[Question #9133] HIV Risk?

36 months ago

Hi Sir,
Hope you are doing well. My situation is as follows:
1. After being in a monogamous relationship for 5 years, recently (3 days back) I decided to hire an high-end escort during one of my business visits.
2.We stayed together for 2 days and during the period we had the following sexual activities:
She performed oral on me 2 times with Condom
I performed oral on her 2 times (unprotected)
5 times vaginal sex with condom (protected)
kissing and breast sucking

3.After each vaginal sex act I checked the condoms and they were intact and also tested them by filling water and they were not broken

4.I have been recently tested for HIV and the result was negative.

Could you please assess my risk of HIV and other STIs? Should I be really worried about the exposure? Should I continue having unprotected sex with my partner?

Regards,

Edward W. Hook M.D.

36 months ago

Welcome to the Forum. Thanks for your questions. I'll be glad to comment. In general, this was a rather low risk series of encounters. Condoms are highly protective for HIV and other STIs (by the way, testing of condoms after use is not needed and if anything can be misleading. Typically when condoms fail, they break wide open and the failure is obvious). Further, most commercial sex workers, particularly high-end ones, typically do not have HIV or STIs. Further. most exposures to infected partners do not result in infection.

Regarding your expsoures=condom protected sex, no risk; performance of unprotected cunnilingus on an HIV infected, untreated partner - HIV risk calculated as less than 1 infection for every 10.000 exposures- very, very rare; kissing an breast sucking - no risk

This was a very low risk exposure. Your recent HIV test will not provide definitive information regarding your exposures in the past week. Conclusive results of HIV testing take 6 weeks following exposure to be definitive.

Hope this helps. I would not be worried about this exposure.. EWH

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36 months ago

Thanks a lot sir for the quick response. Just have the following 2 questions?
1. The HIV test I mentioned earlier was done before the exposure. Do you recommend any testing in this scenario? If yes, what tests should be done? Do you recommend an RNA PCR test to get the results early in my scenario?
2.In this forum, I have read somewhere that there are no cases of HIV reported due to cunnilingus as of now. So the risk assessment that you made regarding the same is based on theoretical point of view?

Regards,

Edward W. Hook M.D.

36 months ago

Thank you for the clarification on your testing. Testing is always a personal choice. Personally, I would not choose to test in the situation you describe. I have never seen a patient who acquired HIV from cunnilingus. There are a very few patients who acquired HIV and claim that their only unprotected exposures were cunnilingus.

If you choose to test, PCR tests typically become positive before 4th generation, combination HIV antigen/antibody tests but they are more expensive, rarely give falsely positive results and even with PCR tests, It is said that in persons who have recently acquired HIV, PCR tests become positive by day 12-14. Even with PCR testing, it is recommended that follow-up tests be performed at about 6 weeks (42 days) after exposure although I have never seen such a follow-p test become positive

As I said, if it were up to me, I would not pursue testing for the exposures you have described. EWH

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36 months ago

Thank you so much sir for the response.

Regards,

Edward W. Hook M.D.

36 months ago

I'm pleased I could help. Take care. EWH---