[Question #8608] TS encounter - ruptured condom

42 months ago

Hi docs

In a very anxious state following the encounter I describe below:

- 21st feb - encounter with Transexual escort (expensive/high class) in seattle, WA

- mutual unprotected oral sex

- use of sex toy on me anally which caused a small amount of bleeding in my anus

- protected anal (I was receptive partner) for a few minutes, halted when she realised the condom had ruptured (I didn’t see it). I also don’t believe she had fully inserted into me.

- she said she was clean, was tested as recently as last month and is also on prep

I’m really worried about my potential HIV risk here and seems like I’m beyond the window to obtain PEP.

Wondering if you might give me a view on how much risk there is here? I plan to get a 10 day HIV test on 4th March on my return to Europe and before that get a chlamydia/gonhorrea test before that (from reading other posts in this forum in understand 5 days would be ok for these tests to be reliable).

Many thanks in advance, trying to keep somehow calm here but my anxiety is getting the better of me and I’m really freaking out.

Thanks

42 months ago

Hi docs

Another couple of things I thought I’d drop in that I neglected to put into original question:

1. She was circumcised.

2. She had an onlyfans site and previously has uploaded Sti tests saying her commitment to monthly testing.

Not sure if these are relevant given the ambiguity of the situation, but thought no harm in adding.

H. Hunter Handsfield, MD

42 months ago

Welcome to the forum. Thanks for your confidence in our services.

You were at little or no risk of HIV from the events described. Your partner probably doesn't have HIV (people usually don't lie about it when asked directly); and if she did, being on PrEP is 100% protective against transmission. The apparently very brief anal exposure before the condom broke also is in your favor.

So testing for HIV is optional. If you do it, 10 days really is too early -- even the most sensitive RNA (viral load) blood tests detect only around 50-60% of infections by that time. Two weeks is a more standard recommendation, followed by an antigen-antibody (AgAb, i.e. 4th generation) blood test at around 4 weeks. Whenever you do it, stay relaxed in the meantime: for the reasons above, it is exceedingly unlikely you caught HIV. (Another option is to get in touch again with your escort partner. If she is willing to be HIV tested again, a negative test at this time would prove you were not exposed at all.)

All that said, it probably is true that the risk was higher for gonorrhea and chlamydia. You are correct about timing: 5 days is plenty of time for reliable rectal swab testing.

For in person professional advice, call the Seattle-King County Public Health Sexual Health (i.e. STD) Clinic at Harborview. I used to be the clinic director -- you'll get world class care. (If their advice is somewhat different than mine, they're probably more up to date -- follow theirs!).

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

HHH, MD

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42 months ago

Hi Dr H

Thanks so much for the caring and reassuring reply, I rather suspect my blood pressure dropped a few points instantly on reading your response. Perhaps predictably, I do have a couple of queries if that’s ok;

1. Minor anal bleeding on my part - for some reason I’d thought this would massively increase my risk of say her precum came into contact… am i oversimplifying/over analyzing?

2. RNA test - I live in London, UK, on my way back there now. RNA tests seem to be marketed as >99% at 10 days - is this artistic license or over selling on the part of the providers offering the test?

3. Appreciating this is totally subjective here - I have a female partner and I guess is thought the best thing to do would be avoid sexual contact with her for 10 days (or now 14 per your advisory) then resume normal sex with her. How risky do you think that proposition is?

Thanks so much

H. Hunter Handsfield, MD

41 months ago

Thanks for the thanks; I'm glad my comments have helped so far.

1. A wound with blood exposure in theory elevates the risk, but probably only a little.. The main risk determinant here, however, is the low probability that your escort partner has a measurable HIV viral load, which in turn means she is non-infectious, even if he has HIV. Which she probably doesn't.

2. Yes, I'm aware that some sources advertise extremely reliable results of RNA testing at only two weeks, and there are data in support of that. However, there also are data indicating 90% is a better estimate. Given the discrepancy, it's generally wiser, in our view, to use the lower figure. This is the statistic. Here's a link to the review article that supports this perspective, and which CDC cites as the main basis of its own advice. I'm not sure what advice BASHH cites for the UK; you may want to check it out when you're back.

3. I can't give you conclusive advice on sex with your regular partner. If I were in your situation, I wouldn't hesitate. The chance you have anything transmissible to her is exceedingly low, if not quite zero. (If you acquired rectal gonorrhea or chlamydia for example, it would not be transmissible with usual heterosexual practices.)

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41 months ago

Ah thanks doc…. If I’m permitted a final question (aware I asked a few bullets in my last reply) - feeling a tingle on my lip here and wondering if Herpes is a risk from me performing unprotected oral on her?

Never had a cold sore or any type before… assume Zovirax or similar is the only thing to do at this stage?

Thanks

H. Hunter Handsfield, MD

41 months ago

Contrary to impressions easily gained online, tingling alone is almost never a herpes symptoms. Tingling may precede a visible outbreak by a day or two, but only for recurrent herpes, not for the initial infection. I would strongly advise you to not attempt to self treat this with acyclovir (Zovirax) or anything else. Taking an anti-herpes drug after exposure does not prevent infection from taking hold, but can interfere with later diagnosis. (In animal research, anti-HSV drugs are effective in prevention only if pre-administered, before inoculation of the virus. Even an hour later, there is no prevention effect whatsoever.)

That completes the two follow-up exchange included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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