[Question #914] HIV, HSV, STD exposure

72 months ago
Hello , 
I am a 35 yr old male, circumcised, that had an exposure from a broken condom with a female CSW at an asian massage parlor 5 days ago. No prior history of STD's. The exposure with the broken condom vaginally,  maybe lasted 5-10 seconds after I found out. Stopped right away, went home and showered.  I have been examining my penis/genitals-  at this point there are no signs of blisters/ red bumps/ etc. The tip of my penis where the urethra is has been a little painful/ tingling. No signs of discharge, or painful urination at this point. I went to my PCP and had a urine specimen sent to the lab for Gon/Chlamdia. Its still pending. I received 250 mg of IM Rocephin/ 10 day course of Doxy 100 mg twice a day
1.) What are my chances of getting an HIV infection?
2.) Gon/ Chlamydia still pending-if Doxy doesn't work- could switch to Zithro after the course is completed?
3.) What are my chances of HSV-1 or 2
Appreciate your input-haven't been able to sleep or eat! Thanks
72 months ago
I haven't had sex with my female girlfriend after this one-off exposure. Also-at what point can I resume sex without a condom with my female girlfriend-Thanks
H. Hunter Handsfield, MD
72 months ago
Welcome to the forum. Thank you for your question.

First, congratulations on using a condom. Too bad it failed, but obviously your intent was wise. But even among the highest risk individuals, such as sex workers, at any point in time the large majority have no transmissible STDs. In the US, no more than 1% of female sex workers (including those of Asian origin) have HIV. Second, all STDs are inefficiently transmitted -- i.e. even if your partner was infected, the odds are you would not have been infected. Accordingly, while of course condoms are always recommended for such exposures, the odds remain strongly in your favor.

Your symptoms do not concern me. They are typical of increased awareness of trivial or entirely normal sensations because of anxiety about the event. It is unlikely your gonorrhea/chlamydia test will be positive. In any case, the treatment you had will effectively prevent or abort those STDs, syphilis, or nongonococcal urethritis (NGU), so none of those should be a continuing worry. There is no point in even having a syphilis blood test. Even if you were exposed and an infecrtion was breweing, it is now gone and your blood test will never be positive.

To your specific questions:

1) Without a condom, the average HIV transmission risk by vaginal sex, female to male, has been estimated at once for every 2,000 exposures, if the female is infected. If we combine that with a 1% chance she has HIV, your risk calculates to 1 chance in 200,000. While you might decide to have an HIV test in a few weeks, this risk is low enough that testing can be considered optional -- for reassurance, not because there is any meaningful risk.

2) There is no chance that these antibiotics would fail to prevent or cure gonorrhea or chlamydia. Azithromycin would add nothing and I recommend against it.  You can dismiss these infections entirely, even if your test returns positive.

3) HSV1, no risk at all unless there was unprotected oral as well as vaginal sex. Genital HSV1 is rarely transmitted. There is a somewhat higher risk of HSV2, but it remains low. When a woman has genital HSV2 and isn't having an overt outbreak, the transmission risk probably is somewhere around once for every 1,000 exposures. I recommend against testing for HSV2, assuming you remain asymptomatic. And by the way, you don't need to closely examine your penis for lesions. If you get herpes, you'll probably know it without close inspection.

I think you can safely resume sex with your regular partner whenever you wish. The only remaining consideration is whether to have an HIV test in a few weeks, but the chance you were infected was so low that many people would not defer sex all that time. But that's not a guarantee you aren't infected, and if you want 100% assurance, a 4th generation ("duo") HIV test would be conclusive at 4 weeks after the event. Of course that would change if you develop symptoms suggestive of a new HIV infection, such as otherwise unexplained sore throat, fever, skin rash, or lymph node inflammation in the next 1-2 weeks.

I hope this has helped. Let me know if anything isn't clear.

72 months ago
So , as you predicted-the urine test was negative for Gon/chlamydia. Today is day 7 of 10 of antibiotics. As far as Hsv-still remain asympotomatic for the exposure that was 8 days ago. No lesions, blisters, etc. At what point would I be so called be " out of the woods" for Hsv. thanks. After this question-you have fullfilled all the info I needed. Thanks for all of the work you do! 
H. Hunter Handsfield, MD
72 months ago
You're almost out of the woods now in regard to herpes. Around 90% of new infections cause symptoms within a week, although it can be as long as 2 or maybe even 3 weeks. 

Thanks for the thanks about our services. I'm glad to have helped.