[Question #2025] HIV and possible other STD exposure

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83 months ago
I was recently in Thailand and on two occasions had oral and vaginal sex with a sex worker. On both occasions I was wearing a condom newly purchased from home. On both occasions the condom was applied before the oral sex and was worn also during the vaginal sex. There was no rupture of the condom nor did it slip up or off at any stage.  At the time I was not concerned about exposure to HIV or other STD.  Since returning home I have read some material on the internet particularly about the use of condoms and HIV risk that seem to suggest some exposure that I was not aware of. I would like your view of my exposure on these 2 occasions.  There is so much diverse information out there I have come to trust your advise.  I am also interested in testing windows for HIV as I keep hearing 12 weeks but I have read on this service that it can be only 6 weeks. As I have written in previous questions I do suffer from anxiety on these matters.
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Edward W. Hook M.D.
83 months ago
Welcome to ur Forum and thanks for your confidence.  As you have experienced, the information available on many internet sources is highly variable and often out of date or sometimes just plain wrong.  Here are some comments which may be helpful:

1.  Condoms remain the single best means of protection against acquisition of bacterial STIs and clearly greatly reduce the risk for viral STIs including HIV.  They should be worn throughout sex and only used a single time (I would not suggest using the same condom for oral followed by vaginal or rectal sex if possible- it slightly increases the risk of breakage)

2.  When condoms fail, they typically break wide open leaving no doubt that have broken   They do not "leak" a  little.  Condoms break in the course of proper use about 1% of the time.

3.  Most commercial sex workers, even in Thailand do not have HIV or other STIs and even if your partner was infected, most single exposures do not lead to infection.

Regarding test window- HIV tests have evolved and steadily become more sensitive, providing reliable results more and more quickly.   Further, the "official" test windows tend to be overly conservative and reflect regulatory baselines set by the FDA many years ago at 12 weeks- this have carried forward although the scientific data clearly indicate that this is overly conservative.  Currently available 4th generation, combination HIV antigen/antibody tests provide accurate results within 4 weeks of exposure.  Tests which test for antibodies detect most recent infections within 6 weeks of exposure and are completely sensitive for detection of recent infections within 8 weeks of exposure.

I think these address your questions and concerns.  I hope this information is helpful.  EWH