I am a 21-year-old male, and I am uncircumcised. I received protected oral sex and had protected vaginal sex with a sex worker in London. Two condoms were used, one for the oral exposure and one for the vaginal exposure. The condoms were provided by the sex worker. The room was dark so I didn’t know what brand the condoms were. But as far as I knew, the condoms were intact.

About 7 days later, I developed a slight sore throat and two mouth sores on my lips. The sore throat is mild (I can’t notice it unless I pay attention to it). I also have TMJ which causes a sore throat from time to time, so it’s possible that this time it’s also due to my TMJ. I also have mild muscle pain, though I think it’s mostly the DOMS after my swimming session a few days ago. But, of course, I can’t be 100% sure about the above justification.

My questions are:

1. What’s my HIV risk from this exposure?

2. Do my symptoms make you feel concerned? Are my symptoms typical for a recent HIV infection?

3. Can I proceed without HIV testing?

4. Can I have unprotected sex with my partner?

Thanks for your time.

1) This was a zero risk exposure in regard to HIV, and close to zero for other STIs as well. HIV is rare in female sex workers in the UK; and even if she was infected, the condoms prevented transmission. There is no such thing as microscopic leaks or defects that allow HIV transmission; that's a myth. It doesn't matter who provided the condoms. If they didn't break wide open, which you obviously would have seen, protection was complete. And oral sex is no risk even without a condom:  there has never been a scientifically proved case of HIV transmission mouth to penis. To your questions:

2) Your symptoms are not typical for ARS; and they began too soon. ARS typically starts 10-14 days after exposure; 7 days is possible but unlikely. And almost all people with your symptoms have a minor respiratory viral infection. (You're a better judge than I am about the possibility it's related to your TMJ issues.)

3) There is no need for HIV testing.

4) If somehow I were in your situation, I would continue unprotected sex with my wife without even the slightest concern I could infect her with HIV or any other STI.

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

HHH, MD

1. Are canker sores part of ARS?

2. Do you think the rate of HIV among sex workers is very low in London (not other parts of the UK)? Which would be a reasonable guess, 1/100 or 1/1000?

2. My understanding about HIV epidemiology in the UK is over 10 years old, when HIV was said to be uncommon in female sex workers in London, with estimates like you quote i.e. 1% to 1 in a thousand. But of course in such a large city it can be highly variable -- with low rates in some CSWs and higher in others. In general, HIV frequency in all settings is believed to be lower in escorts (expensive sex workers by appointment) and higher in brothel workers, street or bar pick-ups, and so on. Up to date information likely is available from Public Health England or other public health resources.

Can sharing dental flosses transmit HIV? For example, if someone who is HIV positive uses a dental floss and leaves some blood on it. Another person uses the same dental floss immediately after the first person. Are there risks?

I am very grateful for your help. Please let me know if you think I should post a new question.

Your original question reflected legitimate concern about a realistic risk. Disregard just about all other possibilities:  you will never be at risk for HIV unless and until you have unprotected sex or share drug injection equipment with a person at similar risk of being infected.

That concludes this thread. I hope the discussion has been useful. Best wishes and stay safe.