[Question #589] Potential exposure to STD/HIV & PEP/testing

44 months ago
Hello,  I had a question about potential exposure to STD/HIV and if PEP or further STD/HIV testing is warranted. Unfortunately, I had a serious lapse in judgement today (have never done this before). I was on a trip to Prague and happened to visit a strip club with some friends. A girl there offered me a private dance. I was aroused and then she proceeded to give me oral sex, with a condom on, after which we had sexual intercourse briefly (a few minutes). After I ejaculated, while I was pulling out of her, I wasn't careful to hold on to the condom. I think the condom was accidently left in and might have exposed my penis briefly as I was pulling out. (there didn't seem to be any break in the condom prior to ejaculating, but I did not check afterwards).  I am really worried about my potential exposure to STD/HIV. 

I was reading that PEP should be considered if there is exposure (unprotected sex). Is this something I should consider? However, I am only back in the USA 72 hours after this incident. Should I consider advancing my flight back, visit a STD clinic and ask for PEP? Also, when is the earliest I can test for STD/HIV? I am super worried about it as I am in a relationship and I don't want to inadvertently expose my partner to anything.

Thank you so much
John
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Welcome to the Forum.  you ask a number of questions.  I'll try to help.

1.  Were you exposed?  Perhaps, many commercial sex workers (CSWs) do not have HIV or other STIs.  Further, you used a condom.  If the condom remained behind in her vagina but was still visible hanging out of her it is most likely that your penis simply slipped out of the condom as you exited.  If so, the condom likely did its job and you were protected.  Another indicator that this happened might be the presence of ejaculate in the tip of the condom when it was pulled out. 

2.  Should you use PEP?  this is a personal choice.  There are no known cases of HIV acquired from receipt of oral sex form an infected person so your receipt of oral sex was a no risk event.  As for UNPROTECTED vaginal sex with an infected person, the average risk of infection is about 1 infection per 1,000 exposures.  Not too high but worth preventing, especially for many people who are not feeling lucky.  PEP is not perfect but markedly (in the range of 80%) reduces the risk for HIV and is more effective the sooner it is started.  If you decide to take PEP, I suspect it can be found at your location, perhaps by inquiring at a local sexual health clinic.  PEP not uncommonly causes side effects (mostly GI)  so I caution you that if you are going to take PEP PLEASE commit to completing the course and to seeking follow-up from an informed clinician upon your return home.

3.  Other STIs.  The major risks from an exposure of this sort are for chlamydia, gonorrhea and trichomoniasis. Again, the majority of exposures to infected partners do not lead to infection.   Testing can be done using a urine test and you can expect accurate results if testing is performed any time more than 3-4 days after your exposure. 

I hope these comments are helpful.  EWH

---
44 months ago
Dear Dr. Edward Hook, thank you so much for your opinion.  I have a a couple of follow up questions. 

Based on your #1 comment below re: exposure, I actually went back and talked to the strip club girl I had the oral sex (with condom) and brief sexual intercourse (with condom). She mentioned that the condom was left in her vagina as I pulled out (exited) post ejaculation, and there was no semen inside her vagina. She further said she is very careful with her engagements, always uses condoms and follows up with regular tests. She also mentioned she has a two year old daughter, she is always super careful. 

Based on this, do you think this was a no risk to little risk encounter? If it is none or minimal risk as there wasn't "unprotected" vaginal sex, I probably wouldn't go through PEP (as it is intensive therapy that I would have to undergo for a month, and it will also be hard for me to go to a hospital here in Prague and start it - will have to take a half day off from my work tomorrow, that I need to finish before leaving for the USA day after tomorrow). 

Also regarding the STDs i.e. chlamydia, gonorrhea and trichomoniasis risk you mentioned - is there risk only if there is "unprotected" vaginal sex, or these could also be transmitted by simple genital to genital contact (while intercourse with a condom), or hand to genital contact?

To be safe, I will plan on getting tested at 5 days with a urine test for the STDs you mentioned. Would you advise a HIV test at 4 weeks in this case?

Thank you again, and I very much appreciate your advice.

Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
You did a good thing to go back and talk with your partner. From the sound of things, this was a very low risk exposure and your condom did it's job.  Given the information you have gathered, if I were you I would not take PEP..  Using the same reasoning, I would not be worried about STIs,  whether or not you pursue testing at this time is up to you. If you test I anticipate the results will all be negative.

Thanks for the followup.  EWH
---
44 months ago
Thank you Dr. Hook. I did not pursue PEP.  I will most likely test at 28 days just for peace of mind.  Thanks again a lot for your guidance and timely responses. Much appreciated!
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
Thanks for your thanks.  We want to help.  I am confident your tests at 28 days will be negative.  Take care.  EWH---