HIV Risks for Recent Encounters

[kindaconcerned48]

Drs.  -  I have read and been reading posts on your forum for some time now and am glad to have access to such a wonderful service.  I have had a few encounters over the past two months that I wanted a risk assessment on from an HIV standpoint.  They are as follows:

1.  An encounter with a recent immigrant from Jamaica.  I gave her some unprotected oral, she gave me some unprotected oral, and we had protected sex.  The condom broke but I realized it when it happened and put on a new one.

2.  Approximately three separate encounters in VIP rooms of strip clubs in which I gave the stripper unprotected oral sex (both cunnilingus and some analingus) and in which the girl gave me unprotected oral sex.  No vaginal or anal intercourse involved in these instances.

3.  Two separate encounters with escorts who gave me protected oral and with whom I had protected vaginal intercourse.  There were no issues with the condoms - both remained intact for the entirety of the encounter.  For at least one of the encounters, however, I used a polyisoprene condom (my ex-gf had latex allergy issues).  Are those as effective as latex?  I think the second encounter involved a latex condom - the escort was the one who provided it.  Both had a stash of condoms, lubricant, etc., so it seems they were educated and not reckless about protecting themselves.  At any rate, any reason to be concerned about these encounters?

All of the girls except one of the strippers mentioned in question 2 are african american.  Does that impact the risk analysis at all?  Is there any need for testing?  If so, when and what kind of test?  I've recently started dating a girl that I really like and I don't want to do anything to expose her to anything.

Thanks in advance for sharing your expertise with me on this subject.  As has often been noted in this forum, there is so much conflcting information on the web that it is hardly reassuring to conduct an in-depth search of any HIV related topics.

[Edward W Hook, MD]

Correct. The encounters you describe have very little risk associated with them and when conveniet, testing will be a good idea but there's no huge rush.  EWH

[kindaconcerned48]

Sorry Dr.  From your most recent response it appears I may have misunderstood your earlier response.  You are saying that it may be a good idea for me to get tested as part of some kind of routine check up but that you don't think any of the encounters described above put me at any appreciable risk of becoming infected.  Based on the above-described encounters I can expect a negative result.  Do I understand correctly now?

[Edward W Hook, MD]

I would call the Emory HIV Clinic. If there is a place it can be done, they'll know.  If not available, a close alternative is to have a standard antibody test and a PCR assay done at the same time. there are a few more falsely positive PCRs than DUO tests and PCR is more expensive but if your dead set on testing that is an alterantive. EWH

[kindaconcerned48]

I've done extensive research on the net and by calling around and I can't find any facility in the area (Atlanta) that knows what the duo/combo test is. Any chance you might be able to provide guidance?

[Edward W Hook, MD]

Glad to help.

There are no data on the effect of orgasm on HIV risk.  I suspect there are none, so no change in my opinion.  For you you can call it screening or for peace of mind but testing for HIV, as well as other STDs is reasonable but not something to worry about or rush out and seek emergently. EWH  

[kindaconcerned48]

Thank you Dr.  I take it from your response that you think it highly unlikely that I contracted HIV and that I can expect a negative test result.  Just looking for a little peace of mind on this issue.  I understand your point about screening.  I neglected to mention a couple of encounters with a particular female in which I gave her unprotected oral sex and she had multiple orgasms.  I assume from your answer above that this fact does not change the risk analysis for unprotected oral sex?  I am not as concerned about the condom break issue.  The girl from Jamaica had been tested about six months prior as part of her efforts to come into the country and she offered to show me her negative test results.  Thanks in advance - this will be my last follow up on this thread.

[Edward W Hook, MD]

Welcome to the Forum. I will not work through your encounters one-by-one but will address the sorts of exposures you describe.  Here goes.

1.  Oral sex, giving or receiving.  We answer this question several times daily.  There is no scientific evidence that HIV is spread through oral sex.  The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high.  This estimate is theoretical.   Some experts, including us, state there is virtually no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  This includes by all of the people who had gum disease, blood in the mouth, oral sores, etc.  We no longer routinely recommend testing related to oral sex.  

2.  You had a condom break. This is an exposure.  The average risk of getting HIV through unprotected penile-vaginal intercourse, IF your partner had HIV (most people do not know whether their partners have HIV and incorrectly assume they do when in fact, it is unlikely that they do) is 1 infection per 1000 sex acts.  While not formally studied, common sense says the longer the exposure, the more likely transmission is to occur.  If you become aware that the condom broke and exit quickly, the risk is almost certainly lower than average.

3.  Condom protected sex. When a condom is used throughout sex, there is virtually no risk of HIV.  Polyisoprene condoms are just as, or perhaps more effective than latex. Certainly not less effective.

4. Partner type.  Certain types of persons are more likely than others to have HIV. Commercial sex workers are more likely than not. Despite that, most people including most CSWs do not have HIV.  If a CSW is providing and using condoms, you should remember that they are using them to protect themselves, from you, not the other way around.  thus is is unlikely that a CSW who wants to use condoms has HIV.  

Testing.  There are several reasons to seek testing.  These include because you suspect you may have HIV. If so and your fear is based on symptoms, the test would be positive at that time.  A second reason is for SCREENING.  We recommend periodic STD (including HIV) "screening (testing in the absence of symptoms) annually because for persons who have had multiple partners over a period of less than a year.  As a matter of personal protection, we recommend annual testing for anyone who has had a new or two or more sex partners in the past year (we consider this to be health maintenance- we also recommend you get your blood pressure and cholesterol checked regularly).  Finally, a third reason is for peace of mind,. This, quite obviously is a personal choice. In our estimation, many of our clients test excessively, trying to gain peace of mind when they really should be focused on issues of guilt and shame that they have because of their behaviors.

I hope these answers are helpful.   EWH