[Question #2656] HIV Risk - Protected Oral and Vaginal Sex with Escort w/ Condom

43 months ago
Hello,

I had protected oral and vaginal sex with 2 high end escorts in Houston two months ago. The 1st escort was Brazilian. The 2nd was caucasian. These were individual encounters on 2 separate occasions.

My concern was with the Brazilian escort. At one point, when removing my covered penis from her vagina - the condom slipped off. The end of it was still visible outside her vagina. At no point was my penis uncovered within her. I have had no symptoms of any STD (HIV or otherwise) following this encounter. 

I've reached out to both escorts who have replied they do not have HIV or any other STD.

I have read through both Dr. Hook's and Handsfield's responses extensively (obsessively). I believe my encounter was virtually zero risk since I was protected by condom at all time. 

I have two questions:

1) Is is still true that during the entire time of answering heterosexual HIV questions - such as mine - not one person has acquired HIV as a result of the encounter they had questioned about? This if still true - puts my mind very much at ease. 

2) I (optimistically) understand that my odds of getting HIV from these encounters -  when broken mathematically are akin to the following formula 

Odds either escort had HIV (1%) - Maybe lower?
Chance of transmission with vaginal sex with condom (0.0001%) - Maybe lower?
Chances I caught HIV without any ARS symptoms (10%) - Maybe lower?

0.01 X 0.0001 X 0.10 = 0.0000001% or 1 in ten million.

Am I correct in my understanding of my mathematical probability from these 2 encounters? Can you provide me with the most optimistic odds when it comes to HIV transmission with condom use?

I am getting a life insurance exam next week - which includes HIV testing - so I will have my what I am very sure will be my negative results soon. If the answer to my 1st question is still true - I believe this worry over such a mathematically improbable event is a manifestation of anxiety from guilt.

Thank you so much for this service.  I appreciate your response immensely



Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Welcome to our Forum and thanks for your confidence in our service.  We try to help.  In your question, the key to my response was the third word in your question -"protected".  In situations of the sort you describe, there is no better way of avoiding STI than using a condom correctly throughout an encounter as you did.  The fact that you "took off" your condom by removing your penis from the condom while it was still in a partner's vagina does not change the fact that you used a condom and it did its job.  You really have nothing meaningfully to worry about. 

I do have one quibble with your calculation which is that your estimate that only 10% of persons who acquired HIV fail to develop  the ARS is probably a bit low.  In all likelihood, more like 40-50% of persons who acquire HIV do not experience that ARS.  That said, other facts which not in your estimate such as your partners have both verbally assured you they do not have HIV or other STIs offset this.   Thus, in answer to your questions:

1) Is is still true that during the entire time of answering heterosexual HIV questions - such as mine - not one person has acquired HIV as a result of the encounter they had questioned about? This if still true - puts my mind very much at ease. 
Correct.  Neither of us is aware of any such occurrences. 

2) I (optimistically) understand that my odds of getting HIV from these encounters -  when broken mathematically are akin to the following formula ...1 in ten million.
Probably in the right ball park.

I would not worry about having acquired HIV, nor would I worry about your forthcoming insurance physical.  You will be fine. EWH
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43 months ago
Thank you for the reassurance, Dr.

I have 1 more question. I took an at home oraquick exam today (which yielded negative results) - but I am still approximately 9.5 weeks post "protected" exposure. 

I also had the life insurance exam draw blood today so I expect conclusive results within 1 week. 

Judging by the other low risk factors below - 

1) Protected vaginal sex
2) Protected oral sex
3) high end escort - who appears to insist on condoms
4) verbal response from both escorts that they both do not have hiv
5) lack of ars symptoms
6) oraquick negative result (9.5 weeks)

- I believe I am now likely well in the 1 in 100 million odds of having contracted HIV - all things considered - practically zero. 

Would you consider my oraquick results combined with the other factors conclusive? I'll know one way or another in about a week - I'm just trying to get my anxiety level down here.  

Thank you again - immensely. The service and knowledge you provide have value beyond measure. 




Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
I agree with your assessment.  AT this time you should be confident that you did not get HIV from the exposure you have described.  EWH
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42 months ago
Dr Hook,

I've since had 3 antibody HIV tests come back negative. All were performed about 9 to weeks post exposure. 

1) Oraquick (9.5 weeks post exposure)
2) Life insurance blood draw - antibody tests (9.5 weeks post exposure)
3) Finger prick test (9.7 weeks post exposure)

I had someone at the clinic, where I had the finger prick test performed, tell me I needed to get another test performed at 3 months post exposure (12 weeks). I realize the 3 month recommendation is extremely conservative and that 9.5 weeks is likely conclusive for 99.8% of cases. 

I believe at this point further testing is not necessary. With the all the factors we've mentioned combined with the 3 negative antibody results tells me I can put this ordeal  behind me, finally. Is that your opinion as well? I suspect it is.

Thank you for all you do. It is an invaluable service.
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Thanks for the follow-up.  I too hope that you will now be able to put your concerns behind you.  This thread will now be closed.  Take care.  EWH---