I am an expat living in Thailand. Recently I had sex with a CSW. We had sex maybe 4-5 times during the night and each time I used a condom (properly I think). At the end of the experience, I noticed that I had a small cut below the base of the condom (it was not covered), which I must have gotten during rough sex. It was a small cut, but it was also bleeding a little bit. Given that it was a fresh cut, made during intercourse, what are my chances for HIV or other sexually transmitted diseases/infections? Admittedly I don't know her status, but the likelihood of her having it is obviously higher on average than a normal Thai woman.

Additionally, there was a lot of rubbing going on without any condom or clothes on -- what most people would call dry humping, though it was still rather wet. (Is it still called frottage if there are no clothes involved?).  Anyway, the tip may have gone in a little but and there were definitely vaginal fluids going over me and the cut during this time.

What is the overall risk for both of these situations? Frankly, I would rather not go get tested all the time, but if need be, I guess I can. What do you guys think?

Thank you as always for your insightful answers,

Joe

There are no data on which to calculate any elevated HIV risk in these circumstances. Logically the risk might be somewhat elevated by exposure of a fresh penile skin injury, but the overall risk is so low that I doubt it makes much realistic difference. Here is how I would judge your overall risk: Let's assume a 1% chance your CSW partner has HIV. With entirely unprotected vaginal sex, the average transmission risk from a single episode of vaginal sex (female to male) is 1 in 2,500 (or 4 in 10,000). Condoms reduce that risk by say 99%. Those figures calculate as 0.01 x 0.004 x 0.01 = 0.0000004, i.e. 4 in 10 million for each exposure, i.e. 1 chance in 2.5 million. Five exposures raises this to one chance in 500,000. Now let's guess having a fresh cut raises the risk tenfold. That's probably too high -- but now we're at one chance in 50,000 you have acquired an HIV infection. Because all these risks are estimated on the high side, that represents your maximum risk. I hope you'll agree these are pretty good odds in your favor! I would put the risk from the dry humping event as virtually zero, so I think it can safely be ignored.

Is this high enough risk to warrant testing? In my mind, probably not. In general, persons with ongoing HIV risk, such as multiple sex partners or regular sex with CSWs, should pretty much ignore individual exposures unless the risk is especially high:  for example, if a condom breaks with a partner known to have HIV. Rather than obsessing about individual events, a plan for regular testing makes most sense -- such as once a year, or maybe every 6 months; or for those at really high risk (e.g. gay men with multiple partners), every 3 months.

For those reasons, I think you're on the right track with "not go get tested all the time". OTOH, some people will continue to worry despite such risk calculations, and regardless of professional advice, no matter how expert. If you're going to lose sleep over the events you have described, it's probably best to be tested, just for peace of mind. In any case, if it's been a while since you were last tested, perhaps this is the time to have it done and then carry on with a regular schedule.

I hope these comments make sense. Let me know if anything isn't clear.

HHH, MD

Unrelated, but how come the advice on the internet, especially with famous Ivy League names behind them, is so neurotic? There is a column on the internet written by someone who is always at the top of the google searches, and she always says X, Y, and Z are possible, but then when I look here you guys debunk it with 40 years of data. What’s up with that?

Thanks a lot.

Anyone can say anything they want on the web. Many or most sites take a black/white approach:  if there is any theoretical risk at all, they say transmission could have occurred, without considering the data on whether or not such cases occur with any proved frequency. Whatever the explanation, on this forum we stand by the science.

Clearly you are noticing something that has been there all along, and no STD is a possible explanation. As you suggest yourself, maybe a small fibroma, cyst, or something like that. I think you can safely ignore it. If it starts to grow larger, you'll have plenty of time to have it medically evaluated long before it causes any problem. However, avoid the temptation to keep evaluating it:  repeated manipulation, pressing, etc could inflame and enlarge it. Hands off.

Thank you!

That completes the two follow-up comments included with each question and so ends this thread. I hope the discussion was helpful. Take care and stay safe.