[Question #5281] Vegas Mistake

24 months ago
Good Morning-  I have been going crazy for about (3) weeks now.  I went on a guys trip to Las Vegas about 25 days ago.  On this trip I had a bit too much to drink one night and brought a CSW back up to my room.  From there she out a condom on me and gave me a protected BJ and then she got on top of me and rode me until I ejaculated (Maybe 3-5 minutes).  When she stood off of me, she went to pull off the condom and she couldn't find it a few seconds later she found it on the floor next to the bed, I assume that it came off on withdrawal.  I cannot be sure but I cant think of anything else--I am now terrified that it came off before sex and that I have contracted HIV--I have never done anything like this before and I am married with children--I stopped looking at the symptoms because I have all of them.  I am also uncircumcised which I know gives me a greater risk.  Please help 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Welcome. Thanks for your confidence in our services.

From your description, I agree it seems likely the condom came off during withdrawal. But I can't say more -- you were there and I wasn't! But even if it were off the whole time, you really shouldn't be very worried, especially about HIV. In most of hte US, well under 1% of female CSWs has HIV, and it's probably lower than that in LV, where many or most sex workers are knowledgeable, know how to protect themselves, and get tested frequently. And if you think about it, probably most of her customers are low risk for HIV (men like you!), and it sounds like she's a regular condom user, right? That she uses condoms even for oral sex, which is low risk for HIV and all STDs, implies a careful person aware of maximal sexual safety.

And when a woman has HIV, the statistics of HIV transmission by unprotected vaginal sex indicate an average risk of one transmission for every 2,500 exposures. You'd have to have daily uprotected sex with such women for several years before transmission would be likely. (You probably aren't aware that many spouses of HIV infected women never catch it themselves. HIV is extremely rarely transmitted in one-off events like this.) I'm not sure what you mean by "all" the symptoms you have experienced, but if you did not develop sore throat, skin rash, enlarged lymph nodes in several body areas, or fever 7-14 days after the event, the ones you do have probably are not significant.

Your circumcision status really doen't make much difference. At a population level -- i.e. across entire societies or countries -- being uncircomcumcised roughly doubles the risk of HIV if sexually exposed, and can be a big deal in some settings:  in some tropical African countries, having all men circumcised would reduce the overall HIV infection rate in men by 50%. But when the risk for any one exposure is, say, 1 chance in a million (a good estimate for you), what does it matter if the risk doubles to 1 in 500,000? Still zero risk for all practical purposes. The risks are higher for other STDs, but still low for any single epxposure. And absence of typical STD symptoms (penile discharge, painful urination, genital blisters/sores, inflamed groin lymph nodes) 3 weeks after the event is pretty good evidence against being infected. 

So my advice is 1) stop worrying -- almost certainly you have neither HIV nor any other STD; and 2) get tested for reassurance. An lab-based (not rapid) antigen-antibody ("duo", "4th generation") blood test now would be over 95% reliable; or wait until 6 weeks for 100% certainty. You could also have a urine test for gonorrhea and chlamydia at any time; and a syphilis blood test at 6 weeks. But in the meantime, if I were in your shoes, I would already be continuing unprotected sex with my wife without worry.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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24 months ago
Thanks for getting back to me.  I went and got test for both gonorrhea and chlamydia yesterday-both results came back negative.  Once I get my courage up I will get the HIV Duo test--hopefully next week.   Just getting your reply has made me feel better about my situation and able to get some sleep.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
I'm glad to have helped ease your mind. However, you should know that I have no patience with your "Once I get my courage up" statrement. You know it's nonsense to delay testing for fear of the result. When people delay testing for potentially serious conditions -- HIV test, mammogram in woman with a breast lump, colonoscopy in someone with blood in stools -- anxiety always declines after testing is finally done, even if the result is the feared one. Psychologically, clearing the air and knowing for sure is always better. And obviously, it isn't the test that gives someone the feared health problem:  you have HIV or you don't. If you have it, you have an absolute obligation, to yourself and others, to know it. Anyway, there's no chance you have HIV, so waiting until you have "courage" for testing makes even less sense. 

Perhaps you'll also be interested to know that in the 14 years I have been doing this and my previous forum, and in the 8-10 years since Dr. Hook joined me, with thousands of questions of this sort, not one user concerned about HIV after a potential exposure has reported s/he became HIV positive. You won't be the first. If and when that happens someday, I expect it will be from a truly high risk exposure, not a highly borderline, very low risk event like yours.

So re-read my comments above explaining why you have almost no chance of having HIV; then get tested, preferably when 6 weeks have passed. In the meantime, mellow out. I'm confident your HIV test will be negative.

I'll leave this thread open until you post your HIV test result (or 4 weeks, whichver comes first), but will have nothing more to say until then -- and will close the thread if you post anything without including your HIV test result. (Call it tough love, if you like -- but there it is.)
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24 months ago
HHH-

Thanks for your tough love--I was tested yesterday with a 4th gen. test and the results came back "non-reactive".  This test was done 32 days after the incident-I know it is only 95% certain at this point but the results definitely will help me calm down and help me put this behind me.  I have a physical coming up at the end of May and I will have the test retaken during my routine blood work.  Do not take this the wrong way but I hope I don't have to write you again---Thanks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
I'm glad you got past your initial reticence and were tested. It's about 98% reliable and you should consider it conclusive. (If there was one in a million chance you caught HIV, the hcance now has been reduced to one chance in 50 million.) Have another test at 6+ weeks if you feel you need it, but you can plan on a negative result -- and there's no need to hold off on sex in the meantime, 

We never take such statements the wrong way. We too hope you don't find a need to return to the forum. Even with another uncertain exposure, probably there would be enough siilarities to this one and others you can read that a new question wouldn't be necessary.

Best wishes and stay safe.
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