HIV - Prevention Expert Forum
Transmission possibility
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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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Transmission possibility

I'm a 24 year old male who was recently out of town on my first business trip, in the Bay Area. I had met an escort and we proceeded from there. This occurred March 12th. I'm back home, and couldn't sleep last night and my heartbeat has been running away for me and I can't focus at work. I've almost thrown up out of shame and terror that I might be infected with HIV. My situation is as follows, and I apologize for the detail, I just want to ensure I'm being thorough.

I had masturbated a couple days earlier with rough, dry hands, and a small scab had formed. I realized this before the escort showed up and I was embarrassed that she'd think it was an STD so I picked it off, and it was essentially reopened- the sort of wound that would slightly sting in the shower the first day fresh. Common sense was not present.

She performed unprotected oral on me for about 2 minutes.  For the purpose of this question, can we assume she had open mouth sores ( she had chapped dry lips) Keep in mind my sore. Then, we proceeded to have vaginal intercourse with a condom. The condom did not break. However, I'm slightly bigger, and so I'm worried that the uncovered base of my penis where it meets my pelvis and testicles was rubbing against her and may have had vaginal fluid in contact for the entirety, or that hiv can enter through the skin in small microscopic openings.  Also, and I believe this is paranoia, I'm second guessing whether the condom completely covered the open area, I believe it did, I just can't be sure.

I've scheduled an RNA test for 3/22. Are these accurate? I can't answer why I did this, or turn the clocks back. My parents would disown me with a diagnosis and my gf would leave me, and I'm not sure if at work I'd be able to perform.

Thabk you very much for your consideration
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Welcome to our Forum.  You are worrying without a good reason to do so.  Most commercial sex workers do not have HIV so the odds are in your favor.  Perhaps even more important, your vaginal exposure was condom protected and therefore no risk and there has never been a case of HIV documented to have been transmitted because of receipt of oral sex.  That you had a sore on your penis or that the condom may not have covered your entire penis during the event makes no difference.  

HIV testing is really not needed related to the exposure you describe.  If you choose to test, antibody testing is preferred over the PCR test you have scheduled.  While the PCR tests do become positive sooner than antibody tests, the PCR also is more expensive and has a higher false positive rate than the antibody tests.  Finally it is unknown just how many infections are missed at two weeks by the PCR test, but there are some.

I hope these comments are helpful.  EWH
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Thank you, Dr. Hook

If I may follow up with one quick question before I'm out of your hair.

Could you expand on what you mean by it makes no difference. Are you inferring that the main risk would be an unexposed urethra? I've read some of your prior posts stating HIV needs to be injected deep into the tissue, but that  fact confuses me somewhat. I  don't understand then how unprotected anal or vaginal sex (or a partially covered penis with an uncovered sore) would equate to little risk. I'll defer to your final comment

THANK YOU!!
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For a number of complex biological reasons urthral mucosal surfaces and actively infected sores represent more easily infected "targets" for the virus than an abrasion that you had created through masturbation and then picked open as it healed, even it it was not covered by your condom.  EWH
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
University of Alabama at Birmingham
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