HIV Risk Exposure - Broken Condom/HIV Test

[Mediquestion]

I am 29 and extremely stressed & anxious about an encounter with 2 escort girls in Spain. The 1st happened on Sept 15th and the 2nd on Sept 24th. I had never been with escorts/SW before.

With the 1st girl I had protected vaginal sex and tongue kiss and gave her oral sex for about 30 seconds. I was not so stressed afterwards as I thought I did the right thing by using a condom.

With the 2nd girl I also had protected sex but in the middle of it the condom broke, it was split open. After it broke I remained inside her for only about 10 seconds. After that I did not think much about it and I removed the condom and she gave me a hand-job using her saliva for about 3min and then put another condom until I ejaculated in the condom. I did not ask her if she was HIV+ or not, we did not talk much about the broken condom, she looked quite relax and I did not think much about it right after.

Lately I have been stressing a lot about this, having negative thoughts about it. I am very anxious, cannot work or do anything I only think about the risk of HIV. I am not sure of the rate of HIV+ sex workers in Spain, the girl I was with was from a very expensive place in Spain for business man.
Could tell me the risk level of this exposure? And if it's low/medium/high, what does that mean?

I cannot imagine waiting for 3 months to take a test, is very stressful. Today is 15 days since the 2nd encounter and I have an appointment for a HIV test on the 28th of Oct, by then it will be day 34. Do you recommend I take a test earlier than day 34? How trustable would the results be for my test on day 34? Not sure about the type of test, but results are ready in 15min.

I am also stressed because I have a girlfriend and we do not have protected sex, we have been together for 2yrs and we have never had any issues with STD, as far as I know. I think the best thing is to start having protected sex now.

I would really appreciate your answer/comments.

Thanks

[Edward W Hook, MD]

The risk for circumsised men, all other things being equal is about half of that of uncircumcised men.

The issue of symptoms is a waste of time to even cosnder.  The "ARS" while real, represents the cause of less than 1% of the explanation for viral-illness like symptoms in persons at risk for HIV.  EWH

[nani2smart]

A related discussion, Terrified If I have HIV Symptoms...PLS HELP was started.

[Edward W Hook, MD]

She is being overly conservative.  At 5 weeks about 90% of tests that are going to be positive will be (I told you this before).   EWH

[Mediquestion]

Hello doctor, today I had the rapid antibody test done (rapid blood test). I am at exactly 5weeks from my exposure. I want to think this is reassuring, however at the hospital the nurse told me this result is not valid at all! And that I need to come back at the 12week mark or after. She even wrote on the report "not valid result". This is stressing me a lot as I am now back to where I started in terms of stress and anxiety.
Please advice the reliability of a 5week negative result for my particular case. I would really appreciate your comments.

Regards,

CB

[Mediquestion]

Doctor I went to take the test yesterday and they did not allowed me to take it arguing that I have to wait 3months at least. This is in Switzerland, I would expect they have the normal antybody tests that would in line with the percentage of accuracy you provided. I will go again in week6 (i am in week 4 today), should I have the same expectation on the accuracy of the test?
thank you

[Edward W Hook, MD]

No, the performance of all commerically available antibody tests are about the same.  whatever test is done should give you reliable results.  EWH

[Mediquestion]

Doctor,

I am taking a antibody test in a couple of days. This would be 4 weeks (or 28 days after exposure). You mentioned in one of your answers before than after 4 weeks it would give me 90% accuracy. Would this be with a particular type of test or also with the antibody test?

Thank you for your comments.

[Mediquestion]

Thank you for your answer doctor. I am still feeling stressed and looking for symptoms that probably are not there. I have two questions:
1/ Is the risk of HIV infection lower for the circumcised men? I am asking this because I am circumcised.
2/ In terms of the potential symptoms after infection. Can they appear independantly? For example a swollen lymph node without fever and any other symptom, or viceversa.

Thank you for your answers.

  

[Edward W Hook, MD]

About 50% of tests that are going to be positve will be postive at 2 weeks.  Don't know if that would help or not.  If you can hold out until 4 weks, that would be best.  EWH

[Mediquestion]

Thank you for your comments, it helps to understand better and be a bit reasured. I am still a bit stressed on the idea that there is somewhat a risk. I would like to finish this period as quickly as possible, I am having a hard time getting in my mind the fact that I will have to wait until Oct 28th. Would an earlier test be of any significance?

Thank you again.

[Edward W Hook, MD]

So to summarize, you would like help in assessing your risk for HIV from the exposures you describe.  For starters, there is very, very little risk to your first exposure.  the risk associated with kissing and oral sex is very low and condom protected vaginal sex is safe sex so there is nothing to be concerned about.  This brings us to the 2nd exposure that you describe which, because of the broken condom, became unintentionally unprotected sex (her use of saliva to finish you off after the condom broke is immaterial).  Even so, your risk of HIV is low.  Here is why:

1.  As you point out, you do not know the infection status of your partner.  Having said that, the probability that she had HIV is low.
2.  Secondly and perhaps even more importantly, after a single exposure, if she was infected which is unlikely, your risk of getting HIV from the exposure is less than 1 in 1000 exposures.  Nonetheless , I understand your anxiety so let's now look at what testing can tell you.

At 34 days (almost 5 weeks) following exposure, a test with any of that standard tests for HIV will detect close to 90% of infections which have occurred from an exposure 5 weeks before.  Thus, when you combine these test accuracy with the relatively low statistical risk of infection from the exposure you describe, the negative result I suspect you will get should provide great reassurance that you were not infected by the exposure you describe.  You may still want to get a second, follow-up test at 12 weeks post exposure to be 100% sure but the major result to focus on is the five week test you will take shortly.  Hope this helps.  Your risk is low.  EWH