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Very anxious after condom breakage
Hi Doctor,
I would like to ask you about an encounter that has been causing me a great deal of worry.
Just over a week ago I was in Edinburgh, UK on a work trip and I decided to see an escort for sex. She was, as far as I can tell, a more high end escort, I paid about $250 for an hour. The girl was Romanian.
She performed oral sex on me, and I performed oral sex on her (cunnilingus) before she introduced the condom and then we had protected vaginal sex. Everything was fine until just before the end. We switched positions, and I checked the condom. It was still in tact. The sex continued for, at most, a couple more minutes. After I had finished (inside her) I pulled out and noticed that during the short time the condom had split.
She went straight to the bathroom to clean herself, and seemed a little angry at first. When she came back I tried to talk to her about her status to assess my risk and she said that she had worked in Germany until around 2 months ago where prostitution is legal and regular health checks are part of the job, she said she does not have sex with anyone else apart from her clients and she wants to protect herself, which I can understand. She seemed a little cagey with me and when I asked her straight "do you have anything that I should worry about?" she just laughed and said "go and see for yourself!"
I know that at the end of last year I was negative as I went for an HIV test after having stepped on a dirty needle. The worry of having been infected then was awful and it's starting to eat away at me again after this encounter. I have not had a full STD check up since 2008, and so I'm also a little worried that if, since then, I have picked up another STD such as Chlamydia that this will have increased my risk for this exposure. I used to be bad for not using condoms with my sexual partners, but I have grown up now, and just want to be safe.
Do you feel I have reason to be concerned about this?
Thank you for your time.
I would like to ask you about an encounter that has been causing me a great deal of worry.
Just over a week ago I was in Edinburgh, UK on a work trip and I decided to see an escort for sex. She was, as far as I can tell, a more high end escort, I paid about $250 for an hour. The girl was Romanian.
She performed oral sex on me, and I performed oral sex on her (cunnilingus) before she introduced the condom and then we had protected vaginal sex. Everything was fine until just before the end. We switched positions, and I checked the condom. It was still in tact. The sex continued for, at most, a couple more minutes. After I had finished (inside her) I pulled out and noticed that during the short time the condom had split.
She went straight to the bathroom to clean herself, and seemed a little angry at first. When she came back I tried to talk to her about her status to assess my risk and she said that she had worked in Germany until around 2 months ago where prostitution is legal and regular health checks are part of the job, she said she does not have sex with anyone else apart from her clients and she wants to protect herself, which I can understand. She seemed a little cagey with me and when I asked her straight "do you have anything that I should worry about?" she just laughed and said "go and see for yourself!"
I know that at the end of last year I was negative as I went for an HIV test after having stepped on a dirty needle. The worry of having been infected then was awful and it's starting to eat away at me again after this encounter. I have not had a full STD check up since 2008, and so I'm also a little worried that if, since then, I have picked up another STD such as Chlamydia that this will have increased my risk for this exposure. I used to be bad for not using condoms with my sexual partners, but I have grown up now, and just want to be safe.
Do you feel I have reason to be concerned about this?
Thank you for your time.
MEDICAL PROFESSIONAL
Chlamydia is not a likely cause of the symptoms you describe, but testing is quick and easy. Even if you have chlamydia or some other STD, it would not change my evaluation about the risk you caught HIV. It is true that chlamydia and other STDs raise the risk of HIV if exposed, but first you of course must be exposed, and we have discussed the strong evidence your partner didn't have HIV. Even if she did, STDs roughly double the risk -- and double a teeny risk still is a teeny risk.
As I said, your local GUM clinc remains a good option for personalized evaluation and testing. They know as much as I do about all this stuff.
As I said, your local GUM clinc remains a good option for personalized evaluation and testing. They know as much as I do about all this stuff.
MEDICAL PROFESSIONAL
Welcome to the HIV forum. Bottom line: you are at little or no risk for HIV from this event.
