[Question #6813] HIV Risk

14 months ago
Hello -

Approximately 30 days ago I had a sexual encounter with an escort. The main act we engaged in was protected (with condom) oral sex. However, for less than 20 seconds I did attempt to engage in protected (with condom) anal sex (to be clear I was insertive) however I was concerned and ultimately decided not to pursue further. I checked the condom after the attempted anal sex and it appeared fine with no significant break. I also used a separate condom for the oral sex. Finally, the escort also said that she had been tested very recently and was clear of any STDs. 

I would like to know how you would classify my risk (is it safe to assume no risk?) and if you would recommend HIV testing for this particular encounter since it involved anal sex (albeit brief and with condom). Should I feel confident to resume unprotected sex with my wife despite this incident?

Thank you

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome to the forum and thanks for your confidence in our services.

As your question implies, you know that anal sex is inherently somewhat more risky than vaginal. However, the chance of HIV transmission during any single exposure still is very low. The average for unprotected anal, for the insertive (top) partner if the receptive (bottom) partner has HIV, is roughly once for every 1,000 exposures. (For unprotected vaginal sex, the estimate is 1 in 2,500.) Condoms that do not rupture are at least 99% protected, lowering the chance to 1 in 100,000. And even these low numbers assume your partner was infected -- and the large majority of female sex workers do not have HIV. And this chance is especiially low in most escorts, meaning expensive female sex workers by appointment. Such women typically know the score, how to protect themselves, use condoms, have mostly low risk clients (men like you), and get tested frequently. So there is little chance sh had HIV.

So considering the low chance your partner has HIV and your (and her) wisdom in using condoms, this was a zero risk event for all practical purposes. While that doesn't guarantee you weren't infected, the chance is eceedingly low -- probably lower than your risk of dying by a lightning strike. If somehow I were in your circumstances, I would not be tested for HIV (or other STDs) and would continue unprotected relations with my wife without worry.

If you remain concerned despite this reassurance, you can have a conclusive HIV antigen-antibody (AgAb, "4th generation) blood test 6 weeks after the event, i.e. about two weeks from now. This doesn't imply I believe you really should be tested; I do not. Strictly for reassurance if you decide a negative test result would help you worry less.

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

HHH, MD
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14 months ago
Thanks Dr. Handsfield. The only other question I have then is when should once consider getting tested after a specific encounter (not that I anticipate being in another situation like this but its helpful to better understand). Is testing after an encounter (vs. regular testing) reserved for someone who engages in unprotected sex (vaginal and/or anal) or if there is a concern that the condom broke? Or does it also depend on who the partner is (for instance if the partner was likely to have HIV)? Thanks again
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Of course the priority for HIV testing depends on the level of risk. Some exposures are so high risk that the need for testing is obvious, such as unprotected sex with a known infected partner. Others are more like yours. And all sorts of exposures between these examples. Risk tolerance varies from one person to another and there is no specific standard recommendation. For most people with repeated potentially risky exposures, when no single exposure is very high risk, the best strategy is testing from time to time (e.g. once a year) while disregarding each specific event.

The fact that you ask this question indicates you are nervous about it and should be tested for reassurance.
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14 months ago
Thank you Dr. My last question is as follows. To the extent the CSW was not low risk as you put it (based on nationality / potential drug use history / etc.) does that change your opinion about my risk level? From your response it seems that it carriers a lot of weight in your comfort (in terms of her low risk nature) for me not to have testing for this encounter and having sex with my wife. But to the extent she was high risk should i have the same high confidence that for brief (less than a few seconds) penetrative anal sex with a condom that remained in tact that I essentially have “zero risk event for all practical purposes” and don’t need testing for this encounter. Is it fair to assume that brief penetrative anal sex with a condom intact is safe and a “zero risk event for all practical purposes”.  Thanks again for your help. I really do appreciate your services. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
I'm not sure what you're asking, except to confirm that indeed this was "a zero risk event for all practical purposes". That you judge your partner to be at higher risk than some other sex workers doesn't change anything. It is exceedingly unlikely you have HIV, but of course nobody can guarantee that without diagnostic testing. If somehow I wer ein your situation, I would not be tested. But it seems you may have a different risk tolerance than I do; you might be more reassured by a negative HIV test than by professional advice, no matter how expert.

That completes the two follow-up comments and replies included with each question and so concludes this thread. I hope the discussion has been helpful. 
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