[Question #1754] STI / HIV exposure question

43 months ago
Hi there, I'll try to keep it short and sweet. 34 year old married heterosexual male who made a single mistake. Was drinking at a strip club and ended up going back to a hotel with one of the strippers. She told me she was clean but am not sure of her STI status. She showered prior to the events below too. She gave me unprotected fellatio for about 3-5 minutes in total and I went down on her unprotected for about a minute with finger inserted. We then had vaginal intercourse WITH a condom and attempted anal intercourse for a couple minutes WITH a new condom on. I never ejaculated and the condoms seemed to be properly worn the entire time.

1. HIV risk for oral and intercourse actions above?
2. Other STI risk from actions above?
3. Would getting tested for HIV be necessary?
4. Any other tests necessary?

Thank you so much!!!

Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Welcome to our Forum and thanks for your questions.  I'll be pleased to comment.   You do not mention how long ago your misstep was and so, as I answer your question, I will also point out that the longer it has been since your exposure, the more a lack of symptoms shifts the likelihood that you acquired any STI.  If the exposure was more than 10-14 days ago, this risk of infection becomes lower still than the generalities I am about to provide. 

In general, the risk of getting any STI from any single sexual exposure is quite low, particularly when you consider that even most commercial sex workers do not have STIs including HIV and even when they do, the majority of single exposures to infected partners do not lead to infection.  Further, from a biological perspective some sorts of sex acts transmit infection more "efficiently" than others.  Oral sex is not an "efficient" way to transmit STIs.  With these general comments, lets go to your specific questions..

1. HIV risk for oral and intercourse actions above?
There are no proven cases in which HIV has been acquired from either receipt of oral sex from an infected partner or when someone has performed oral sex on an infected woman.  Thus I would say that your risk for HIV from the two oral exposures you describe is essentially zero.  As for condom protected sex, this too is considered safe sex, not only for HIV but for other STIs as well.  Thus, from a medical perspective there in no reason to worry about HIV.

2. Other STI risk from actions above?
Few STIs are acquired through cunnilingus, with the one which is most likely (but still, overall, unlikely) would be gonorrhea.  Similarly, the two STIs which most commonly follow receipt of oral sex (fellatio) if your partner had an STI is gonorrhea as well.  If you had acquired penile gonorrhea, there is a bout a 90% chance that you would have developed symptoms within 3-4 days after exposure.  Some men also acquired a syndrome called NGU after receipt of oral sex but again, this risk is low and this problem is also usually symptomatic.  To be completely sure that you were not infected you could have urine and throat tests for gonorrhea performed.  In the absence of symptoms, other STIs are most unlikely.

3. Would getting tested for HIV be necessary?
I see no medical reason related to the events you describe for HIV testing.

4. Any other tests necessary
See my comments above.  this depends on your level of concern.  If you choose to test, testing for gonorrhea is the test which I would recommend most strongly and I suspect that overall, your risk for  infection is low.

I hope these comments are helpful.  EWH

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43 months ago
Thank you so much for the quick response Dr.! The exposure was only 3 days ago so I am assuming I would have not seen any symptoms by now. 

1- are there specific timeframes for each of the STIs including HIV to show up?
2- if so, and symptoms do not appear would you still suggest getting tested?

Due to the fact that I have extremely high health anxiety, I was hoping you could possibly provide some statistics / odds of contracting HIV through:

3- both oral exposures listed above 
4- both intercourse exposures with condom listed above

As I'm sure many people on here do, I am a "professional" Internet searcher which is probably the worst thing to do. However, through my readings, it appears that HIV affects a fairly small portion of the US population and a solid percentage of that being gay/bisexual men. 

5- Is there a number or percentage you can put to the number of women currently living with HIV vs men in the US?
6- overall odds of encountering one of these women coupled / added to the odds of the exposures I had?

Again thank you!!!
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago

Straight to my responses:

1.  The infections that are of concern would be urethritis (penile infection) or possibly herpes.  For all of these symptoms could have already occurred and most probably would be apparent by day 10.

2. In my opinion your risk is low and I do not feel strongly that testing is needed.  On the other hand, many of our clients like to have the assurance that a negative test provides.  If you choose to test, as I said above, I would do a urine test and a throat swab for gonorrhea. Particularly given your self acknowledged anxiety.  I do NOT recommend testing for herpes in this situation.

3.  I told you there were no proven cases of HIV acquired through either receipt of oral sex or performing oral sex on an infected woman.  The CDC which tends to be conservative lists the risk as less than 1 in 10,000.  I think that number is too high.

4.  Same for condoms if used throughout the sex act and it does not break.

5.  Estimates are that there are about 250 women in the U.S. living with HIV, out of about 150,000,000 females in the country.  It is unlikely your partner had HIV.

6.  See above.  Odds are very, very low.

I would suggest you stay off the internet.  Much of the information there is either wrong or taken out of context.  EWH


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43 months ago
Hi there again Dr., thanks again for the prompt reply your answers are definitely providing ease. I know this is the last question and wanted to make sure I understood. I don't mean to question your expertise but you say in answer 5 above there are only 250 women living with HIV in the US, from data seen from the CDC it appears there are roughly 215,000 women living with HIV at the end of 2013. Any clarification on this would be greatly appreciated.
43 months ago
Was hoping to add one more question before you had a chance to review. Statistically speaking would this be a correct assumption:

-1,200,00 people living with HIV in the US
-242,500,000 adults in the US
-odds of catching HIV vaginal / anal insertion let's say 1/1000 (without condom which I had on so I would assume odds are even lower)

So:

(1,200,000/242,500,000) x (1/1000) = .0000049 chance of my encounter catching HIV (and even lower due to the fact I had a condom on)?
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Sorry for the typo.  The figure I meant to provide was about 250,000 women with HIV in the US, not too different from the 215,000 figure that you found.  Tho only other comment I would make is that properly used condons reduce the risk for HIV acquisition by more than 99%.  Your risk for HIV is tiny and, as I said, not something to worry about.

This is my third reply to your questions.  As per Forum guidelines, this thread will be closed in a few hours.  I hope you will not continue to worry about the low risk exposure you have described.  Take care.  EWH
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43 months ago
Can't thank you enough!!