HIV risk outside US

[askaquestion26]

Hi doctor,
Last week in Taipei Taiwan I went to a hostess bar. I had quite a lot to drink and left with one of the ladies. I was quite drunk to say the least. We went to a hotel. She performed oral sex on me and then put a condom on. I Then took the condom off.(I didn't want to have intercourse right away) She then performed oral sex on me again. The thing is, I could not remember anything after that except for when she said she was leaving. In this blackout I was not sure if we had unprotected intercourse. I went back the next day to ask what happened during my blackout. She said that we did have unprotected vaginal intercourse 3 times over the course of say two hours.  I asked her if she had any stds and she said that she did not and that they must wear condoms and that she would be more worried that I had something.. She did not say when or if she had been tested.  She was frightened that I would tell her boss there because she says they must wear condoms with clients.

My question is:

1) I am a circumcised male. I read Dr Handsfield wrote that the risk per episode is around one in 2000. What does it mean episode? does it mean per act? Sometimes I have seen it written per encounter or per exposure.. So does this mean I had 3 exposures(3  episodes)? How does this now affect my risk?

Dr hook wrote before "Yes, a male can contract HIV from a single expsoure HOWEVER, as I said it is very, very rare.  EWH"  

Would I then be correct in saying that I had 3 exposures so now my risk is much higher?
I am very worried about this....
I never want to drink alcohol again....

[askaquestion26]

Dear Doctor Hook,
Thank you very much for your prompt reply.Thank you also for your comments about my situation with alcohol. You are very correct in your statement and I have stayed away from drinking and hope to continue this way.

I would just also like to ask.

I saw that Dr. Handsfield wrote to one forum member
2) In my 35 years in the STD business, I have never seen HIV acquired in a one-off sexual encounter.  It is quite rare.  And in the 7 years of this forum, nobody has reported catching HIV after an encounter they were nervous about.  You aren't likely to be the first.

Do you by any chance know what Doctor Handsfield means by "once off sexual encounter?" Does he mean one act of sex   or meeting the person one time and and perhaps engaging in a few acts of sex but then not meeting the person again?

Sorry if this question sounds a bit silly

Another post I read by him is
The large majority of heterosexual transmissions occur in the regular sex partners of infected persons who have repeated sex with their infected partners; and most of those infected persons got that way because of traditional high risk behviors, such as injection drug use or sex wtih other men.
He mentioned this about America.

So in Africa would it be correct to say that a lot of hiv  heterosexual transmissions occur in the regular sex partners of infected persons who have repeated sex with their infected partners and because of traditional high risk behviors, such as injection drug use or sex wtih other men?

Or is heterosexual transmission in America less because less heterosexual people in certain population groups have HIV?

I'm just curious about why hiv has spread so rapidly in Africa.

I would also like to ask what has happened about that resistant strain of gonorhhea? Is it becoming more widespread? I have not had any symptoms of this but I am just curious about the resistant strains of STDs
Are Zithromax and Cefixime still safe treatments against gonnorhea?  
Has syphilis, and chlamydia also developed any resistance to any antibiotics?

Is there any plan in the future for what they are going to do about resistant strains?


Thank you again doctor

[Edward W Hook, MD]

Welcome to the Forum.  I will try to help. Before I do however, let me tell you that alcohol is clearly not your friend.  Drinking to the point that you black out is a greater risk for other things than for HIV.

As for your HIV/STI risk., it is low.  Most commercial sex workers do not have HIV or other STIs (in fact, in general rates of STIs and HIV are lower in CSWs than in casual partners who you might pick up in a bar- bad for business) and most exposures to not lead to infection.  I would not worry. Testing for routine STIs is reasonable but unless you develop symptoms, probably not essential.  

You ask about the statistics related to risk.  The quotes that you have mentioned form Dr. Handsfield and I are in agreement.  To give you an example, since the average risk for infection is about 1 in 2000 sexual encounters  if you had 2 acts of intercourse with an infected partner, your risk would be about 1 in 1000 (2 X 1 9n 2000= 1 in 1000).  Conversely, if there were 2000 people who each had sex with an HIV infected sex partner 1 of those persons would, on average become infected- it might be the first person to have sex, the last, or anyone in between.  This, quite rarely, even in very low risk situations, infections may occur after a single exposure.  

As I said, the odds are very much in your favor. Try to not worry. EWH