Dear Doctors Handsfield and Hook,

I have already read your helpful posts on Medhelp, however I would like to have an assessment of my specific situation. Recently I visited a brothel in Melbourne (Australia) and engaged the services of an Asian sex worker.

These services consisted of oral sex and then vaginal sex- both acts were protected with a condom. However prior to putting the condom on, the CSW applied some kind of substance on my penis. This is what has gotten me worried. 

I can’t remember what that substance was. If it was lubricant, then I am almost certainly safe. However it may also have been some kind of infected secretion, like if she had dug fluids out of her vagina and applied it to my penis. I know from your previous posts, that there has never been HIV transmission from hand-genital contact, even if infected fluid were used as lubricant. What concerns me is that if it was infected fluid, straight after applying it to my penis she rolled a condom on. The condom would have sealed the infected fluid to the surface of the penis, and I am worried that this has heightened the risks involved.

So my questions are:

(1) What is my risk for HIV infection based on these facts?

(2) I have read from your posts and the general literature that HIV is inactivated quickly after being exposed to air and the external environment. I am hoping this rendered the secretion non-infectious, but given that a condom was rolled over it immediately afterwards, I am worried that this might have protected the HIV from such exposure? 

Objectively speaking, I probably shouldn't be too worried. But on an emotional level I am quite terrified, given how difficult being HIV-positive still is.

Welcome to our Forum and thanks for your confidence in our advice.  I would assess the events you describe as being no risk for infection,  If you went to a licensed brothel in Melbourne your partner would have been checked on a regular basis for HIV and STIs- this is part of the procedure for licensing.  Even if the brothel was not licensed, the events would still be no risk, in part for the reason that you describe.  CSWs regularly use lubricants in the course of their sexual activities and this was most likely what occurred for you.   It is difficult to imagine why a CSW would intentionally infect anyone, not to mention that such a practice would be quite bad for business.  That said, answers to your specific questions are below:

1.  As above, I would assess this to be a no risk event.  Even in the extraordinarily unlikely event that your partner had applied infectious genital secretions to your penis before applying the condom, any HIV present would have been non-infectious and you would not be at risk.

2.  Please see above.

I hope these comments are helpful.  I really see no medical reason for concern or for testing.   EWH

Thanks for reporting back.  As you have found out, the Melbourne Sexual Health Center is a wonderful resource providing wonderful sexual health care for all who desire it.  I think you are over-stating and over-reacting with respect to the consequences of HIV infection for infected persons (and based on your reports, you will not become one related to the recent encounters you have described) .  This sort of mis-perception is out of date in the modern era of anti-retroviral therapy and reflects social misperceptions that are evolving to a more accurate reflection of the fact that persons with HIV who hare being appropriately treated act and function entirely normal, living an essentially normal lifespan.  I hope that you will join the forces in correcting the misperceptions that you mention.  I remain confident that your tests will prove (and hopefully, you will accept the results) that you were not infected with HIV. 

This is the final comment made as part of this thread which will be closed later today.  I wish you well.  EWH .