[Question #7307] HIV risk

58 months ago

I recently sort of had protected sex with a female of unknown HIV status. I had on a condom but now that I think about it I remember the condom being on half way. I'm worried because I'm uncircumsied and not sure if the penis was covered enough to avoid hiv transmission. She took an oraquick hiv test a week after our encounter which came out negative but I'm worried that she could have been only a few weeks into being positive and she could have transmitted the virus to me even though she tested negative. What do you think my risk are and do you think I require testing based on what I described.

H. Hunter Handsfield, MD

58 months ago

Welcome back to the forum and thanks for your continued confidence in our servicers. I'm happy to help. FYI, I happend to log on very soon after you posted this question. Most users shouldn't expect nearly real-time replies!

There was little or no risk of HIV from this event -- for all practical purposes, zero risk.

First, congratulations for using a condom for sex with a new partner or any partner of unknown STD/HIV status. Good move -- and it worked! Here's some basic info about condoms. Almost always they cover only part of the penis; in vaginal sex, 1-2" of penile skin above the condom is normally exposed to the woman's vaginal fluids and genital tissues. Whether a prticular event has 80% of 50% exposure of the penile skin makes no difference in HIV risk; as long as the head of the penis and meatus (urethral opening) are covered, protection is complete -- not only for HIV, but for all STDs transmitted by fluids, including gonorrhea and chlamydia. Contact of HIV with intact skin of the penis (or anywhere else) is risk free. Incomplete penile coverage is why condoms work less well in preventing STDs transmitted by skin-to-skin contact, like herpes, syphilis, and HPV.

For those reasons, you can consider your exposure completely protected from HIV transmission. In addition, the vast majority of women (including the riskiest, such as sex workers) do not have HIV; even without testing, it was unlikely your partner has HIV. And with her negative test result, it is almost certain she is uninfected. Any any point in time, a very tiny proportion of all women have been infected so recently that the HIV test is negative.

So all things considered, your risk of having caught HIV was well under one chance in many million -- zero for all practical purposes. If somehow I were in your situation, I would not get tested for HIV and would continue unprotected sex with my wife without worry. However, I'm not you, and you may be more of a worrier about such things than I am. Also, everybody who has sex outside a committed monogamous relationship, even rarely, should be tested for HIV from time to time, like once every year or two. If you haven't been tested recently, maybe this would be a good time. But not because of this particular sexual event.

I hope these comments resolve your concerns. Let me know if anything isn't clear.

HHH, MD

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58 months ago

(Whether a prticular event has 80% of 50% exposure of the penile skin makes no difference in HIV risk; as long as the head of the penis and meatus (urethral opening) are covered, protection is complete -- not only for HIV, but for all STDs transmitted by fluids, including gonorrhea and chlamydia)

One thing that is not clear. With an uncircumcised male does more of the penis require covering besides the head because of the foreskin? That is what has me worried.

H. Hunter Handsfield, MD

58 months ago

I suppose some uncircumcised men with redundant or lengthy foreskins might have a slight risk of exposing some of the under-foreskin surface -- but even here, 50% coverage seems likely to have completely covered those surfaces. You're the only one who can judge this for yourself. But remember that even entirely unprotected vaginal sex by an uncircumcised male, with a known HIV infected woman, ahs roughly 1 chance in a thousand of catching for any single exposure. You're overly worried about a very trivial risk. ---

58 months ago

I dont believe I have lengthy or redundant foreskin. Just normal foreskin. I was just reading before I contacted that HIV could pass through the mucos membrane of an uncircumsised penis and I'm not totally sure where the mucus membrane is located. If it's normally around the head of the penis then I feel good about the situation. I'm certain that the condom was at least 50% on/covered the penis. Also is there a chance that the female could be positive enough to transmit the virus even though she tested negative with a oraquick test the next week. I'll leave this alone after I see your answer.

58 months ago

H. Hunter Handsfield, MD

58 months ago

How to interpret your question mark? Do you imagine the moderators staff the forum 24/7?

We don't expect much of forum users, but we do expect they will at least read and try to understand our replies. These additional quesitons are answered above, or at least the answers are obvious with a little thought.

The surface you refer to is actually not a mucous membrane, but thin skin on the inside of the foreskin and surface of the penis under it. As I said, I cannot judge whether these tissues were covered by the condom -- I would think so, but that's your call, not mine. But I also said that even if you hadn't used a condom at all, your risk of HIV would be low. And I also explained that there is almost no chance your partner has HIV.

That completes the two follow-up exchanges included with each question and so ends this thread. No more questions on this topic, please.

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