Hello Doctor,I recently had sex with a Turkmenistan CSW from i picked up from a bar. The condoms were provided by her, we started off with her giving me a protected oral, then i gave her unprotected oral. After this we started to have sex, however in between changing position i saw that the condom had torn apart and my penis head was exposed in her vagina for approximately 2-3 minutes. we changed the condom and continued having sex until she gave me handjob and i came.

The condom breakage did distress me at the time and i asked her about her health however she understands very little english but i guess she got the jist of it after i said condom break. she replied saying "No problem i have no problem" which i took as meaning that she is clean.

This was the first time I had a condom break and so the next day I went to my doctor and described the situation and he said he personally would not prescribe it. Today it is the 5th day after exposure and I managed to use translate to get through to her in her language specifically asking "Do you have any health problems like HIV and sex disease?". To which i got a voicenote from her saying  "I am no problem please understand I am no problem" I also asked if she has sex without condoms to which she said only condoms. 

I asked her if she gets tested regularly to which she got quite annoyed but never really gave a reply. SO, at this moment in time I am disregarding her no problem assurances and placing her in the unknown HIV status category.I did go through a few of the other posts on the forum with one recently all having a issue similar to mine where you stated: "very unlikely circumstance that your partner was infected and untreated, the risk of HIV from a single unprotected exposure is less than one infection for every more than 1000 exposures. "       

Is this the same scenario as the other post and what are my risks?

I'm sorry to hear of your condom mishap.  Condoms do break during sex about 1% of the time they are used.  Despite this mishap, as you have already learned, your risk for any infection is quite low.  Your partner stated that she always used condoms with partners as she did for you and that she had her own condoms supports this.  Further she stated that she was "safe" and indeed, most commercial sex workers do not have STDs.  Even if she was infected, your risk for infection was low.  The risk for acquisition of any STI from your performance of cunnilingus is very, very low for bacterial STIs and virtually zero for HIV.  During the brief portion of your vaginal sex when the condom was broken, infection was also unlikely to occur even if she was infected- most single exposures do not lead to infection and in your case the brevity of the exposure is further in your favor.  That you remain asymptomatic today, 5 days after the exposure is likewise evidence that you were not infected.

Your quotation of my statement that, even if she had untreated HIV infection, your risk for infection is less than 1 infection for more than 1000 encounters is correct.  In other words- in the unlikely situation that she was infected with HIV, there is a more than 99.9% chance that you were not infected.

Like your doctor, I would not recommend treatment of any kind related to these events.  Certainly if you wish to test for your own peace of mind that would be fine and I am confident that you will find that the tests show you were not infected.  Testing for the most common STIs, gonorrhea and chlamydia will be completely reliable at this time and testing for HIV and syphilis would provide conclusive results at any time more than 6 weeks after the encounter.

I hope this information is helpful.  If you have additional question, please feel free to use your up to two follow-ups for clarification.  EWH

Thank you for your response,

Just a couple more things, unfortunately in between me posting the question and you replying, my throat has started to have slight irritations.

Also You say : "That you remain asymptomatic today, 5 days after the exposure is likewise evidence that you were not infected." Which infections are you referring to in this statement?

At five days, tests for gonorrhea and chlamydia- the most common STIs would provide reliable results.

She is ignoring you because she has provided you with her statement that she is not infected and yet you persist in repeating your questions.  Her behavior is not at all uncommon and in no way changes my assessment.  

As I have already said, your risk for acquiring ANY STI, including HIV is very, very low.  I anticipate that, should you choose to test, your results will be negative, proving that you were not infected.  Please don't worry.  EWH

Today is the 7th day after exposure. Yesterday night  i had a slight pain in my groin area on the right side. i attributed this to me climbing 3 flights of stairs and then climbing another spot which was had to reach. The pain would only occur in certain positions and was there till this afternoon. However after this, a very  small patch of skin in my pubic area right next to the base of my penis has a burning sensation. I have tried to feel if any lymphs are there through references on google however at the moment i cannot feel any swollen lymph. What could be causing this sensation. Can this be related to ARS or could it just be irritation of some sort.

I have also started to get stiff shoulders mainly going from the left to my neck. since these 2 things have popped up, I have entered a heightened state of panic, stress, and anxiety.

1) i was going through the forum where a recent post from yesterday, similar to my situation, Dr Hunter stated the "The average transmission risk by unprotected vaginal sex with an infected female partner is around 1 in 2,500." Could you comment on the difference between your estimate and his if possible.

I thank you for your comments thus far and really appreciate your advice and the work you do!

There is little statistical difference between 1 in 1000 ( I.e. a 99.9% chance you were NOT infected) and 1 2500 ( a 99.96 chance you were not infected).  Sorry if this small difference left you concerned.

Persons who are in the earlier stages of infection ( first 30 days or so) are more infectious then people whose infections are well established. That however does not change my assessment or my advice. Please don’t worry.  EWH 

I would just like to finally ask, in regards to the sensation in the pubic area that i forgot to add last time. The sensation comes and goes and i applied talcum powder on it when it was there and it subsided quite a bit. The next day it was completely gone, however, today, 10 days post exposure, it has come back. Earlier I was wrong to classify it as a burning sensation, but it is some sort of a sensation that makes it uncomfortable. It is most felt when sitting or lying down in certain positions however very little or completely gone while standing or walking. The groin pain also came back today originating from the pubic area a little above the the base of the pelvic bone into the inner thigh, however that went away in about 2 hours.

I have not experienced any of the characteristic symptoms of Gono or chlamydia till date.

Could the sensation be due to any another STI?

Thank you once again for your advice!

I hope the information I provided you has been helpful. Please don’t worry. EWH