HIV - Prevention Expert Forum
Hiv Risk
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Hiv Risk

3 1/2 weeks ago I had sex with a white CSW in North Jersey, she gave me oral without a condom for a few minutes and they we had vaginal intercourse for about 7 minutes.  At the end I realized the condom broke, it may have broke when I ejacuated, but then it could have broke before that as well.  I asked her if she had anything and she said no, but I am unsure if she was telling the truth.  I also had a small cut on my penis on the shaft that was about half healed that may have been exposed.  I have had no symptoms but am still very worried due to the fact the condom broke and of the small cut on my penis.  Do you recommand that I get tested?  What percentage of white escort women have hiv in New Jersey/New York?  Is four weeks enough time to get tested?  Have you ever heard of a sitituation like this where a man got hiv, and you belive that they weren't lying?
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Welcome back to the forum.

Most people, including CSWs, tell the truth about STD and HIV status when asked directly.  And the fact that your CSW partner used condoms suggests she does it routinely with all her clients, which in turn implies she understands STD/HIV risks and tries to avoid infection.  Often such people are successful in doing so.  Obviously it's in her interest; after all, the risk of bad outcomes is much higher for female sex workers than it is for their clients!

It's amazing to me how many questions we get from users who say they have a cut on the penis.  It's hard for me to imagine how that happens.  Are you sure it's a cut (i.e. an injury) and not herpes?  Anyway, it really doesn't significantly increase the risk, unless the cut is deep and freshly bleeding.

I can't say what proportion of escorts in the NYC/NJ area have HIV, but it's under 1%, probably closer to 1 in 1,000.  And when a woman has HIV, the risk to her male partner from a single episode of unprotected vaginal sex averages around once for ever 2,000 exposures.  That means your risk of HIV from this event is in the ragne of 1 in 200,000 to 1 in two million.

And with odds like that, of course I have never seen someone in your situation who caught HIV.  Heterosexually acquired HIV is almost never seen (in industrialized countries) from one-time sexual exposures; almost always it's the result of repeated sex for many years with HIV infected partners, e.g. in a couple when one person unknowingly has HIV.

From a strict risk standpoint, you don't need HIV testing.  However, I recommend you do it; most people nervous enough to come to a forum like this should be tested for reassurance -- the negative result will probably be more reassuring than anything I can say.  Testing at 4 weeks is definitive with a duo test (for HIV antibody plus p24 antigen); for a stand-alone antibody test, better to wait until 6-8 weeks.

In the meantime, stay mellow.  It is exceedingly unlikely you caught HIV.

Best regards--   HHH, MD
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H. Hunter Handsfield, M.D.Blank
University of Washington
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