HIV Anxiety

[PBM1006]

Hi Dr.,

I am a 26 yo male and on April 24, 2009 I received unprotected oral sex from a female CSW.  This was my first and only encounter with a CSW and I am very worried about HIV transmission.  The CSW was 29 yo.  

Here is the sequence of events:

(1) CSW performed unprotected oral sex on me for approx 10 mins (no visual evidence of blood, inflammation, cold
     sores, etc.)

(2) After approx. 10 mins of unprotected oral sex we had protected (condom) vaginal intercourse for approx 5-6 mins.
    No ejaculation.

(3) Immediately following protected vaginal intercourse, the CSW performed oral sex on me for approx 5 mins while
     the "contaminated" condom was still on my penis.  

(4) She then removed the "contaminated" condom from my penis and resumed oral sex for another 5-6 mins.  No
     ejacualtion.

Additional Details:
- no evidence of IV drug use (i.e. track marks)
- CSW stated she did not have HIV or other STDs when I asked her directly
- CSW said she "gets tested all the time, don't worry"
- i never ejaculated
- i cleaned myself with soap and warm water as soon as she left
- i am not circumsized
- this was my first sexual encounter in over two years
- i have not experienced ARS symptoms (with exception to headache, but that was probably anxiety induced)
- i have no existing STDs
- i have an STD and HIV test scheduled for this week (6-week mark)

I understand this risk of HIV transmission from unprotected oral sex is low, however, what concerns me is the fact that she performed oral sex over a "contaminated" condom and then after removing it resumed unprotected oral sex.  Is my risk of contracting HIV increased because of this?  If the residual vaginal fluid on the condom contained HIV, would her saliva have "killed" the virus?  What do you think my overall risk for contracting HIV is?  How reliable will the results of my 6-week test be?  How concerned should I be about herpes?

Thank you so much for your help.

[Edward W Hook, MD]

Thanks for the detailed description, it certainly makes it easier for me to comment on your situation.  As you already know, condom protected sex is low risk so there is no risk from your condom protected exposures.  Your question really boils down to IF she has HIV, could she have infected you by transfer of her own vaginal secretions from the outside of a contaminated condom to her mouth and then infected you through unprotected oral sex.  The simple answer is no.  The reasons for this are both theoretical and data from observation.  These include:
1.  As you know, the mouth is a hostile environment for HIV. If there had been HIV in her genital secretions, it would not have survived long in her mouth.
2.  She was probably not infected. She told you this and most people do tell the truth.  In addition, you should assume that she used the condom to protect herself from you, not the other way around.  This too makes it unlikely she was going to infect you.
3.  Even if she had HIV, the risk of transmssion through oral sex is less than 1 transmission per 10.000 exposure and probably far less..
4.  While your circumcision status might influence your risk from genital sex, there are no data on oral sex.  Further, since she was probably not infected, this becomes a moot point.
5.  No one has EVER been described to get HIV in the manner you describe

My assessment.  Your HIV risk is close to, if not zero.  Your 6 week test will be negative and when it is, you should accept this as evidence that you do not have HIV.

As far as herpes is concerned, again the risk is very, very low.  If you were going to develop herpes, lesions would have been expected to asppear within 2 weeks after your exposrue.  Thus you are not at risk for this either.

Hope these comments help.  Your risk is close to zero and once you have been tested and have a negative test result, you should consider this as proof that you did not get HIV from this exposure.  eWH

[PBM1006]

Dr. Hook,

Thank you for putting this into perspective for me. What yourself and Dr. HHH do on these forums is a wonderful and special thing.