[Question #7642] One night stand / Unprotected

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54 months ago
Evening Doctors

Made a huge mistake in Vegas.  Had a drunken one night stand with a mid 30s white female from Utah.   She is middle/ upper middle class with kids, but suspect wilder over the last few years since divorce.   We had unprotected oral sex both ways, and about 20-30 seconds of unprotected vaginal sex with her on top.   She said she was tested end of January (I guess no reason to not believe her)   but that could mean she could have acquired something since.    

I'm am right at about 36 hours post....  would you suggest I start PEP?    What are my potential STDs I am at risk for?  
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Edward W. Hook M.D.
54 months ago
Welcome to the Forum and thanks for your question.  I’ll be glad to comment.  This was a low risk encounter.  The concept that most commercial sex workers have HIV or, for that matter, any other STI is a misperception.  Other than the most worrisome, street based CSWS. In general sex with a CSW is lower risk than sex with someone casually picked up in a bar.  These folks take care of themselves, appreciate their risk, and get tested regularly.  Good scientific data Suggest that there is little likelihood of acquiring HIV from the sort of exposure you have described. If you were seen in my clinic requesting Papp, I would not be willing to provide it.  Oral sex is particularly low risk and the risk from your brief vaginal exposure is less than, on average, 1 infection per more than 2000 exposures 

Your risk for infection is low.  Testing for the most common STIs ( Gonorrhea and chlamydia)  4-5 days after the event is reasonable and will probably prove that you were not infected.  I would not worry. EWH 
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54 months ago
This was not a CSW, a girl I just met in Vegas.   Does that change your opinion
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Edward W. Hook M.D.
54 months ago
Even less risk for HIV but probably more appropriate for you to seek testing for Gonorrhea and chlamydia. EWH ---
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54 months ago
Thanks Doctor for the info.  I would be lying if i did not say i was pretty stressed out / worried about the situation.     I never have unprotected sex with anyone other than my wife (so there is some regret/shame here).      If this girl was to be infected prior to her "negative tests"  in January or after, would that put her in the early stages of HIV and MUCH more prone to spreading it?     I plan to test for Gonorrhea and chlamydia at exactly 5 days.. if this is negative, is this a good sign that she may not be an HIV carrier?
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Edward W. Hook M.D.
54 months ago

I'm not totally sure I follow your question.  Practically, if her tests for HIV she cannot transmit the infection (there is some internet misinformation regarding transmission during a so-called "window" period when a person's tests are not infected but for practical purposes, this is a non-issue).  If her tests are negative, I would not be worried. 

FYI, the prevalence of HIV among American women is a small fraction of 1%.  On average, if you were expose to an HIV infected women with unprotected vaginal intercourse, your risk for infection, on average would be less than 1 infection per more than 2000 sex acts.  Considering the brevity of your vaginal encounter and the low risk nature of your partner, as I noted, I would not be worried about HIV.

Your risks for gonorrhea or chlamydial infection from this brief, low risk encounter are very small.  Your tests at 5 days will be conclusive for both bacterial and when they are negative, it is a good sign that your partner was unlikely to have HIV

Normally we would close this thread now that I have provided three responses however in that I had trouble following your final question, I will leave the thread open so that you can provide clarification if need be. 

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54 months ago
Thanks Doctor for allowing clarification.   So if she tested end of January, that means she was "negative" 4-6 week prior.   I'm wondering if say she had acquired HIV say in the 2 - 3 weeks prior to our interaction, would she be extremely contagious?   (Google says so)

And last, would you say I am at about a 1 in 25,000 odds of being infected with HIV? 


Thanks for your time & expertise.  Much needed and appreciated.  
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Edward W. Hook M.D.
54 months ago
If she had acquired HIV in the few weeks since being last tested, indeed she would likely have high circulating levels of virus and be more infectious.  OTOH, the odds of her acquiring HIV  in the preceding few weeks are extraordinarily low.

I’m saying that in the unlikely circumstance that she had HIV, your risk of infection would be no greater than 1 in 2500.  If you consider the low likelihood that she was infected, your statistical risk would be less than 1 in 250,000 and probably far lower than that.

This concludes this thread.  As I’ve tried to indicate, I think that your guilt is leading you to worry far more than is needed. EWH 
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