[Question #4174] std and hiv risk please

30 months ago
Thanks for all you do. Its been a great help to me and others!  Ive gone through the website in depth and have learned a lot. A couple weeks ago, August 8, I stupidly visited a seedy massage parlor that offered full service here in Seoul. I told myself that I would only partake if I used protection, as I did not want to go through what I did last time.  Bottom line,  I ended up having protected oral (receiving) and protected vaginal sex.  The service provider was the one who actually put the condom on, as it was her condom, and it seemed to be a requirement with her too. The only part unprotected was me receiving oral on my scrotum for a few minutes. No rimming, just scrotum, and maybe a little  of the perineum. No anal insertion or anything like that. No kissing, and I didnt give oral sex. From my understanding, this is mostly safe. Where my question comes in is, in the middle of the sex,my condom rolled up. I don’t think it came off, but it was very close to the tip. I cannot be 100% sure in the moment. I do know that I always had the condom on inside of her. I think it rolled up while trying to insert from behind, with the friction from the sides of her rolling it up.   We rolled it back on (same condom) and finished, with condom intact.  Does this affect anything? Following, I washed immediately with soap to groin, and followed with a shower a few minutes later.  I further washed at home with some bleach. About a week ago, I developed a small rash on my abdomen and chest. Its light colored, irregular shaped spots. Not pimply, and not really raised. Kind of looks like a fungal infection. Two weeks ago, some external hemorrhoid. No other symptoms. From my understanding, if ARS symptoms appear, its a rash, sore throat, and flu like symptoms, all together. Am I right?My questions are: what’s the likelihood that i have caught an std?  Would the condom rolling up be a risk? The rash? Anything else to add? Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
Welcome back to our Forum.  I'm pleased to hear that you used a condom for this most recent encounter. Condoms remain the most effective means for preventing HIV if you are sexually exposed to an infected partner.

As you know from our previous interaction, few commercial sex workers in Korea have HIV and with UNPROTECTED sex your risk for acquiring HIV would have been less than 1 in 1000 if she had HIV.  Condoms worn throughout sex which do not break reduce the risk further, about 99% more.  Even if your condom rolled down your penis, if the tip of the penis was covered (and it was, otherwise the condom would  have come off) , the condom did its job.  Thus the risk for infection, considering to low probability that your partner had HIV and that you used a condom approaches 1 chance in a million.  You are far more likely to be struck by lightening than to acquire HIV from the exposure that you describe.   

The rash you describe is in no way suggestive of the ARS and your description is correct.  I really would not worry at all about this exposure.  I hope you will not.  EWH
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30 months ago
Thank you very much for your really quick reply Dr. Hook.  This has helped relieve some of my anxiety.  Of course I still do have some. I have a couple follow-up questions:

1.  In regards to the condom rolling up on my penis, if it did come off completely outside of her, and then we put it back on, would that change anything? Or would it still be considered that the condom did its job?  Also, if the condom rolled up, and then we rolled it back down, wouldn't there be some vaginal secretions that have made its way to inside the condom (from when it rolled up, touching the outside portion of the condom?  Is there a possibility of that excretion (or a virus) making its way up to the tip of the condom/my urethra?  I know this is stretching it, and probably my anxiety and guilt, but just curious if this affects anything.

2. I have noticed tonight itchiness in my pubic area.  Considering the rash on my chest, would you believe it to be ringworm, or something similar?

3. There is a mild "heaviness", or maybe light pain in my groin area, and occasionally in my testicles.  It is mild, more like discomfort/generalized light pain.  What would this possibly be?

4. What about other STD's?  What is the likelihood of acquiring anything else?  2.5 weeks post exposure.

Thank you again for providing your expertise!  I am going to see my regular Dr. this week in regards to the rash, and will bring this stuff up with him too. 
30 months ago
I should add, in regards to the rash, it is about 30--40 spots on my chest and abdomen area, all above the belly button.  Some are on my sides, but not really on my back.  Is it most likely just a fungal infection that I could have caught at the massage parlor, either from her, or from less than clean settings?  Would the rash be a side effect/symptom of any other STD?  Or, just coincidence?
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
1.  It is not at all unusual for condoms to slip down on the penis during intercourse.  they still work.  As long as the condom covered the tip of your penis while it was inside her, you were protected.  If the condom was entirely off and you had penetrated her, your exposure was unprotected but that does not sound like what happened. Don't let your anxiety make you mis-remember. 

