[Question #1476] Exposure

45 months ago
Hello
Last night I had an exposure. I hired a SW and as we proceeded for sex i wore a condom even though I was not fully aroused, she started by giving me a handjob and then I had protected vaginal sex with her.  After we were done i checked my condom and it was on and intact, for further assurance that there were no little tear i filled the condom with water, but there were no holes.  My questions are: am I at any risk of hiv or other stds? Should I get tested? Can I have unprotected sex with my wife? Please help 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Congratulations for your wisdom in using a condom for this event, and it seems clear the condom was properly used and did not leak. ("Water testing" isn't necessary. If a condom doesn't break wide open, protection is complete. Pinhole defects don't occur and wouldn't be much risk anyway.)

Condoms are very good for STD prevention, but there is always at least a small risk from vaginal sex with a partner at risk. The chance any particular female sex worker has an active infection usually is low, especially for escorts (expensive SWs who work by appointment, often with regular clients), but higher for brothel workers, street walkers, etc. In this case it sounds like you are at virtually no risk from this exposure for STDs transmitted through blood or genital fluids (HIV, gonorrhea, chlamydia, hepatitis B). In theory, there is a bit more risk for those transmitted by skin-to-skin contact, above the condom (HPV, HSV, syphilis).

In general, STD/HIV testing is almost never recommended after any single condom-protected exposure. The risk is too low. However, you are free to be tested if the negative results would give you additional reassurance. If so, have a urine test for gonorrhea and chlamydia, which would be valid any time more than 3-4 days after exposure; a 4th generation HIV blood test at 4+ weeks; and a syphilis blood test at 6 weeks. However, if I were in your situation, I would not be tested and would continue unprotected sex with my wife without worry of infecting her.

This is your fifth question (using different usernames, which is against the rules) that reflect anxieties over low to zero risk exposures. In my closing response a month ago, I said "Do not be tempted to start a new thread with the same kinds of question. Repetative anxiety driven and irrational questions are not permitted; if you try, it will be deleted without reply and without refund of the posting fee." This question was somewhat different -- at least it involves a sexual exposure. However, this policy WILL be invoked if and when you post any new questions after this one.

Let me know if anything isn't clear. Best wishes and stay safe--   HHH, MD

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45 months ago
Dr. i am not that person.  I was on this forum 5 months back with a question regarding false positive PCR RNA test for which I tested up to  24 weeks and you were right that it was indeed false positive. 
I had made my mind of no more outside exposure but was not able to resist.  Coming back to the current situation Dr do you feel and think that I am at no risk of HIV and should not worry about it? I went through hell but again I did the same stupid thing. I hope that I did the right thing to go protected from the beginning?  Well I am really concerned about hiv what do u think? I will test for the other Std. 
Thanks again 
With kind regards 
W
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Sorry if any confusion. The email address you used for this account is the same as at least one and perhaps two other persons, all of whom have what I think are middle eastern names.

You definitely did the right thing by using a condom. And your risk for HIV is zero for all practical purposes. Even without condoms, if a woman has HIV, the average risk of transmission during a single episode of vaginal sex, is around 1 in 2,000. That's equivalent to having unprotected vaginal sex once daily for 5 years before transmission would be likely. Obviously any single exposure carries risk, but it's very small. And if we assume 99% protection from condoms, your risk becomes 1 in 200,000 -- and in fact probably lower than that (condoms are even better than 99%).

Given your anxieties about this, you probably should be tested for HIV. This doesn't mean I have changed my mind about your risk:  I have not. But when someone is highly anxious, often a negative test is more reassuring than advice based on probabilities and statistics. So get tested 4 weeks after the event. However, I would recommend you continue unprotected sex with your partner in the meantime. There really is no realistic chance you caught HIV.

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44 months ago
Hello Dr.
As per your advise I went for an HIV combo test after 27th day of my exposure and it was Non reactive. The test was carried out on Abbott Architect ag/ab combo machine. I also had my syphilis (RPR test) done and it was non reactive too. Well as I did my tests after 27 days or on the 28th day of exposure are they conclusive? 
Dr your answers are very much appreciated.
Thank you
With best regards
W
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
44 months ago
Your HIV test is conclusive; there is no significant difference between 27 and 28 days. Your syphilis test was a bit early; it is not considered conclusive until 6 weeks. However, a negative result at 27 days is highly reliable -- that result, plus condom use, plus lack of a penile sore all add up to 100% certainty you did not catch syphilis.

That completes the two follow-up comments and replies included with each question and so concludes this thread. Thanks for your thanks about our services -- I'm glad to have helped. Best wishes and stay safe.

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