In 29 April 2023. I met with a CSW in Bangkok, Thailand (First time stupid move which I will never do again). I took and shower and she gave me unprotected oral for few seconds (probably she rubs me one to two time as well, no penetration) and then we had protected vaginal sex. After that I cleaned myself and she gave me unprotected oral for a few seconds and we had protected vaginal sex again. Both of the time, condoms seem to be intact and stay on my penis.  I am not circumcised. Since I came back, I am so scare of HIV and cannot sleep/ cannot work and cannot stop searching in internet. It seem to be risky based on internet. However, According to your older answers, this seem to be low risks. Can condom really protect the STDs like HIV in this case ? Am I at risk since it is in Bangkok (high HIV rate) ? Does not circumscription increase risk? Have you ever encounter people got HIV from this situation?  The only symptom I have for now is frequent urge to urination possibly from my severe anxiety from(some source said symptoms of STI). Is that true ? And Can I have sex with my long-term gf for now ? I trust your enterprise and Kindy advise me. Thanks you so much.

Thailand in general and Bangkok in particular can take pride in the effectiveness of their HIV prevention programs, with marked reduction in the frequency of HIV in female commercial sex workers. While I do not have the latest statistics at hand, I'm quite certain that well under 1% of all CSW have HIV -- so it is unlikely your partner has HIV. Second, even with entirely unprotected vaginal intercourse (i.e. lasting 5-10 minutes), if the woman has HIV, the chance her male partner will be infected averages once for every 2,500 exposures. Third, condoms are highly protective against HIV, probably around 99% effective for vaginal sex. Oral sex is nearly zero risk, under one chance in 20,000 for oral to penile transmission. These estimates suggest your risk of having acquired HIV to be somewhere in the neighborhood of 1 chance in 25 million, if you'd like to do the math (0.01 x 0.0004 x 0.01). 

The risk of other STDs is higher, however. But still low. The main possibilities of importance are the result of unprotected oral sex, namely gonorrhea and syphilis. Both are unlikely, however. If you had acquired gonorrhea 5 days ago, you would already be having pus dripping from your penis and painful urination. It's too soon for syphilis symptoms, but if you do not develop a penile sore in the next week or so, you can safely assume you didn't get syphilis. Chlamydia is almost never transmitted by oral sex.

All in all, I would consider STD/HIV testing optional in this situation. But if you feel that negative test results would reassure you, have a urine test for gonorrhea any time in the next few days. (That probably will include chlamydia testing as well, even though you are at no risk for chlamydia; testing usually automatic along with the gonorrhea test.) And then have blood tests for syphilis and HIV, both of which will be valid 6 weeks after the event.

You definitely can expect negative results on all these tests. While of course this isn't a guarantee, if somehow I were in your situation, I would continue unprotected sex with my wife with no worries that I could infect her with anything.

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

HHH, MD

Dear Dr. HHH,

I anxiety had calm by your previous detialed explainations. However, I have now some issues. I haven't had any gonorrhea and syphillis symptoms as you explained and I havn't test for them yet. My biggest concern is HIV. Two days ago, I feel like something struck in my throat and feel like need drink often to clear that. But No pain,No trouble sallowing just slight discomfort. I only notice a few time. At the time, I aslo had acidic reflux. Now My thoat feel normal. Yesterday, I had small itchy spots in my arm. Look like heat rashes. I unintentional scratched and become very itchy and pricky feeling.Since I am brown skin, not very noticable. I currently live tropical weather (hot and humid). I saw on some forum at ARS can cause rashes and some doctors said ARS rash typically non-itchy and very severe.Is that true? For now, I don't have any fever yet. Currently, I am working in a small offshore facility and we only have a GP and small medical facilty. I went to him to test for HIV. He even think virtualy no risk. However he only had screening test kit (INSTI 3rd gen fingerprick antibody rapid test). The test came back negative but as I read your previous reply the test is not reliable in 17 days.May be the test can confirm I don't have previous exposure. I had plan to test when I come back from offshore facility (probably about a month later) but my girlfriend is working together with me and we had sex ocasionally. For now, I was frusatrated scare although I use condom because this was the only time I had sex outside my relaionship and I don't want to get HIV.

Does that throat symptom look like ARS ?

Does rashed ARS look like heat rash? What does ARS look like ? Is that true most ARS rash are not itchy? Does my rashes sound like ARS ?

How much reliable is the antibody test I took in 17 days ?

When does ARS start usally? I found that your answer that ARS set in 1-2 weeks. Is still corret?

Does my symptoms sound like ARS to you ?

Is that possible that vaginal fluid contact (unnotically) with my foreskin and increase risk when I remove the condom and clean my penis with water and soap ?

How likely I will not have HIV and can I continue to have sex with my girlfriend?

Thanks you so much again. Doctors.

In addition, we already discussed the near-zero risk of HIV from the exposure you described. I am glad to hear your own doctor agrees!

Finally, your symptoms don't sound like HIV or ARS anyway. The main problem seems to be anxiety making you more aware of minor symptoms or even normal body sensations that otherwise would not be bothersome and maybe not even noticed.

In the nearly 20 years of this forum and our preceding one (starting in 2004), with thousands of questions from people worried about having HIV, nobody has yet actually turned out to be infected. You will not be the first! If and when that finally happens, surely it will be a genuinely high risk situation, not a near-zero risk exposure such as you had.

You can safely continue sex with your girlfriend without putting her at risk.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Please do not worry:  you do not have HIV.