[Question #3589] worried about exposure

37 months ago
hello dr
im 39 yr, male from tel aviv israel. im married.
yesterday i had an encounter with woman from sex-dating website. she told me shes married and that she always practice safe sex when she doin it outside her merriage, i dont know if its true, if shes really married and if she really doin only safe sex i dont know even her real name or phone...
we met at motel and had vaginal penetration with condom it was agressive and long, about 40 minutes. but at the end i didnt noticed any failure. we had oral sex for somthing like 15 minutes for both sides, she sucked my penis with no condom and i licked her vagina in and outside...
really woried now about hiv. particulary worried me the oral because  somtimes i have small cuts in my mouth even i didnt noticed any open bleeding cuts yesterday.
do you think it was risk activity due to hiv?
do you see reason for test?
thank you!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Welcome to the forum. Thanks for your question.

First, congratulations on limiting your activities to safe sex in this situation. Condoms work, and oral sex carries little or no risk for HIV transmission and is low risk (but not zero) for all other STDs.

Second, research shows that persons who use online sites to find sex partners tend to be truthful about their sexual histories. While there's no guarantee for any single partner, most likely you got a straight story from yours -- just as you probably told her the truth. (And while I'm not aware of research results about the kinds of partners people select in this setting, I would guess that mostly monogamous people seeking occasional sexual release outside their primary relationships tend to choose partners with exactly the same backgrounds and motivations. In other words, she's probably low risk in her day to day sexual lifestyle.)

Third, my understanding is that the rate of heterosexual HIV transmission is quite low in Israel, further reducing the odds your partner has HIV.

Fourth, when a woman has HIV, the average transmission risk for unprotected vaginal sex is 1 in 2,500. Even if we more than double that (because 40 minutes probably is a longer exposure than average), perhaps the risk would be 1 in a thousand. With the condom, we can drop that risk by 99%, i.e. 1 chance in 100,000:  and even that is only if she has HIV. So the odds are very heavily in your favor. As for oral sex, there has never been a scientifically proved case of HIV transmitted by cunnilingus or by fellatio, oral to penis (and very few penis to oral).

So what to do now? If somehow I were in your situation, I would wait 7-10 days and if no symptoms (urethral discharge, painful urination, penile sores, etc), I would resume sex with my wife without being tested for anything. Another approach is to have a urine gonorrhea/chlamydia test (wait until 4-5 days after the event) and resume sex at home after the anticipated negative result. Of course you could also have blood tests for HIV and syphilis after 6 weeks, but the chance of either is so low that I don't really recommend it -- and even if you go ahead, that you not wait that long to have sex with your wife. The chance is so microscopically low that it would be reasonable to take that small risk, in my opinion. Another approach would be to re-contact your partner. You may find she is equally nervous about your encounter and would also be reassured if both of you seek STD/HIV testing. If both negative, you would both have 100% assurance in just a few days.

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

HHH, MD
---
37 months ago
Thanks for youre answer and youre kind explanations.
2 more questions, 
Do you know or heared about case study who proved hiv infection from receptive oral or giving cunnilingus, or case of penetrative vaginal with condom when the condom didn't brake or fail?
Do you see medical reason testing for hiv or its just for my peace of mind?
Thanks a lot.
Thanks again, youre answer give me good perspective...
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Thanks for the thanks. I'm glad my comments are reassuring.

I have no personal awareness of any patients who acquired HIV after such exposures. And no, I do not see a medical indication for HIV testing. That's why I offered it as an option for reassurance, and not as a specific recommendations.
---