There are good reasons to believe your partner does not have HIV. First, HIV is rare among sex workers throughout the UK, Scotland, etc, especially in expensive ones (escorts). Second, when sex workers expect and/or require their clients to wear condoms (and when upset over a condom failure), it tends to be evidence they are not infected and intend to stay that way. Third, most people don't lie about HIV status when asked directly, so you probably can believe her testimony about being careful, uninfected, and the timing of her last test. Fourth, her concern about your health is also a good sign -- it shows she understands the basics of STD/HIV transmission. Statistically, sex workers are at higher risk of being infected by their clients than the other way around. Sounds to me like your partner is a wise lady.
And in the very unlikely possibility she in fact has HIV, your risk was still low. Without condoms, if a woman has HIV the average transmission risk to a male partner during a single episode of vaginal sex is around 1 in 2,000 (equivalent to having sex with infected women once daily for 5+ years before infection would be statistically likely). And in this case, the unprotected exposure was obviously brief, suggesting a still lower transmission risk under 1 in 2,000.
So HIV really should not be a serious worry for you. The chance of other STDs, like chlamydia, may be higher, simply because they are more common and more easily transmitted than HIV -- but still probably unlikely, in view of her apparent regular condom use and probable periodic HIV testing. Still, if you remain nervous about all this, you could of course visit your local GUM clinic for personalized advice and testing. But if I were in your situation, I wouldn't feel it necessary to do so.
In closing, congratulations on your own re-dedication to sexual safety. Don't freak out too much when safe sex plans don't quite work out, e.g. from the occasional condom failure.
Regards-- HHH, MD
There are good reasons to believe your partner does not have HIV. First, HIV is rare among sex workers throughout the UK, Scotland, etc, especially in expensive ones (escorts). Second, when sex workers expect and/or require their clients to wear condoms (and when upset over a condom failure), it tends to be evidence they are not infected and intend to stay that way. Third, most people don't lie about HIV status when asked directly, so you probably can believe her testimony about being careful, uninfected, and the timing of her last test. Fourth, her concern about your health is also a good sign -- it shows she understands the basics of STD/HIV transmission. Statistically, sex workers are at higher risk of being infected by their clients than the other way around. Sounds to me like your partner is a wise lady.
And in the very unlikely possibility she in fact has HIV, your risk was still low. Without condoms, if a woman has HIV the average transmission risk to a male partner during a single episode of vaginal sex is around 1 in 2,000 (equivalent to having sex with infected women once daily for 5+ years before infection would be statistically likely). And in this case, the unprotected exposure was obviously brief, suggesting a still lower transmission risk under 1 in 2,000.
So HIV really should not be a serious worry for you. The chance of other STDs, like chlamydia, may be higher, simply because they are more common and more easily transmitted than HIV -- but still probably unlikely, in view of her apparent regular condom use and probable periodic HIV testing. Still, if you remain nervous about all this, you could of course visit your local GUM clinic for personalized advice and testing. But if I were in your situation, I wouldn't feel it necessary to do so.
In closing, congratulations on your own re-dedication to sexual safety. Don't freak out too much when safe sex plans don't quite work out, e.g. from the occasional condom failure.
Regards-- HHH, MD
Thanks again for your quick reply!
Your response has been very helpful.
Much appreciated!
Your response has been very helpful.
Much appreciated!
Thank you for you quick reply. It was very helpful.
The only thing I still wasn't too sure about was if a current STD may have been another factor to consider for this exposure.
I have not been tested for anything, but I occasionally experience slight discomfort/burning at the end of the penis. It only comes and goes and sometimes I am only aware of it because I focus on it.
Because I'm now worried ithat this is Chlamydia, if this is the case, and I had it at the time of this encounter, would this have put me at a much greater risk of being infected with HIV?
Thank you again for your previous response, this is my only follow-up question.
Regards
The only thing I still wasn't too sure about was if a current STD may have been another factor to consider for this exposure.
I have not been tested for anything, but I occasionally experience slight discomfort/burning at the end of the penis. It only comes and goes and sometimes I am only aware of it because I focus on it.
Because I'm now worried ithat this is Chlamydia, if this is the case, and I had it at the time of this encounter, would this have put me at a much greater risk of being infected with HIV?
Thank you again for your previous response, this is my only follow-up question.
Regards
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