2.  Itching is a common complaint with anxiety-related hypervigilance.  I doubt that your abdominal rash and your pubic itch are related.  FYI, ringworm is not an STI.

3.  This is an unfamiliar symptoms however it certainly is not a sign of STI.

4.  I really think you are worrying entirely too much.  Relax.

I would attribute your rash to co-incidence.  What you describe sounds like folliculitis perhaps but not an STI.  FYI, fungal infections are almost never passed directly between people.

EWH
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30 months ago
Thanks for your followup.  I went to the doctor today, and he said that the rash is a fungal infection.  It is basically blotches on the torso and chest, with just one spot on my upper back, near my armpit.  After explaining my encounter, he mentioned that my exposure is low risk, but because of the fungal infection, gave me a full STD workup, including a preliminary Antibody Antigen HIV test.  The tests were with blood and urine.

Now that we know that it is a fungal infection, does this at all change your assessment/judgement.  I am worried about HIV especially, even though you stated it was very low risk, seeing that I have gotten this fungal infection about 10-12 days post exposure (from when I first noticed it).  The infection is a little worse these days.  Is it possible this could be a sign of infection?  I never really get rashes.

I guess this is my last followup.  I get the results on Friday/Saturday, so if you want to leave it open, I will just wait to post my results.

Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
Thanks for the follow-up.  The additional information in no way changes my assessment or advice.  Your doctor is being cautious but that is not a reason for you to worry.  I am confident that your tests will be fine.

As you point out, this will be my final reply as part of this thread but I will keep it open so you can share your test results.  Take care.  EWH
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29 months ago
Hello Dr. Hook (or Dr. Handsfield if you are answering while Dr. Hook is traveling.  You can tell I research here a lot :)  )

Thanks again for all your advice.  I have learned so much from you guys, not only with my two stupid encounters (and NO MORE!), but from reading.  I thought that my anxiety would be fixed if I made very sure that protection was used 100% throughout, but that didn't prove true.  So, it just is not worth it!  Not to mention, I owe it to my loving family at home.  I am ashamed and embarrassed with myself, but this is my issue, not yours.  You guys have helped me out greatly, and you should know that you are a great beacon of support and hope for countless people!  There should be more people like you.

My test results are in (20 days, actually, 19 days and about 19 hours post exposure)

I tested negative for everything, including HIV Ag/Ab combo (i'm assuming this is fourth generation antigen, antibody).  My doctor last week, when I had my blood drawn stated that this test should be about 99% conclusive already, but to test again at 6 weeks for 100% conclusiveness.  Is this information correct? I was so concerned about the condom rolling up (not sliding up) and possibly coming off outside of her.

MY IMPORTANT FINAL QUESTION, if you could please: Now that the test has come back negative, does this mean that the fungal infection (which turned out to be pretty big) on my stomach and chest (about 30-40 spots, ranging from small to dime-size in diameter, is definitely not from a HIV infection, since I tested negative?  If it was due to HIV, the test would have come out positive, right? I have since developed about 3 small, red dots on the back of my hand, but they look like they could just be  from the heat lately.  I've been a wreck, laying on the couch all day, and it is usually about 82 degrees in the house (wife doesn't like air-con).

Again, I can't thank you enough for your services.  I greatly appreciate it, and wish I could shake your hands in person.  If needed, when my 6 week mark comes, and I test again, I will purchase a new question and update you guys.

On another note, do you guys have a foundation to which I could donate? I would love to give back to an organization you support/are involved in?  Your information you give is worth so much more than the meager $25 that we spend.  I am even considering volunteering somewhere in this regard soon, also.

Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
1.  Yes, your doctor is correct.  Your six week result will be entirely conclusive.  I am confident it will be negative.

2.   If your fungal infection had been somehow related to an HIV infection your test would have been positive.   I would encourage you to work with your doctor to get the fungal infection treated and not to continue worrying that it might be related to HIV. 

 Thank you for your thanks. If you wish to make a donation we would encourage you to make a donation to the American sexual health association who host our site. They would use your funds to do good work for others with, at risk, or worried about STI & HIV.

 As you know, with this reply this thread is now completed and will be closed. Take care.  EWH 
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