Risk, need testing?

[vik162]

Had unprotected oral, protected vaginal with a CSW from thailand in a macau sauna on the 28th of jan. Questions as follows:

1. Im not sure if the condom which she had supplied was a reliable one. It had chinese characters in the wrapper, and as far as I could tell when i withdrew after ejaculation, the condom did not burst or break. Is this considered a protected encounter? what about poor latex quality which allows the virus to permeate?

2. csw was from thailand, do i stand a higher probability of infection as a different subtype applies to the asian region, as well as a higher incidence of infection among thais?  i am a circumcized asian unlike most thais.

3. do i need to test because of this encounter? im on my third week now and could go to a hospital for HIV AB AG CMIA.  

Thanks Doctor

[Edward W Hook, MD]

No change in my assessment or advice.  EWH

[vik162]

Dr.,
I forgot to mention that I did not withdraw immediately after ejaculation. I let her keep at it for a minute longer. I didnt get entirely soft though, and the condom didnt roll up more than halfway if ever it did. Am I still all right?

[Edward W Hook, MD]

Glad to help. EWH

[vik162]

Roger that. Cheers!

[Edward W Hook, MD]

Welcome to the Forum.  I'll be happy to comment but I'll point out that either your exposure occurred nearly a year ago or your dates are wrong ( I presume the latter is the case).  Either way however, this we a virtually no risk exposure.  HIV is not transmitted through condom protected sex when the condom is worn throughout the encounter and there has never been a case of HIV proven to have been transmitted through receipt of oral sex.  In fact, if these were your only exposures there really is not even a medical reason for testing.  

As for your specific questions:
1.  Commercial sex workers typically use condoms to protect themselves and thus their condoms are typically reliable.  Further, if your condom appeared intact when you completed sex, it was- when condoms fail they break wide open leaving no doubt about the failure, they don't lead "just a little".

2.  While CSWs from SE Asia have a somewhat higher rate of infection than from some other parts of the world, most CSWs do not have HIV (or other STDs for that matter).  I would not worry about your exposure and certainly would not worry about rare sub-types.

3.  There really is no medical reason to test related to this specific encounter.  The U.S. CDC recommends that all persons get tested at least once and more frequently if they feel they are at risk but related to this encounter there is no meaningful risk for HIV.  I would not test.  If you choose to do so despite my reassurances however, please wait until at least 4 weeks after your exposure since at that time the results will be scientifically conclusive.  

I hope these comments help.  You need not worry.  EWH