[Question #240] Potential exposure to STD/HIV - please advise

36 months ago
Hi, I have a question re: possible STD/HIV exposure. Two days ago, I was on a trip and had Asian massage. 
The girl gave me a massage including rubbing my penis with her hands and breasts with some massage oil. I was aroused and then put on a latex condom. She continued the massage. Towards the end,  I was reluctant but she put a lubricant on the condom, climbed on top of me and had sex for < 1 min (with the condom on) and I ejaculated. I did not see any condom breaks after. I did not know this girl and am worried about STD/HIV transmission. I have never done anything like this before (have been in a monogamous relationship for a long time). Do I have a risk of STD/HIV exposure? Do I need to consider PEP, or STD/HIV testing. If I do need to test, what's is the earliest time frame I can test (ex: can I do a RNA test at 14 days?)

Thank you so much for your advise, in advance.

-John
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

Welcome to the Forum.  While in terms of your relationship you may have had an error in judgment, there is no reason to worry about any STI, including HIV, and no need for testing related to the exposure that you describe.  Let me give you the details of why I say this.  First, the statistical fact is that most commercial sex workers, even in foreign countries do not have STIs and even if they do, most STIs  are not transmitted following a single, unprotected exposure.  There are no STIs which are transmitted more than once in three exposures and viral STIs like herpes or HIV are transmitted less than 1% of the time following a single UNPROTECTED exposure.  In your case, your exposure was condom protected and use of a condom throughout sex is the best protective measure one can take when having sex with a potentially infected person, greatly reducing the risk for infection.  You do not need to worry that your condom may have broken either- when condoms fail, they break wide open leaving no doubt that they failed.  Thus both statistics and, more importantly, your use of a condom make this an essentially no risk event.

Personally, I see no medical need for concern or for testing related to the exposure you describe.  If testing would give you peace of mind, the most common STIs are gonorrhea and chlamydia and a urine test for these problems at this time would provide conclusive proof that you are not infected.  Blood teds tests for far rarer infections, such as HIV or syphilis would need to wait until a month after your exposure.  As for herpes, unless you develop lesions at a site of exposure, I would recommend against blood tests as such tests are very often misleading (i.e. falsely positive) in situations such as the one you describe. 

I hope this comment is helpful. EWH

---
36 months ago
Thank you so very much for your response. Makes sense. One follow up question - do you think I should wait for a month, till I get the hiv/syphilis/other STIs test (for my peace of mind) to have unprotected sex with my spouse. 
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
If you are testing for peace of mind, syphilis and 4th generation combination HIV blood tests will provide completely reliable tests a month after your exposure. Testss taken before 28 days may not be completely reliable.  Personally however I do not think testing is warranted.  Take care.  EWH
---