Am I at risk?

[TribecaJoe]

Dear Dr. H,

I am a 36 year-old married man with a young child living in Manhattan.  Every once in a while, I go to a massage parlor that offers a happy ending release.  It never involves oral sex, just the masseuse’s hand and massage oil.  I thought I would check out a new place today and I was surprised when the masseuse (a young Korean woman who barely spoke English) proceeded to put a condom on me and get on top of me.  I came inside her (with the condom on) and subsequently, she removed the condom using tissues.  The condom may have slightly slipped up the shaft of my penis during intercourse but remained on.  I stupidly tried to ask her afterward if she got tested and how often but she had no idea what I was asking.  My questions to you are:

1. What are my risks of contracting an STD – primarily HIV?
2. Should I get tested?
3. How soon can I get tested – even if just to reassure myself?  
4. Do I put my wife or child in any danger?  

Thanks very much and I appreciate your help.  Also, I mistakenly posted this same question in the STD forum so I apologize for that – I paid both times and don’t mind doing so as the work you are doing is truly valued.

TribecaJoe

[Edward W Hook, MD]

The symptoms you describe are those of the sorts of viral illness that we all get from time to time.  This time they occur, by coincidence, 5 days after your protected sex with the masseuse.   As we discussed, between the low overall risk of any sort or encounter of the type you described and the fact that there was no exchange of secretions in your condom protected encounter, I would urge you to attribute this to coincidence, not HIV.  No change in my assessment or recommendations. EWH

[TribecaJoe]

Dear Dr. H, yesterday (5 days after the encounter described above), I came down with diarrhea, fever (100.9), fatigue and loss of appetite.  I’m feeling much better today – though not quite 100%.  My worry is that this could be signs of some kind of acute HIV or other STD versus food poisoning or some other kind of virus going around.  Do you think this is purely coincidence?  
Thanks again,
TribecaJoe

[Edward W Hook, MD]

Not an issue.  If the condom was intact following sex, it worked.  Please remember, typically the reason commercial sex workers use condoms is to protect themselves, not their clients.  She has nothing to gain by using condoms that don't protect her.  EWH

[TribecaJoe]

One more thing, she provided the condom - I did not look to see if it was of decent quality nor do I recall her taking it out of the wrapper.  Does this change any part of your response?

[Edward W Hook, MD]

Welcome back to the Forum. I have deleted your other post on the STD Forum.  The exposure you describe did not put you at risk for HIV or for other STDs.  Even when condoms slip a bit they offer protection, thus I would not worry about your risk.  As for your specific questions:

1.  See above.  This was not a risky exposures.
2.  There is no medical reason for testing related to this exposure.
3.  See above.  If you are concerned about HIV, at the NYC Health Department STD Clinics where tests are performed using both tests for antibodies and using PCR-type assays, a test at 4 weeks would be  definitive evidence that you did not get HIV.
4.  No, absolutely not.  

I hope these comments are helpful to you.  EWH

[TribecaJoe]

One more thing, she provided the condom - I did not look to see if it was of decent quality nor do I recall her taking it out of the wrapper.