HIV risk

[david2010]

[1] I am a 40-year old man.  I had oral unprotected sex with a young lady 9 days ago, where she gave me oral sex(for a long time), & I also went down on her (several minutes).

[2] I then had vaginal sex with a condom (did not burst), & discovered on withdrawing she was having her period.  I had not seen or tasted any blood earlier when I was going down on her / giving her oral sex

[3] I then had anal sex with a condom, but the condom burst (noticed & withdrawn after less than 1 minute).  I washed myself off, & finished off by she giving me unprotected oral sex to completion, in her mouth.

Just for my peace of mind, what are my overall risks.  She is a young escort (early 20's) in England (UK), and appeared to not have any needle marks on her hands, other than a tattoo on her leg & abdomen.  I also looked in her mouth before we began.  I am a medical doctor myself, and am immunised against Hep B.

Thanks

[Edward W Hook, MD]

I did notice that she was menstuating, no change in my assessment.

As for the anal sex, I missed that the condom broke.  While is is unlikely that she had HIV.,IF she did, your risk of HIV form a single episode of unprotected anal sex with an infected partner is about 1 infection per 100-200 sex acts, and that is only IF she had HIV.  EWH

[david2010]

Thank you for your feedback, especially on the other STD's.  With regards HIV:

[1] I just wanted to be sure you read that when I performed oral sex on the lady, she was actually menstruating.  I did not realise this, and did not see or taste any blood when I performed the oral sex, but only realised the situation after subsequent vaginal penetration with a condom, and on withdrewing my penis noticed it was coated in blood (but condom still intact).  Thus the risk was not the vaginal sex with the condom, but oral sex on a menstruating partner, with perhaps the menses not clinically visible / just about to start...

[2] You had not commented on the anal sex and subsequent burst condom either ?

Thanks

[Edward W Hook, MD]

Welcome to our Forum.  The exposures you describe are no risk for HIV.  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. Some experts state there is 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.  With respect to condom protected vaginal sex., again, this is safe sex and does not represent a risk for HIV.  I see no need for concern or for HIV testing related to this exposure.  

Your unprotected receipt of oral sex does carry a slight risk for other STDs.  Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you had gotten gonorrhea or NGU you would have most likely developed symptoms of urethritis (penile infection).  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection but I did want you to know of this risk as well.

I hope this assessment and comment is helpful to you. EWH