zero risk exposure like yours, but from a genuinely high risk event; think unprotected anal between two men, for example. (There also have been very few who reliably reported they acquired other STDs.)

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

HHH, MD

 

---
Avatar photo
1 months ago
Thanks for the reply, I will get the tests done at 4 weeks and thereafter as advised.

In the meantime, I had resumed Condom-Protected sex with my regular partner once a week over the past weeks.

Should I be doing this? Thank you.
Avatar photo
1 months ago
Sorry, missed out on 1 point. The bar girl can be considered a CSW, as she was paid for the services. 

Would this change your risks assessments?
Avatar photo
H. Hunter Handsfield, MD
1 months ago
I assumed your pick-up partner was a CSW. This doesn't change my advice. I see no reason not to continue condom protected sex with your partner.---