[Question #1767] hiv risk

42 months ago
hi i had sex with a csw in spain i used a condom but after 60 or 90 seconds i saw a small tear about a inch or so from the head of the penis from what i understand as long as the head is coverd theres no risk but i had a abrasion not deep like red skin from masturbating earlier that day that might have been uncovered  i called a helpline they told me as long as the abrasion wasnt bleeding im ok is that true? can i have sex with my wife now?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your question. Congratulations for having safe sex, i.e. using a condom.

This is an unusual type of condom failure; mostly they break wide open or not at all. It is difficult to judge the exact risk from this. It is true that the risk of HIV and some STDs (e.g. gonorrhea, chlamydia) is low as long as the head of the penis, and the urethral opening, are covered. However, it sounds like the tear was near the head of your penis, and it seems possible that genital fluids could have gotten inside -- and since the penis often slides inside the condom, fluids could have come into contact with susceptible areas. Also, if you are uncircumcised, you should assume the inside of your foreskin was exposed -- which is highly susceptible to HIV. Having said that, even without a condom, the chance of HIV and other STDs is always low for any one exposure, and certainly you can consider this sexual exposure as largely protected, if not quite perfectly.

I agree with the helpline advice about the abrasion. It doesn't signfiicantly elevate the risk of HIV.

As for sex with your wife, it is impossible to give any kind of guarantee and the risk is not zero, so you probably should be tested for HIV and other common STDs. I recommend a gonorrhea/chlamydia urine test, which you can do at any time (the test is valid any time more than 3-4 days after exposure); an HIV 4th generation (antigen-antibody, "duo") test at 4 or more weeks; and a syphilis blood test at 6 weeks or more after the event. If I were somehow in your circumstance, once the gonorrhea/chlamydia result was known to be negative, I would resume unprotected sex with my wife -- i.e. the risk of HIV and syphilis is low enough that I would not feel a need to waiting for those test results. 

If you are able to contact your CSW partner and ask her to be tested for syphilis and HIV (perhaps helping her, e.g. paying for the tests?), you could stop all worry if she has negative test results.

I hope this information is helpful. Let me know if anything isn't clear.

Best wishes--  HHH, MD

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42 months ago
hi thanks im not there anymore so i cant take her for testing but i did text her and she said i dont have what to worry about since she never has sex without a condom but who knows so if i understand you are saying i should not worry about hiv why is that im sorry im just freaking out this is the first time i did anything like this and yes i am circumcised
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
OK, understood. People rarely lie about STDs, HIV, and condom use when asked directly by concerned partners. You probably can trust that she is unlikely to have any STDs. And being circumcised further lowers the risk of HIV if you had been exposed. And the risk of HIV was very low anyway. The average transmission risk for vaginal sex, female to male, if the woman has HIV, is once for every 2,000 events. That's why many spouses of HIV infected persons remain HIV negative for many years (which perhaps you didn't know).

No reason at all for you to be "sorry" about all this. You haven't done anything unusual, and wisely used a condom, and with a partner who seems to be relatively low risk. Don't beat yourself up over normal behavior or a bit of bad luck.
 
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42 months ago
So if i understand you're saying even if it was completely unprotected which mine wasn't the odds are that i didn't get hiv she did tell me that she gets tested every three months and when a condom breaks she's more nervous about catching something then transmitting it but she might be lying to clarify if i dont have chlamydia or gonorrhea i can have sex with my wife?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
"you're saying even if it was completely unprotected which mine wasn't the odds are that i didn't get hiv":  Correct.

"when a condom breaks she's more nervous about catching something then transmitting it":  I didn't say that, but it's certainly possible she is more concerned about protecting herself than worried about infecting her clients. That's why most people use condoms, including sex workers.

"she might be lying":  What I said is that most people do NOT lie about this when asked directly. Of course I have no way of knowing for any particular person.

"if i dont have chlamydia or gonorrhea i can have sex with my wife":  I did not and cannot tell you whether and when to resume sex with your wife. If you want 100% assurance, you'll have to wait until your HIV and syphilis tests also are negative, i.e. 4-6 weeks from now. Even then, there are no good tests for herpes and HPV, so the STD risk in this situation can never be zero. As I said, I would have sex with my wife once the gonorrhea/chlamydia tests were negative. But I'm not you, and you'll have to make your own decision. 

That completes the two follow-up comments and replies included with each thread, which will be closed shortly. Best wishes and stay safe.


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