Seeking Advice

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On the 22nd of December I  found myself in bed with a unknown 24 year old white girl w/unknown status. Out of character for me. Received unprotected oral sex and protected vaginal sex that lasted approximately 3-4 minutes the condom did come off while outside of her but was put back on before re entering - there is a chance I tried putting it on wrong side out and had to switch it around thus coming in contact with her fluids.  I never asked her of her status but she did ask that I wear a condom. I went to the Health Clinic in my town yesterday and  I explained the situation to The Dr and also told him that she was a drug user (marijuan,cocaine etc I myself am not) as far as I know not a intravenous user. I was also diagnosed with HSV1 on my genitals 13 years ago but rarely have any break outs. I have had 3-4 in the past 13 years.  He told me I am at a low to MODERATE risk due to her drug use as it speaks of her character. I was disappointed to hear this.  He did a full work up for all ST D's and a specialized HIV test looking for the Virus its self rather than the antibodies. He said that it would be 95% accurate even in this short window.  He is a HIV specialist as I saw the credentials on the wall.  I  also have a small lesion that is hardly noticeable on the very tip of my penis.  I am assuming the condom must not of worked all that well?  He said that it would be HSV2 or HPV  I am not sure how he would know that as it didn't have any distinct characteristics.  I am very nervous about this and am looking for your opinion.  I have to now wait 2 weeks for the results and this is going to be very hard for me. I am looking to calm my nerves. I have seen on here that you put all paid sex workers in a 1%  category of Having HIV I am assuming that non paid sex workers would be even less. I know that HSV1 can increase the odds of contracting HIV but are the numbers still in my favor? If you could please let me know what you think I would greatly appreciate it.

[H. Hunter Handsfield, M.D.]

No need to post negative HIV test results on this forum.  If you want to ventilate your relief over the result, please use the HIV support forum.

[H. Hunter Handsfield, M.D.]

You clearly have a knowledgeable provider; most likely he has more experience with patients like you than I do.  I agree completely with him, with the single exception of "moderate" risk.  Perhaps your partner's risk of having HIV approaches "moderate".  However, your risk of having caught HIV is miniscule to zero.  Even if your partner had HIV and you hadn't used a condom at all, the average risk is one transmission per 2,000 episodes of unprotected vaginal sex.  Personally, I would not have recommended the viral DNA/RNA test ("test for the virus").  However, if negative it indeed will be highly reassuring; your doc's estimate of 95% sounds about right.

A few additional comments:  HSV-2 increases the risk of HIV if exposed, but the available data suggest that HSV-1 does not.  When a person asks a partner to use a condom, it is not usually because that person is infected with something.  She was worried about getting infected by you, not the other way around.  In other words, it's a good sign when a partner suggests a condom - evidence that the person probably is NOT infected, not that she is.

From your description, I cannot tell what your doc was trying to convey in regard to HSV-2 or HPV.  You'll need to ask him.

All in all, I put your risk of having acquired HIV from this exposure in the range of 1 in a million.  That's almost 600 times lower than the chance you'll die accidentally in the coming year (1 chance in 1,756, if you live in the US).  In other words, don't lose sleep over this as you await your test results.  You can expect them to be negative.

Best wishes---  HHH, MD

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Thank you - I find your response very reassuring.  I will post back in 2 weeks with the results.