What do you think?

[YahtzeeMan]

I am a married, heterosexual male.1 week ago I had protected sex with an escort. She is in her early twenties, claims she is std free, claims she has only been escorting for 3 months, and she says she is only escorting in order to offset college expenses (pharmacy school). We were having sex for a bit. She orgasmed a couple times, and we changed positions. I was on top of her backside, she was very tight and dry, and upon inserting my pens into her vagina, I felt my condom tear. I immediately pulled out without thrusting into her. I noticed a slight tear near the head of my penis. I immediately removed the condom, washed with soap and water, dried off, and opened a new condom. She told me she had been tested 1.5 months ago and assured me she was clean. She also told me that she occasionally smokes marijuana, but no other drugs.

What do you think about the brevity of my exposure? Should I continue to let this matter worry me? Do I need to be tested?

Thanks!

[H. Hunter Handsfield, M.D.]

No I, never even heard a rumor of such an instance.  In the US or other industrialized countries, almost nobody ever catches HIV from a single heterosexual exposure.  The large majority of HIV infections occur in people who are repeatedly exposed to infected persons.  The typical heterosexual with HIV in the US is a woman who is the regular partner of a man with HIV, usually without her (and often without his) being aware of his infection.

FYI, in the 7 years of this forum, there has never been a questioner who described an exposure of concern who turned out to have HIV.  If and when that happens, almost certainly it will be someone in an obvious high risk category, like a gay man or injection drug users -- not a heterosexual male or female, certainly not after a single exposure.

[H. Hunter Handsfield, M.D.]

My, what a wise doctor you have!   ;-)

Glad to have been of help.

[YahtzeeMan]

Thanks for all of your help. I made an appointment with my Dr., explained my situation, and she agreed with you. She said there was no need to test and gave me some medication for my anxiety. I am feeling much better and have finally been able to deal with my guilt and forgive myself. Thanks again for having patience with "nuts" like me!

Have a blessed day!

[H. Hunter Handsfield, M.D.]

1) This is re-asking the same question in different words.  I haven't changed my mind and of course the answer is no.  Re-read my replies above.

2) Almost certainly yes.

That will have to end this thread.  I won't have any further comments or advice.

[YahtzeeMan]

Thank you for your help. I have been replaying my scenario in my head a lot. The only unprotected exposure that I had was when the condom tore. I don't think the tip of my penis was exposed. Even if it was, it was for no longer than 1 or 2 seconds. Two questions and that's it:

1. How much of the HIV virus is required in order to infect someone? Is 1 or 2 seconds' exposure long enough to be infected?

2. Am I overthinking this situation due to feelings of guilt?

Thanks for being patient with me!

[YahtzeeMan]

I know you are very busy. I have just one more question and I will leave you alone.

Have you ever known someone that was infected in the manner that I described?

Thanks!

[H. Hunter Handsfield, M.D.]

Welcome to the HIV forum.  I'll try to help.  The bottom line is that there is virtually no risk for HIV In this sort of situation and I do not recommend testing, unless you decide you need the additional reassurance of a negative test result.

It is the rare escort (expensive sex worker, typically by appointment) who has HIV, especially among those who routinely ask and expect their clients to use condoms.  And people rarely lie about HIV status when asked directly -- so your escort partner is doubly unlikely to be infected.  Statistically, she is at greater risk of HIV from you than you are from her.

Further I agree with the premise behind your question about the brevity of  unprotected exposure.  Even with entirely unprotected sex of several minutes duration, the average female to male transmission risk for each episode of vaginal sex is around 1 in 2,000.

So I really wouldn't worry about this event.  But as I said above, if you find yourself worrying despite this reassurance, you can always be tested in a few weeks for peace of mind.

I hope this helps.  Best wishes --  HHH, MD